Genetic and environmental contributions to stability and change in social inhibition across the adolescent and adult life span.

Feeling inhibited and socially not at ease is reflected in the trait social inhibition (SI). SI is associated with psychopathology that arises in young adulthood, such as anxiety. We aim for a better insight into the genetic and environmental contributions to SI across the life span, and as such examine their contributions to SI stability and change across adolescent and adult life span. We analyzed cohort-sequential longitudinal data from the Netherlands Twin Register (NTR), spanning a period of 25 years (Men (N, %): 17855, 37.4%; Age (Median, IQR): 19 years, 16-26 years; 7474 complete MZ twins and 8799 complete DZ twins). The data were organized into 7 age groups: < 14 (preadolescence), 15-16 (early adolescence), 17-18 (mid adolescence), 19-20 (late adolescence), 21-30 (young adulthood), 31-40 (adulthood), 41 + (middle-age-older adulthood). SI was assessed with the ASEBA-based proxy questionnaire. Phenotypic stability was established across the entire age range. Next, a longitudinal genetic simplex model was fitted to estimate the genetic and environmental contributions to the observed phenotypic stability. Results showed SI correlated well across follow-up of a single decade (.44 ≤ r ≤ .59) and moderately across the 25 years (.23 - .32) from adolescence to middle-age and older. Broad-sense heritability (h²) was between 40 and 48% across the 7 age groups. Additive and nonadditive genetic effects together explained most of the stability of SI across the life span (about 60-90% of the phenotypic correlation between ages), whereas environmental effects played a lesser role (about 10-40%). Concluding, SI, known to increase the risk of internalizing psychopathology, is phenotypically stable across the life span, which is largely attributable to genetic contributions to individual differences in SI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Situation selection and modification in social inhibition: a person-centered approach.

OBJECTIVES: The current study aimed to identify patterns of situation selection and modification behaviors using a person-centered approach, and to examine to what extent the trait social inhibition (SI) is associated with these patterns of situation-targeted emotion regulation. METHODS: The sample comprised 504 participants (Mage = 21.5, SD = 8.2; 82% women), who completed questionnaires on situation selection and modification behaviors, and the social inhibition questionnaire (SIQ15). A three-step latent profile analysis (LPA) was performed to (A) identify existing latent profiles of situation avoidance and approach and situation modification behaviors, and (B) to examine the association of SI and facets with the latent class posteriors. RESULTS: LPA revealed the presence of four profiles that differed in how situation selection and modification were applied. SI, behavioral inhibition, and social withdrawal were significantly associated with a higher odds of belonging to the profile characterized by avoidance selection and modification. Interpersonal sensitivity was associated with using more conversational modification behaviors, which may illustrate that interpersonal sensitive individuals are motivated to approach, but use avoidance behaviors to prevent confrontation. CONCLUSIONS: SI individuals particularly rely on avoidance selection and modification behaviors, which may be considered maladaptive emotion regulation.

A review and conceptual model of the association of Type D personality with suicide risk.

The role of personality as distal risk factor for suicidal thoughts and behavior is still unclear. This review aims to propose two conceptual models that explain the psychological plausibility of Type D personality as distal risk factor and contributor to the transition from general to suicide distress. To support this aim, we performed a systematic review of existing studies on the association between Type D personality and suicidal distress. A systematic search yielded eight studies that reported on Type D personality and suicidal distress. Type D personality was robustly associated with suicidal thoughts and behaviors, across populations and countries. Type D was related to the level/frequency of suicidal ideation in seven studies, and suicide attempt in two studies. Our first theoretical model identifies intra-psychic (depression, alcohol misuse, posttraumatic stress) and interpersonal (low belonging, social isolation, lack of support) vulnerabilities of individuals with Type D that may fuel the development of suicidal thoughts and behaviors. Type D by itself will not account for why people become suicidal, but our second theoretical model suggests that the avoidant-passive tendencies of Type D individuals may result in persistent problem-solving deficits, and, eventually, feelings of entrapment that may contribute to the desire to escape from pain. We conclude that empirical evidence supports the hypothesized link between Type D personality, and suicidal thoughts and behaviors. Our conceptual models - albeit often supported by indirect evidence - further substantiate the plausibility of this link, and offer concrete guidance for future studies. Primarily, more longitudinal research is necessary.

