Year of Award


Document Type

Dissertation - Campus Access Only

Degree Type

Doctor of Philosophy (PhD)

Degree Name

Clinical Psychology

Department or School/College

Department of Psychology

Committee Chair

Duncan G. Campbell

Commitee Members

Bryan Cochran, David Schuldberg, Jennifer Robohm, Charles Palmer


Cardiovascular Disease, Depression, First Responders, Health behavior, Type D Personality, Wildland Fire


University of Montana


Cardiovascular diseases (CVDs) are the leading cause of death worldwide (WHO, 2016). Yet, nearly 80% of CVD can be prevented through changes in cardiovascular risk behaviors (e.g., smoking, unhealthy diet, physical inactivity) (Benjamin et al., 2017). Depression has been robustly linked to increased risk of CVD (Bradley & Rumsfeld, 2015), and individuals with depression are more likely than those without depression to engage in cardiovascular risk behaviors. Although many mechanisms have been explored, depression appears to influence CVD risk primarily through behavioral pathways (Hamer, Molloy, & Stamatakis, 2008). Type D “distressed” personality is an emerging psychosocial construct that has been linked to increased risk of CVD mortality (Denollet, Schiffer, & Spek, 2010), adverse cardiac events (O'Dell, Masters, Spielmans, & Maisto, 2011) and depression (Romppel, Herrmann-Lingen, Vesper, & Grande, 2012). Some research has found that individuals with Type D personality are likely to engage in cardiovascular risk behaviors (Williams et al., 2008). However, few studies have examined the influence of Type D personality on cardiovascular risk behaviors independent of depression. The present study examined relationships between Type D personality, depression, and health risk behaviors among a sample of US wildland firefighters (n=2,625), a population that has been linked to an increased risk of CVD (Navarro et al., 2019). After accounting for depression, Type D personality predicted decreased likelihood of nicotine use and reduced fruit and vegetable consumption. Depression was a significant predictor of risky alcohol use, current nicotine use, fruit and vegetable consumption, physical activity, and sleep duration. After accounting for depression, non-significant relationships were found between Type D personality and risky alcohol use, nicotine use intensity, physical activity, and sleep duration. Results suggest that Type D personality and depression are related, and that overall, depression better predicts CVD risk behaviors than Type D personality. Wildland firefighters in the sample also reported rates of anxiety, depression, PTSD, suicidality, risky alcohol use, and smokeless tobacco use at rates 2-10 times higher than the general public. Findings highlight the need for health surveillance and evidence-based health promotion and illness/injury prevention program development for wildland firefighters, particularly in psychological and behavioral health domains.

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© Copyright 2019 Patricia Anne O'Brien