Shocks, personality, and anxiety in patients with an implantable defibrillator

Studies have examined the relationship between shocks and anxiety, but little is known about the role of personality. Our aim was to examine the determinants of self-reported and interviewer-rated anxiety following implantable cardioverter defibrillator (ICD) implantation.

At baseline, that is, 0-3 weeks following ICD implantation, 308 ICD patients (82% men, mean age = 62.6 years) completed the DS14 (Type D personality) and ASI (anxiety sensitivity). The STAI (self-reported symptoms of state-anxiety) was assessed at baseline and follow-up, which was 2 months following ICD implantation. At this follow-up, the HAM-A interview (interviewer-rated anxiety) was assessed in a subsample (57%); the occurrence of ICD shocks was deduced from medical records.

Analysis of covariance (ANCOVA) for repeated measures showed a significant interaction effect between time and shocks (F = 9.27, P = 0.003) with patients who had experienced a shock experiencing higher levels of self-reported anxiety at follow-up. The main effects of Type D personality (F = 33.42, P < 0.0001) and anxiety sensitivity (F = 66.31, P < 0.0001) were significant, indicating that these patients scored higher on self-reported anxiety across time points. Multivariable linear regression analyses yielded Type D personality (beta= 0.18, P = 0.021) and anxiety sensitivity (beta= 0.19, P = 0.016), but not shocks, as independent predictors of interviewer-rated anxiety. Covariates included gender, marital status, education, age, ICD indication, cardiac history, and comorbidity.

Type D personality and anxiety sensitivity were independent predictors of both self-reported and interviewer-rated anxiety outcomes while ICD shocks were related to an increase in levels of self-reported anxiety only. Identification and support of ICD patients with Type D personality, increased anxiety sensitivity, or shocks is important.