The Heritability of Type D Personality by an Extended Twin-Pedigree Analysis in the Netherlands Twin Register.

Type D (Distressed) personality combines negative affectivity (NA) and social inhibition (SI) and is associated with an increased risk of cardiovascular disease. We aimed to (1) validate a new proxy based on the Achenbach System of Empirically Based Assessment (ASEBA) for Type D personality and its NA and SI subcomponents and (2) estimate the heritability of the Type D proxy in an extended twin-pedigree design in the Netherlands Twin Register (NTR). Proxies for the dichotomous Type D classification, and continuous NA, SI, and NAxSI (the continuous measure of Type D) scales were created based on 12 ASEBA items for 30,433 NTR participants (16,449 twins and 13,984 relatives from 11,106 pedigrees) and sources of variation were analyzed in the 'Mendel' software package. We estimated additive and non-additive genetic variance components, shared household and unique environmental variance components and ran bivariate models to estimate the genetic and non-genetic covariance between NA and SI. The Type D proxy showed good reliability and construct validity. The best fitting genetic model included additive and non-additive genetic effects with broad-sense heritabilities for NA, SI and NAxSI estimated at 49%, 50% and 49%, respectively. Household effects showed small contributions (4-9%) to the total phenotypic variation. The genetic correlation between NA and SI was .66 (reflecting both additive and non-additive genetic components). Thus, Type D personality and its NA and SI subcomponents are heritable, with a shared genetic basis for the two subcomponents.

Emotion regulation in social interaction: Physiological and emotional responses associated with social inhibition.

Social inhibition may be associated with individual differences in emotion regulation. Mechanisms relating emotion regulation to social inhibition are largely unknown. We therefore examined how social inhibition is associated with emotional, sympathetic, and parasympathetic responses during sadness induction, and while employing emotion regulation strategies during social interaction after sadness induction. Undergraduate students (N = 216; 72% female) completed the Social Inhibition Questionnaire and participated in a sadness induction and emotion regulation (i.e., suppression and reappraisal) social interaction task, while emotional states, and sympathetic and parasympathetic reactivity were assessed. Repeated measures ANCOVAs showed that during sadness induction, social inhibition was unrelated to the emotional response, but social inhibition was associated with a blunted parasympathetic withdrawal response, due to an already withdrawn parasympathetic tone at rest. This may be suggestive of increased allostatic load with higher social inhibition, and may contribute to stress-related health risks. Both suppression and reappraisal tasks successfully diminished sadness, and this reduction was smaller with increasing levels of social inhibition. Physiological responses to emotion regulation efforts were independent of social inhibition. Elevated sadness in response to instructed emotion regulation in socially inhibited individuals may indicate more emotional distress during social interaction due to heightened threat sensitivity they experience.

Social inhibition and approach-avoidance tendencies towards facial expressions.

This study examined how different manifestations of social inhibition (behavioral inhibition, interpersonal sensitivity, and social withdrawal) are related to automatic approach/avoidance behaviors in a social context. A sample of 115 undergraduate students and 20 adults from the general population (Mage = 24.8, SD = 11.4; 75% women) were assessed with the 15-item Social Inhibition Questionnaire (SIQ15). During a facial expression version of the Approach-Avoidance Task (AAT), participants reacted to images of emotional facial expressions (angry, happy, and neutral) or to control images (neutral objects) in portrait or landscape formats by pulling a joystick towards themselves (approach) or pushing it away from themselves (avoidance). The superordinate social inhibition construct was not associated with approach/avoidance tendencies. However, individuals high in the interpersonal sensitivity domain of social inhibition showed stronger approach tendencies for happy and neutral facial expressions compared to neutral objects, which may relate to their focus on seeking the approval of others.

A Personalized eHealth Intervention for Lifestyle Changes in Patients With Cardiovascular Disease: Randomized Controlled Trial.

