Objective The aim of this research was to explore the relationship between type D personality and symptom duration/emergency admissions/mental health status/quality of life (QOL) in Chinese rectal cancer patients. Methods Rectal cancer patients who were treated in our hospital form Oct. 2010 to Oct. 2012 were selected prospectively, and then their type D personality was measured with the 14-item Type D Personality Scale (DS14). Mental health status was measured with the Hospital Anxiety and Depression Scale (HADS). The QOL was assessed longitudinally by using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and QLQ-CR38 questionnaires at the baseline and 6 months after diagnosis. Comparison between the type D personality group and non-type D personality group in social-demographic characteristics, clinicopathological features, mental health status, and QOL was performed. Results Of the 596 patients (92%) who responded, 131 patients (22%) had type D personality. ① Compared with non-type D personality group, the proportions of patients with duration of symptoms ≥1 month, without medical insurance, and emergency admissions in type D personality group were all higher, as well as the poor economic situation and more complication ( P<0.050). ② EORTC QLQ-C30. At the baseline, scores of role function, emotional function, cognitive function, social function, and overall health status in type D personality group were all lower than those of non-type D personality group ( P<0.050), but scores of fatigue, constipation, and financial difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). In 6 months after diagnosis, scores of role function, emotional function, cognitive function, social function, and overall health status in type D personality group were all lower than those of non-type D personality group ( P<0.050), but scores of fatigue, insomnia, constipation, and financial difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). ③ EORTC QLQ-CR38. At the baseline, score of expectation for the future in type D personality group was lower than that of non-type D personality group ( P<0.001), but score of urinary problems in type D personality group was higher in type D personality group than that of non-type D personality group ( P<0.001). In 6 months after diagnosis, scores of expectation for the future and sexual function in type D personality group were both lower than those of non-type D personality group ( P<0.050), but scores of urinary problems, gastrointestinal symptoms, male sexual dysfunction, and excretion difficulties in type D personality group were all higher than those of non-type D personality group ( P<0.050). ④ At the baseline and 6 months after diagnosis, the incidences of anxiety and depression in type D personality group were all higher than those of non-type D personality group at the same time point ( P<0.001). In type D personality group, the incidences of anxiety and depression in 6 months after diagnosis were both higher than baseline ( P<0.001). Conclusion Type D personality may be a general vulnerability factor to screen for subgroups at risk for longer SD and emergency admissions in clinical practice of rectal cancer patients, and it was associated with poor QOL and poor mental health status.