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PubMed2005

Topiramate in treatment of depressive and anger symptoms in female depressive patients: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Depression is associated with increased aggression and diminished ability and quality of life. The goal of this study was to compare the efficacy of topiramate in influencing depressive symptoms, aggression, ability, and health related quality of life in depressive women. METHODS: We conducted a randomized, double-blind, placebo-controlled 10-week study of topiramate in 64 female subjects from the general population who met criteria for recurrent major depressive disorder. Primary outcome measures were changes on the Hamilton Depression Rating Scale (HDRS), the State-Trait Anger Expression Inventory (STAXI), the Test of Attention (d2), and the SF-36 Health Survey (SF-36). RESULTS: According to the intent-to-treat principle, a significant difference on the HDRS (P=0.02), all scales of STAXI (all P<0.001), Total efficiency of d2 (P<0.001), and on most scales of SF-36 (P between 0.15 and <0.001) were observed in the topiramate-treated subjects comprised the placebo group. The reduction in expression of anger correlated significantly with changes on the HDRS, and several scales of d2 and SF-36. Additional weight loss, which was significantly more pronounced in the topiramate group than in those treated with a placebo, was ascertained (difference in weight loss between the two groups: 4.2 kg, P<0.001). All the patients tolerated topiramate relatively well. LIMITATIONS: Only moderately ill women were included. CONCLUSIONS: Topiramate appears to be an effective agent in the reduction of depressive symptoms and anger and in the improvement of ability and health-related quality of life in depressive women. Additional weight loss can be expected.

Adult↗

PubMedDate not supplied

Anger in adolescents: sex, ethnicity, age differences, and psychometric properties.

BACKGROUND: The State-Trait Anger Expression Inventory (STAXI), a self-report questionnaire, is designed to measure the experience and expression of anger. Reliability and validity of the STAXI have been well established among African and European Americans aged 13 years and older. However, little is known of the use of this instrument among adolescents younger than 13 years and Hispanic American adolescents. OBJECTIVES: Objectives were (a) to test ethnic, sex, and age group differences in STAXI scores in a sample of 11-to-16-year-old African, Hispanic, and European American adolescents; and (b) to assess the psychometric properties of the STAXI among these same adolescents with special emphasis on Hispanic youths, for whom no data are available. METHODS: A cross-sectional design was used with stratified quota sampling techniques. Participants (N = 394) were African, Hispanic, and European Americans aged 11-16 years and were drawn from one public middle school and two public high schools in Houston, Texas. RESULTS: Internal consistency reliability for the anger scales (STAXI) ranged from 0.61 (anger-in) to 0.91 (state-anger) for the younger group (aged 11-13 years), and 0.68 (anger-in) to 0.88 (state-anger) for the older Hispanic Americans (aged 14-16). No notable differences were seen among the three ethnic groups in regards to internal consistency. Results of factor analyses of the five anger scales were similar to those reported originally by the scale author. Ethnicity and age had statistically significant main effects on the anger scales, and there was only one interaction. DISCUSSION: The use of the STAXI among a tri-ethnic adolescent population is warranted. The anger-in scale may be less reliable, especially among younger adolescents.

Adolescent↗

PubMed1996

Early onset (< 40 years age) psoriasis is comorbid with greater psychopathology than late onset psoriasis: a study of 137 patients.

Early onset (< age 40 years) psoriasis has been reported to be more readily triggered by environmental factors such as stress, in contrast to late onset (> or = age 40 years) psoriasis. We examined whether certain psychopathologic factors differentiated the psoriasis patient with early onset versus late onset disease. One hundred and thirty-seven psoriasis inpatients completed a battery of psychosocial questionnaires. Logistics regression analysis, using the psychologic measures, age and TBSA affected as independent variables, revealed that higher Anger-in (Anger Expression Scale) scores significantly (p < 0.05) increased the odds or probability of having early versus late onset psoriasis. Psoriasis with onset prior to age 40 is comorbid with greater difficulties with assertion and expression of anger, a personality trait that may adversely affect the patient's capacity to cope with stress.

Adolescent↗

PubMed1998

Family history of hypertension: a psychophysiological analysis.

Family history of hypertension (positive and negative) and gender groups were compared on cardiovascular responses at rest, during stressors and during recovery. Two tasks were employed, mental arithmetic and an anger recall interview. Both levels and reactivity measures of blood pressure, heart rate, cardiac output and total peripheral resistance were included. In addition, participants filled out several questionnaires measuring state feelings during the task and recovery periods, trait anger/hostility and emotions. Both men and women with a positive family history of hypertension exhibited higher tonic levels of blood pressure and heart rate at rest, recovery and during both tasks. They also exhibited greater heart rate reactivity during the mental arithmetic task and greater blood pressure reactivity to both tasks when post-math recovery, but not initial rest, was used as a covariate. Positive family history individuals reported less trust and gregariousness, more depression and aggression, less awareness of somatic responses to the tasks and less effort to relax during the post-task rest periods. Finally, significant correlations were found between low anger expression how anger experience and high anger control and task SBP levels in positive family history individuals.