BACKGROUND: Behavior change methods involving new ambulatory technologies may improve lifestyle and cardiovascular disease outcomes. OBJECTIVE: This study aimed to provide proof-of-concept analyses of an intervention aiming to increase (1) behavioral flexibility, (2) lifestyle change, and (3) quality of life. The feasibility and patient acceptance of the intervention were also evaluated. METHODS: Patients with cardiovascular disease (N=149; mean age 63.57, SD 8.30 years; 50/149, 33.5% women) were recruited in the Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) trial and randomized to the Do CHANGE intervention or care as usual (CAU). The intervention involved a 3-month behavioral program in combination with ecological momentary assessment and intervention technologies. RESULTS: The intervention was perceived to be feasible and useful. A significant increase in lifestyle scores over time was found for both groups (F2,146.6=9.99; P<.001), which was similar for CAU and the intervention group (F1,149.9=0.09; P=.77). Quality of life improved more in the intervention group (mean 1.11, SD 0.11) than CAU (mean -1.47, SD 0.11) immediately following the intervention (3 months), but this benefit was not sustained at the 6-month follow-up (interaction: P=.02). No significant treatment effects were observed for behavioral flexibility (F1,149.0=0.48; P=.07). CONCLUSIONS: The Do CHANGE 1 intervention was perceived as useful and easy to use. However, no long-term treatment effects were found on the outcome measures. More research is warranted to examine which components of behavioral interventions are effective in producing long-term behavior change. TRIAL REGISTRATION: ClinicalTrials.gov NCT02946281; https://www.clinicaltrials.gov/ct2/show/NCT02946281.

Type D personality and global positioning system tracked social behavior in patients with cardiovascular disease.

OBJECTIVE: Social behavior (e.g., loneliness, isolation) has been indicated as an important risk factor for cardiovascular disease. Recent studies show that Type D personality might be an important predictor of social behavior. Hence, the current exploratory study aims to examine, using ecological assessment, whether Type D personality is associated with a lower likelihood to engage in social encounters in patients with cardiovascular disease. METHOD: Cardiac patients who participated in the Do CHANGE (Phase 2) trial were included in current analysis. As part of the Do CHANGE intervention, real-life data were collected in the intervention group using the MOVES app, which was installed on patients' mobile phones. For a period of 6 months, Global Positioning System (GPS) data from the participating patients were collected. From the GPS data, 3 target variables were computed: (a) general activity level, (b) social variety, and (c) social opportunity. RESULTS: A total of 70 patients were included in the analysis. Patients with a Type D personality had lower scores on the "social opportunity" variable compared to non-Type D patients (F = 6.72; p = .01). Type D personality was associated with lower social participation after adjusting for depression and anxiety. No association between Type D personality and general activity or behavioral variety was observed. CONCLUSIONS: This is the first study to use an ecological measure to assess social behavior of cardiac patients with a Type D personality. Results show that Type D personality might be associated with lower social engagement, which could, in turn, partly explain its association with adverse health outcomes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Personalized eHealth Program for Life-style Change: Results From the "Do Cardiac Health Advanced New Generated Ecosystem (Do CHANGE 2)" Randomized Controlled Trial.

OBJECTIVE: Unhealthy life-style factors have adverse outcomes in cardiac patients. However, only a minority of patients succeed to change unhealthy habits. Personalization of interventions may result in critical improvements. The current randomized controlled trial provides a proof of concept of the personalized Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) 2 intervention and evaluates effects on a) life-style and b) quality of life over time. METHODS: Cardiac patients (n = 150; mean age = 61.97 ± 11.61 years; 28.7% women; heart failure, n = 33; coronary artery disease, n = 50; hypertension, n = 67) recruited from Spain and the Netherlands were randomized to either the "Do CHANGE 2" or "care as usual" group. The Do CHANGE 2 group received ambulatory health-behavior assessment technologies for 6 months combined with a 3-month behavioral intervention program. Linear mixed-model analysis was used to evaluate the intervention effects, and latent class analysis was used for secondary subgroup analysis. RESULTS: Linear mixed-model analysis showed significant intervention effects for life-style behavior (Finteraction(2,138.5) = 5.97, p = .003), with improvement of life-style behavior in the intervention group. For quality of life, no significant main effect (F(1,138.18) = .58, p = .447) or interaction effect (F(2,133.1) = 0.41, p = .67) was found. Secondary latent class analysis revealed different subgroups of patients per outcome measure. The intervention was experienced as useful and feasible. CONCLUSIONS: The personalized eHealth intervention resulted in significant improvements in life-style. Cardiac patients and health care providers were also willing to engage in this personalized digital behavioral intervention program. Incorporating eHealth life-style programs as part of secondary prevention would be particularly useful when taking into account which patients are most likely to benefit. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03178305.

