Open Access Research article

Health inequalities in the Netherlands: a cross-sectional study of the role of Type D (distressed) personality

Marja JH van Bon-Martens12*, Johan Denollet3, Lambertus ALM Kiemeney4, Mariël Droomers5, Monique JA de Beer6, Ien AM van de Goor1 and Hans AM van Oers17

Author Affiliations

1 Academic Collaborative Centre Public Health Brabant, Tranzo, Tilburg School of Social and Behavioral Sciences, University of Tilburg, Tilburg, the Netherlands

2 Department of Health Promotion, Regional Health Service Hart voor Brabant, 's-Hertogenbosch, the Netherlands

3 CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, the Netherlands

4 Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

5 Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands

6 Department of Local Health Policy, Regional Health Service West-Brabant, Breda, the Netherlands

7 Centre for Public Health Status and Forecasts, National Institute for Public Health and the Environment, Bilthoven, the Netherlands

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BMC Public Health 2012, 12:46  doi:10.1186/1471-2458-12-46

Published: 18 January 2012



In the Netherlands, as in many European countries, inequalities in health exist between people with a high and a low socioeconomic status (SES). From the perspective of the 'indirect selection hypothesis', this study was designed to expand our understanding of the role of Type D personality as an explanation of health inequalities.


Data came from two cross-sectional Dutch surveys among the general population (aged between 19 and 64 years, response 53.7%, n = 12,090). We analyzed the relative risks of low SES, assessed using education and income, and Type D personality, assessed using the Type D Scale-14 (DS14), for different outcomes regarding lifestyle-related risk factors and health, using multivariate Generalized Linear Models.


Results showed that Type D personality was significantly associated with low SES (OR = 1.7 for both low education and low income). Moreover, the relative risks of Type D personality and low SES were significantly elevated for most adverse health outcomes, unconditionally as well as conditionally.


The cross-sectional design hinders the making of definite etiological inferences. Nevertheless, our findings suggest that Type D personality does not explain the socioeconomic health inequalities, but is a risk factor in addition to low SES. Prevention of adverse health outcomes in low SES populations may have more effect when it takes into account that persons with a low SES in combination with a Type D personality are at highest risk.