Open Access Research article

The validity of the Type D construct and its assessment in Taiwan

Chia-Ying Weng1*, Johan Denollet2, Chin-Lon Lin3, Tin-Kwang Lin34, Wen-Chung Wang5, Jyun-Ji Lin1, Shu-Shu Wong6 and Floortje Mols2

Author Affiliations

1 Department of Psychology, National Chung-Cheng University, Chia-Yi, Taiwan

2 Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands

3 Division of Cardiology, Department of Internal Medicine, The Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan

4 School of Medicine, Tzu Chi University, Hualien, Taiwan

5 The Hong Kong Institute of Education, Tai po, Hong Kong

6 Department of Child Development and Family Studies, Tzu Chi University, Hualien, Taiwan

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BMC Psychiatry 2013, 13:46  doi:10.1186/1471-244X-13-46

Published: 4 February 2013



Type D (distressed) personality, defined by negative affectivity and social inhibition, is related to cardiovascular outcomes. Little is known about Type D in non-Western cultures. We examined the validity of this construct and its assessment in Taiwanese patients with coronary artery disease (CAD) and adults from the general population.


CAD patients (N = 87) and adults from the general population (N = 421) completed the 14-item Type D Scale- Taiwanese version (DS14-T), State-Trait Anxiety Inventory, Beck Depression Inventory-II, and Chinese Hostility Inventory Short-Form.


Based on the psychometric examination, item #3 of the original DS14, "I often talk to strangers" was replaced by "I don't like to have a lot of people around me" which comes from the “Withdrawal” facet of social inhibition of DS-24. The reliability of Type D assessment in Taiwan was good, with Cronbach’s α for negative affectivity and social inhibition of .86 and .79. Factor analyses confirmed the two-factor model of the Type D construct. The prevalence rate of Type D personality in Taiwan was 20% in CAD patients and 16% in the general population. Negative affectivity was positively associated with anxiety, depression and hostility, and social inhibition was positively associated with suppressive hostility and negatively associated with expressive hostility after controlling for the total hostility. Furthermore, Taiwanese individuals with a Type D personality displayed elevated levels of anxiety, depression and hostility.


The Type D construct and its assessment with the DS14-T is generalizable to an Asian setting, Taiwan. The DS14-T showed good psychometric properties, and the prevalence of Type D personality in Taiwan was similar to the prevalence rates in Western countries and Mainland China, and Type D was associated with anxiety, depression and hostility.

Type D personality; DS14-T; Coronary artery disease; Taiwan