Are illness perceptions, beliefs about medicines and Type D personality associated with medication adherence among thyroid cancer survivors? A study from the population-based PROFILES registry.

Objective: To examine self-reported medication adherence and its association with illness perceptions, beliefs about medication and personality among thyroid cancer survivors. Methods: Individuals diagnosed with thyroid cancer between 1990 and 2008, as registered in the Eindhoven Cancer Registry, received our survey; 86% (n = 306) responded.Results: Many patients reported that they never forgot taking their medicines (n = 168; 56%), never altered the dose (n = 258; 88%), never stopped taking them (n = 291; 99%), never decided to miss a dose (n = 284; 97%) and never took less than instructed (n = 286; 97%). Fifty-two percent were classified as nonadherent; of which 14% intentional nonadherent only, 70% were nonintentional nonadherent only and 16% were both intentional and nonintentional nonadherent. Nonadherers were younger, more highly educated, more often employed, had a lower stage at diagnosis, and less often reported ≥2 comorbid conditions than adherers. Furthermore, their illness affected them more emotionally and they more often reported that their life would be impossible without their medicine. Logistic regression models showed that higher age, lower education and lower perceived necessity of medication was associated with better adherence while beliefs about medication, illness perceptions, and personality were not associated with adherence.Conclusions: Despite lifelong dependence on supplement therapy, 52% of thyroid cancer survivors were nonadherent.

Physiological and emotional responses to evaluative stress in socially inhibited young adults.

BACKGROUND: There are large individual differences in dealing with everyday social stress. Therefore, we investigated the association of social inhibition (and its facets) with the emotional and physiological responses to the Trier Social Stress Test (TSST). METHODS: Undergraduate students (N = 312) completed the 15-item Social Inhibition Questionnaire (SIQ15) and participated in the TSST, while emotional and cardiovascular stress responses were recorded. We examined the effect of social inhibition across time with repeated-measures ANCOVAs. FINDINGS: During social stress (and recovery), social inhibition was associated with increased negative mood reactivity (especially the behavioral inhibition facet) and heightened sympathetic activation (especially the social withdrawal and interpersonal sensitivity). Physiological stress reactivity seems to be mostly α-adrenergic in women, and also ß-adrenergic in men. CONCLUSIONS: Emotional and physiological stress responses are associated with individual differences in social inhibition. This warrants more research on mechanisms that underlie the relations between social inhibition, stress and health.

Self-Care and Pathophysiological Function in Patients with Chronic Heart Failure.

BACKGROUND: Self-care is assumed to benefit physiological function associated with prognosis in patients with chronic HF, but studies examining these relations are lacking. This study aims to prospectively examine the association of self-reported HF self-care with HF-associated pathophysiological markers, including renal, hematological, and immune function. METHOD: Patients with chronic HF (n = 460, 66.2 ± 9.6 years, 75% men) completed questionnaires and provided blood samples at baseline and 12-month follow-up. Linear mixed models examined random intercept and fixed between- and within-subjects effects of global self-care and the individual self-care behaviors on log-transformed TNF-α, IL-6, and IL-10, the glomerular filtration rate of creatinine (GFRcreat), and hemoglobin (Hb), controlling for sociodemographic and clinical covariates. RESULTS: Self-care was independently associated with lower GFRcreat levels (ß = - .14, P = .023) and improvement in self-care with a reduction in GFRcreat (ß = - .03, P = .042). Individual self-care behaviors were differentially associated with renal, inflammatory, and hematological markers. Regular exercise was associated with level differences in IL-6 (P < .001), and improvement in exercise was associated with increasing GFRcreat (P = .002) and increasing Hb (P = .010). Fluid restriction was associated with lower overall GFRcreat (P = .006), and improvement in fluid restriction was associated with decreasing GFRcreat (P = .014). Low-sodium intake was associated with lower levels of Hb (P = .027), lower TNF-alpha (P = .011), and lower IL-10 (P = .029). Higher levels of medication adherence were associated with reduced pro-inflammatory activation (P < .007). CONCLUSION: Our findings suggest that better global self-care was associated with poorer renal function. Performing self-care behaviors such as regular exercise and medication adherence was associated with improved physiological functioning, while restriction of fluid and sodium, and the associated daily weight monitoring were associated with adverse levels of pathophysiological biomarkers.