Adult↗

PubMed2005

Do negative emotions predict alcohol consumption, saturated fat intake, and physical activity in older adults?

This study examined anger, depression, and stress as related to alcohol consumption, saturated fat intake, and physical activity. Participants were 23 older adults enrolled in either an outpatient or in-residence executive health program. Participants completed (a) a health-risk appraisal assessing medical history and current health habits, (b) the State-Trait Anger Expression Inventory (STAXI), and (c) the Center for Epidemiological Studies-Depression Questionnaire. Bivariate correlations revealed that anxiety was negatively correlated with alcohol consumption. High levels of depression, trait anger, and outward anger expression style were positively associated with saturated fat intake. Trait anger was also associated with less aerobic exercise. Inward anger expression was positively correlated with regular participation in strength training. Results suggest that anger, anger expression style, and depression interact with healthy and unhealthy behavior patterns and that these interactions may be complex.

Affect↗

PubMed1989

The role of the experience and expression of anger and anxiety in elevated blood pressure among black and white adolescents.

Differences between black and white adolescents in the experience and expression of anger and anxiety, traditional risk factors for hypertension, and blood pressure were examined among adolescents enrolled in a health science course in Tampa, Florida. Relationships between blood pressure and anger/anxiety and traditional risk factors were also examined. Black adolescents of both genders experienced feelings of anxiety more frequently and with greater intensity than did their white counterparts. Although black and white adolescents did not differ in their ability to experience anger, blacks experienced more intense reactions in situations involving unfair criticism and time pressure. More importantly, black males and females suppressed the expression of their anger more often than did their white counterparts. The blood pressure of black adolescent males and females was found to be significantly higher than their white counterparts. Blacks were also more likely to have a family history of hypertension, but were less likely to smoke cigarettes. Racial differences on other risk factors were found only among black females who were heavier and consumed more salty junk foods than white females. Although a number of the personality and risk factor measures were significantly correlated with blood pressure, measures of suppressed anger were more strongly correlated with blood pressure for both black and white adolescents. Findings from the multiple regression analyses showed that suppressed anger was the best independent predictor of blood pressure for all groups except white females. Overall, the findings from this study demonstrate that adolescents with elevated blood pressure can be identified by emotional/psychological factors, which are predictive of high blood pressure for both blacks and whites.

Adolescent↗

PubMed1997

[Anger and risk of suicide. Study of elderly psychiatric patients].

A brief review of the literature on anger, depression, and suicidal behavior is presented. One problem of these investigations is in a lack of differentiation between the concepts of anger and anger expression. Especially, the question remains of whether depression is associated with anger turned outward or may be understood as a correlate of hostility directed to the subject. Self-destructive actions may be predicted more accurately if, in addition to severity of depression, anger and anger expression are included. In the present study of 48 older psychiatric patients the following variables were assessed: Measures for intelligence, the Self-rating Depression Scale of Zung, the questionnaire for assessing suicidality of Pöldinger, the number of attempted suicides, and the State-Trait-Anger Expression Inventory of Schwenkmezger, Hodapp and Spielberger. Anger-out and Anger Control, in contrast to depression, differentiate between patients with and without suicides attempts. The actual risk for suicide, assessed by the questionnaire for suicidality, is significantly predicted by the depression scale. The different associations of anger and depression with suicide indicators and the relevance of these results for diagnostics and prophylaxis are discussed.

Aged↗

PubMed1982

Habitual anger-coping styles: I. Effect on mean blood pressure and risk for essential hypertension.

In this study we examined the effect(s) of race, sex socioecological stress, and habitual anger-coping systolic/diastolic blood pressure levels and risk for being classified hypotensive. A total of 495 black/white males and 511 black/white females, residing in high/low stress areas of Detroit, were classified in terms of high, medium, and low levels of anger expression to various provocative interpersonal situations. Results indicated that: 1) race and anger expression were major determinants of diastolic pressure; 2) race and sex influence systolic pressure; 3) anger expression was related to systolic pressure, but only for female respondents; 4) all four behavioral factors were independently related to one's relative risk of being labeled hypertensive; and 5) the odds of being hypertensive by a multiple 1.56 with the addition of each behavioral risk factor. These findings extended our understanding of both the important role played by sociodemographic factors and socioecological niche in predisposing humans to vascular disease and the magnitude of difference in mean blood pressure and risk for hypertension attributable to chronic suppressed anger. The present finding also provide a basis for identifying subgroups of individuals who are especially at risk for hypertension and, similarly, a basis on which to calculate the amount of potential therapeutic benefit resulting from attempts at modifying one or more risk factors.

