Prevalence of Type-D Personality and Its Association with Pain, Disability, and Psychological Distress in a University Spine Outpatient Clinic: A Cross-Sectional Study

TL;DR

This study found that Type-D personality is common in spine clinic patients and linked to higher pain, disability, and psychological distress.

Contribution

The study reports the prevalence and impact of Type-D personality in a spine outpatient clinic, a context with limited prior evidence.

Findings

Type-D personality was present in 32.3% of spine clinic patients.

Type-D patients reported significantly higher pain, disability, anxiety, and depression compared to non-Type-D patients.

Strong associations were found between Type-D traits and psychological distress.

Abstract

Objectives: Type-D personality, characterized by negative affectivity (NA) and social inhibition (SI), has been associated with adverse outcomes in chronic pain and cardiovascular populations. Evidence in spine outpatient settings remains limited. We aimed to assess the prevalence of Type-D personality and its association with pain, disability, and psychological distress in patients presenting to a university spine outpatient clinic. Methods: This exploratory cross-sectional study included 300 consecutive patients (18–85 years) presenting to a university spine outpatient clinic between 2023 and 2025. Patients completed the Type-D Scale-14 (DS14; Type-D defined as NA ≥10 and SI ≥10), the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale for pain (VAS, 0–10), and the Oswestry Disability Index (ODI, 0–100). Demographic and clinical characteristics were recorded. Comparisons between Type-D and non-Type-D patients were performed. Results: The prevalence of Type-D personality was 32.3% (95% CI: 27.0–37.6%). Compared with non-Type-D patients, Type-D patients reported higher pain intensity (VAS: 5.23 vs. 3.88), disability (ODI: 38.6 vs. 31.3), anxiety (HADS-A: 10.0 vs. 6.5), and depression (HADS-D: 8.4 vs. 6.4); all p < 0.01. Between-group differences were clinically relevant, with large effect sizes for pain intensity (VAS; Cohen’s d ≈ 1.10) and moderate-to-large effect sizes for functional disability (ODI; Cohen’s d ≈ 0.75). Correlation analyses showed moderate to strong associations between Type-D personality traits (negative affectivity and social inhibition) and psychological distress. In stratified analyses, longer pain duration was descriptively associated with greater disability, particularly among patients with Type-D personality. Conclusions: Type-D personality is common in spine outpatient populations and is associated with greater pain, disability, and psychological distress. These findings underscore the relevance of psychosocial factors in spine outpatient care and highlight the need for further longitudinal research to clarify prognostic implications and potential targets for intervention.

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