Maternal cognitive function during pregnancy in relation to hypo- and hyperthyroxinemia.

OBJECTIVE: To assess a possible relationship between maternal cognitive dysfunction during pregnancy and hypothyroxinemia, adjusted for major confounders. BACKGROUND: Thyroid dysfunction in general is associated with cognitive dysfunction. Cognitive dysfunction is common during pregnancy. DESIGN: Prospective follow-up study from 12 to 32 weeks of pregnancy. PARTICIPANTS: 2082 healthy pregnant women. MEASUREMENTS: Cognitive function, depression and sleeping problems were assessed by self-report questionnaires at 12, 22 and 32 weeks of gestation, higher scores reflecting more symptoms. FT4, TSH and TPO-Ab were assessed at 12 weeks of gestation. DEFINITIONS: healthy (euthyroxinemia) control group: FT4 within 10-90th percentiles, without elevated TPO-Ab titres and TSH within first trimester-specific reference range (0.23-4.0 mU/L). Hypothyroxinemia: FT4 <2.5th percentile with TSH within first trimester-specific reference range. Poor cognitive function: a score >1 SD > mean on the cognitive function scale. RESULTS: A total of 54 women showed hypothyroxinemia and 1476 women had euthyroxinemia. At 12 weeks, multiple logistic regression showed that poor cognitive function was independently related to hypothyroxinemia: OR: 2.9 (95% CI: 1.6-5.4), adjusted for depression (OR: 3.1; 95% CI: 2.7-4.6) and sleeping problems (OR: 2.8, 95% CI: 1.9-3.9). TPO-Ab + women with hypothyroxinemia had the highest levels of cognitive dysfunction. Other cut-offs of hypothyroxinemia (<5th or <10th percentile with normal TSH) showed similar results. GLM-ANOVA showed that throughout pregnancy women with hypothyroxinemia at 12 weeks had significantly higher cognitive dysfunction scores compared with the healthy controls: F = 12.1, P = .001. CONCLUSIONS: Women with hypothyroxinemia during early gestation are at risk for poor cognitive function throughout gestation, adjusted for depression and sleeping problems.

Increase of depressive symptomatology during pregnancy over 25 years' time in four population based cohorts.

BACKGROUND: The use of psychotropic drugs for depression during pregnancy has increased over the past decades, but it is unclear whether women are becoming more depressed over time. METHODS: We investigated the occurrence of depressive symptoms during pregnancy in four cohorts (N 300-2000) in the same area in the Netherlands over a period of 25 years using a similar study design. Depressive symptoms were assessed using the Edinburgh Depression Scale (EDS) at various time points during pregnancy. Demographics, lifestyle factors, obstetric characteristics and EDS scores were compared between the four cohorts. RESULTS: From 1988 to 2014, Mean EDS scores during the first and third trimester of pregnancy increased significantly (P < 0.001). The number of women with elevated EDS scores doubled from 7% in 1988-1989 to 14% in 2012-2014 (P = 0.001). The number of highly educated women increased from 23% to 66% and those with paid employment from 75% to 95%, while smoking and alcohol use decreased significantly (all Ps < 0.001). These trends were similar to those of the National Statistics. A previous history of depression, multi-parity and paid employment were associated with higher EDS scores. LIMITATIONS: Women were highly educated, predominantly Caucasian and had a partner. CONCLUSIONS: Paradoxically, there was a significant increase in depressive symptomatology during pregnancy over a period of 25 years, while protective factors for depression during pregnancy improved. Potential explanations could be greater awareness, high societal expectations, use of social media or the stressful combination of paid work and children at home.