Adaptation, Psychological↗

PubMed1993

Anger suppression: its relationship to beta-adrenergic receptor sensitivity and stress-induced changes in blood pressure.

While studies from diverse fields of research suggest a relationship between problems expressing anger and cardiovascular illness, few studies have provided a potential pathophysiological link of such a relationship. Forty-five males were classified according to one of three anger expression categories: those who did not suppress their anger (N = 13), those who partially suppressed their anger (N = 19), and those who definitely suppressed their anger (N = 13). For each, we determined lymphocyte beta-adrenergic receptor function and blood pressure responsiveness to a standardized mathematics stressor. Those subjects who routinely suppressed their expression of anger had increased beta-adrenergic receptor sensitivity (P = 0.01) (isoproterenol-stimulated cyclic AMP production) and a greater systolic blood pressure response to the stressor (P = 0.001). Anger suppression was unrelated to the subject's age, weight, or socioeconomic status. These findings may be germane to prior clinical and epidemiologic observations relating anger expression and cardiovascular illness.

Adaptation, Psychological↗

PubMed1994

[Coping with anger by cardiovascular patients].

Patients with essential hypertension and coronary heart disease were compared to a healthy and clinical control group an the recently developed Müller-Anger-Coping Questionnaire (MAQ). The inventory measures the factors "Spontaneous Behavior" (f1), "Controlled Affect" (f2), "Guilt" (f3) and "Social Inhibition" (f4) as a trait. The patients, suffering from essential hypertension, in comparison to the healthy control group, showed significant differences on factors 2 to 4, indicating, that they are expressing anger to a lesser degree and that they are more likely to exhibit an anger-in/guilt coping style. The same was true for patients suffering from coronary heart disease with respect to factors 2 and 4. With respect to "Guilt" coronary heart disease patients showed a clear trend for more feelings of guilt after anger expression, as compared to the healthy control group. None of the groups showed significant differences on expressing anger-in an aggressive manner (factor 1). These results provide further evidence, that patients with cardiovascular disorders have a clear tendency to show anger to a lesser degree in an socially assertive manner and to suppress anger. If anger is expressed by these patients, they tend to feel guilty. Implications of the findings are discussed.

Adaptation, Psychological↗

PubMedDate not supplied

Repressive adaptive style in children with chronic illness.

OBJECTIVE: The primary objectives of this study were 1) To assess whether previously reported findings of high levels of repressive adaptation in children with cancer are unique to the cancer population or are generally characteristic of children with serious chronic illness and 2) to assess the utility of including a new measure of anger expression in the adaptive style measurement paradigm. METHODS: Measures of defensiveness, trait anxiety, and anger expression were obtained from three groups of children: those with cancer (N = 130), those with chronic illnesses (diabetes, cystic fibrosis, and juvenile rheumatoid disorders; N = 121), and healthy control participants (N = 368). Based on their self-reports, participants were categorized according to the adaptive style paradigm as either high anxious, low anxious, defensive high anxious, or repressor. The prevalence of these categories was compared across groups. RESULTS: Children in the cancer and chronic illness groups both reported significantly higher levels of defensiveness and lower levels of anxiety than did the healthy control participants. Application of the adaptive style paradigm produced a significantly higher percentage of children identified as repressors in the both cancer and chronic illness groups relative to healthy children. Children classified as repressors also reported significantly less expression of anger than did nonrepressors. CONCLUSIONS: An increased prevalence of repressive adaptation is not unique to children with cancer, but may be generally characteristic of children with serious chronic illness. Use of anger in place of anxiety as the repressed affect produced a similar distribution of adaptive styles in the study populations.

Adaptation, Psychological↗

PubMed1985

An evaluation of three crisis intervention programmes for general hospital patients.

Three crisis intervention programmes were implemented on the basis of prior research and observation with patients in a general hospital. Programme 1 had been designed to decrease their anxiety and depression, programme 2 to decrease their indirectly expressed anger and increase anger which was directly expressed, and programme 3 to decrease the feelings of helplessness and increase their levels of competence. Examination of the psychological states of the sample of ill and injured patients on admission showed that those who were judged to have a poor counselling prognosis were found, as hypothesized, to be highly anxious, depressed and helpless, and to be expressing their anger only indirectly. The goals of the programmes therefore seem to have been appropriately selected to meet the psychological needs of the patients. After crisis intervention counselling, these differences on admission were no longer apparent on discharge or on follow-up 12 months later. Programme 1 did not prove differentially effective on discharge or follow-up. Programme 2 was not found to be more effective than the other programmes on discharge but, as hypothesized, was associated with direct expression of anger and decreased anxiety and depression more at follow-up. Programme 3 increased patients' expressions of competence and decreased their anxiety more on discharge; but on follow-up it proved more liable to maintain their depression than to have beneficial effects.