Effect of remote monitoring on patient-reported outcomes in European heart failure patients with an implantable cardioverter-defibrillator: primary results of the REMOTE-CIED randomized trial.

AIMS: The European REMOTE-CIED study is the first randomized trial primarily designed to evaluate the effect of remote patient monitoring (RPM) on patient-reported outcomes in the first 2 years after implantation of an implantable cardioverter-defibrillator (ICD). METHODS AND RESULTS: The sample consisted of 595 European heart failure patients implanted with an ICD compatible with the Boston Scientific LATITUDE® RPM system. Patients were randomized to RPM plus a yearly in-clinic ICD check-up vs. 3-6-month in-clinic check-ups alone. At five points during the 2-year follow-up, patients completed questionnaires including the Kansas City Cardiomyopathy Questionnaire and Florida Patient Acceptance Survey (FPAS) to assess their heart failure-specific health status and ICD acceptance, respectively. Information on clinical status was obtained from patients' medical records. Linear regression models were used to compare scores between groups over time. Intention-to-treat and per-protocol analyses showed no significant group differences in patients' health status and ICD acceptance (subscale) scores (all Ps > 0.05). Exploratory subgroup analyses indicated a temporary improvement in device acceptance (FPAS total score) at 6-month follow-up for secondary prophylactic in-clinic patients only (P < 0.001). No other significant subgroup differences were observed. CONCLUSION: Large clinical trials have indicated that RPM can safely and effectively replace most in-clinic check-ups of ICD patients. The REMOTE-CIED trial results show that patient-reported health status and ICD acceptance do not differ between patients on RPM and patients receiving in-clinic check-ups alone in the first 2 years after ICD implantation.ClinicalTrials.gov Identifier: NCT01691586.

Modeling Interactions Between Latent Variables in Research on Type D Personality: A Monte Carlo Simulation and Clinical Study of Depression and Anxiety.

Several approaches exist to model interactions between latent variables. However, it is unclear how these perform when item scores are skewed and ordinal. Research on Type D personality serves as a good case study for that matter. In Study 1, we fitted a multivariate interaction model to predict depression and anxiety with Type D personality, operationalized as an interaction between its two subcomponents negative affectivity (NA) and social inhibition (SI). We constructed this interaction according to four approaches: (1) sum score product; (2) single product indicator; (3) matched product indicators; and (4) latent moderated structural equations (LMS). In Study 2, we compared these interaction models in a simulation study by assessing for each method the bias and precision of the estimated interaction effect under varying conditions. In Study 1, all methods showed a significant Type D effect on both depression and anxiety, although this effect diminished after including the NA and SI quadratic effects. Study 2 showed that the LMS approach performed best with respect to minimizing bias and maximizing power, even when item scores were ordinal and skewed. However, when latent traits were skewed LMS resulted in more false-positive conclusions, while the Matched PI approach adequately controlled the false-positive rate.

Type D personality in Russian patients with cardiovascular disease: validity of the Russian DS14 (DS14-RU).

BACKGROUND: Type D personality is associated with unfavorable outcomes in patients with cardiovascular diseases (CVD). However, there is no valid Type D Scale in Russian language. The purpose of the study was to examine the factor structure of a new Russian version of 14-item Type D Scale (DS14-RU), and to evaluate the reliability and construct validity of the DS14-RU in clinical research. METHODS: The study included 929 participants, 496 (53.4%) of which had coronary artery disease, 195 (21.0%) congestive heart failure, 84 (9.0%) arterial hypertension and 154 (16.6%) were relatively healthy volunteers. The mean age was 57.5 years, 565 (60.8%) participants were males. The respondents filled out an extended Russian version of the Type D scale and new DS14-RU, as well as the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Reeder Stress Inventory, and State-Trait Personality Inventory. RESULTS: The new Russian version of DS14-RU was internally consistent with Cronbach's α = .80 for both the negative affectivity and social inhibition subscales. The prevalence of Type D personality, as measured with the DS14-RU, was 21.4% among patients with CVD, and 20.0% among relatively healthy participants. The mean scores for anxiety, depression, psychosocial stress and anger were significantly higher in patients with Type D personality and they had significantly lower levels of social support and curiosity. CONCLUSIONS: The new DS14-RU is consistent with the original DS14 in terms of reliability, factor structure and construct validity. The DS14-RU can be used for the reliable assessment of Type D in Russian-speaking respondents.

Social inhibition in population-based and cardiac patient samples: Robustness of inhibition, sensitivity and withdrawal as distinct facets.

OBJECTIVE: Behavioral inhibition plays a key role in animal stress research and developmental research in children. Therefore, we examined the robustness of our multifaceted model of adult social inhibition that comprises behavioral inhibition, interpersonal sensitivity, and social withdrawal components. METHOD: A total of 899 adults completed the 15-item Social Inhibition Questionnaire (SIQ15) and measures of emotional distress. Confirmatory Factor Analysis (CFA), reliability estimates, and correlational and second-order factor analyses were used to examine the robustness of our model. RESULTS: CFA (RMSEA = 0.052; NFI = 0.938; CFI = 0.957) and Cronbach's α estimates ≥0.87 confirmed the robustness of our multi-facet social inhibition model based on three correlated inhibition, sensitivity, and withdrawal factors in 560 adults from the general population and in 194 undergraduate students. Inhibition, sensitivity, and withdrawal were stable over time (3-month test-retest correlations ≥ 0.78), and were closely related to the Gest Behavioral Inhibition and PID-5 Withdrawal measures in a clinical sample of 145 cardiac patients. Of note, male cardiac patients reported more inhibition and withdrawal than female patients. Across samples, social inhibition was distinctly different from negative affectivity. CONCLUSIONS: Our 3-facet model of inhibition, sensitivity and withdrawal was robust across samples, and may promote research on adult social inhibition in population-based and clinical studies.

Social inhibition and emotional distress in patients with coronary artery disease: The Type D personality construct.

We examined the validity of the social inhibition component of Type D, its distinctiveness from negative affectivity, and value regarding emotional distress as measured with the DS14 in 173 coronary artery disease patients. In dimensional analysis, social inhibition and negative affectivity emerged as distinct traits. Analysis of continuous negative affectivity and social inhibition measures showed main effects for several emotional and inhibition markers and an interaction effect for social anxiety. Categorical analysis indicated that Type D patients reported more depression, negative mood, social anxiety, and less positive mood. Social inhibition is not a redundant trait, but has additional conceptual value.

The multidimensional nature of adult social inhibition: Inhibition, sensitivity and withdrawal facets of the SIQ15.

BACKGROUND: Social inhibition may promote emotional problems in children, but little is known about this disposition in adults. Our research builds on a theory-based model to suggest that adult social inhibition involves distinct behavioral (inhibition), cognitive (sensitivity), and affective (withdrawal) characteristics. METHODS: A total of 1385 adults completed measures of social inhibition, emotional distress, and social stress. Factor analyses, reliability estimates and regression analyses were used to examine the robustness of our model, and the validity of the 15-item Social Inhibition Questionnaire (SIQ15). RESULTS: In Study 1 (N = 1180; Mage 46.9 years; 52% women), factor analysis confirmed that behavioral inhibition, interpersonal sensitivity, and social withdrawal reflected distinct facets of social inhibition. Next, we developed the SIQ15 that covers these facets with 5 items each; e.g. has difficulty making contact; expects negative reactions from others; keeps others at a distance. Study 2 (N = 209; Mage 20.3 years; 77% women) showed that the SIQ15 and its 5-item Inhibition, Sensitivity and Withdrawal facet scales were internally consistent (Cronbach's α between 0.86/0.94) and stable over time (test-retest between r = 0.73/0.78). The SIQ15 facets differentially predicted related inhibition (Behavioral Inhibition Scale), rumination (Penn State Worry Questionnaire) and withdrawal (Personality Inventory for DSM-5) scores at 6 months follow-up. Younger age and having no partner were associated with more social inhibition. LIMITATIONS: Findings are based on self-report; experimental and prospective studies are needed to further validate our inhibition model. CONCLUSIONS: Inhibition, sensitivity, and withdrawal are distinct manifestations of adult social inhibition that can be reliably assessed with the SIQ15. Research needs to examine how this multidimensional nature of social inhibition has an effect on stress, health, and wellbeing.