Adolescent↗

PubMed2005

Anger management style, opioid analgesic use, and chronic pain severity: a test of the opioid-deficit hypothesis.

Anger management style is related to both acute and chronic pain. Recent research suggests that individuals who predominantly express anger (anger-out) may report heightened chronic pain severity due in part to endogenous opioid antinociceptive dysfunction. If exogenous opioids serve to remediate opioid deficits, we predicted that regular use of opioid analgesics by chronic pain patients would alter these relationships such that anger-out would be related to chronic pain severity only among opioid-free patients. For 136 chronic pain patients, anger management style, depression, anxiety, pain severity, and use of opioid and antidepressant medication was assessed. Results of hierarchical multiple regressions to predict chronic pain severity showed: (a) a significant Anger-out x Opioid use interaction such that high Anger-out was associated with high pain severity only among patients not taking opioids; (b) controlling for depressed affect and anxiety did not affect this association; (c) the Anger-out x Antidepressant use interaction was nonsignificant; (d) Anger-in did not interact with use of any medication to affect pain severity. Results are consistent with an opioid-deficit hypothesis and suggest that regular use of opioid medications by patients high in anger expression may compensate for an endogenous opioid deficit, and mitigate the effects of elevated anger expression on chronic pain intensity.

Adaptation, Psychological↗

PubMed2004

Life events, entrapments and arrested anger in depression.

OBJECTIVES: A recent, evolution derived theory of depression has suggested that aroused but arrested defences of fight (arrested anger) and flight (entrapments) may be important components of depression. This study therefore set out to explore unexpressed anger and entrapment in depression. The focus was on the nature of severe life events and difficulties, the time course of arrested defences, fantasies of escaping, fantasies of expressing anger, and reasons for not acting on emotions/behaviours. METHODS: Fifty diagnosed depressed people, being treated for depression, were interviewed using the Life Event and Difficulties Schedule (LEDS). They then completed five further questionnaires: the escape inhibition questionnaire; the reasons for not escaping questionnaire; the anger inhibition questionnaire; the reasons for not expressing anger questionnaire, and the Beck Depression Inventory. RESULTS: In regard to arrested flight, 88% of the group acknowledged strong desires to escape difficulties in their life but many felt unable to. Transcript analysis from the LEDS also indicated strong themes of entrapment. 38.7% felt trapped before becoming depressed. Fantasies of escaping were common, but making actual plans to get away less common. A variety of reasons were given for not escaping: In regard to arrested anger, 82% felt they suppressed their anger and 56% felt this problem predated their depression. A number of different reasons were given for not expressing anger. Despite self-blame often being seen as important to depression, we found that for many severe life events and difficulties patients did not blame themselves. Rather they blamed external circumstances or other people and saw these as the source of their entrapment. CONCLUSIONS: Disturbances in fight/flight mechanisms are common in depression. For some these may predate a depression and may play a causal role, whilst for others these experiences emerge with the depression. Depression is related to chronic stress states and clinical attention to disturbances in flight/flight may throw light on these states and offer novel approaches to intervention.

Adult↗

PubMed2006

The relation of free plasma tryptophan to anger, hostility, and aggression in a nonpatient sample of adult men and women.

BACKGROUND: Dysregulation of central nervous system serotonergic (5-HT) activity is implicated in behavioral states and psychological traits associated with depression and aggression, with some studies suggesting possible gender-related differences. PURPOSE: This study examined the relation of free plasma tryptophan (TRP) to aggression and depression in a sample of 138 nonsmoking adults recruited from the general community. It was hypothesized that TRP would be associated with anger, hostility, and aggression. METHODS: To minimize effects of diurnal variation and menstrual cycle, fasting blood samples were collected in the morning, and, for women, during the follicular phase of the menstrual cycle. Participants were administered questionnaires following blood draw. Plasma TRP was determined by high performance liquid chromatography. RESULTS: In women, but not men, higher levels of TRP were associated with trait hostility, propensity for anger, a tendency to express anger outwardly, and an antagonistic interpersonal style. For men and women, greater severity of depressive symptoms, anger, and the verbal expression of anger were associated with higher TRP. These associations were independent of age, body mass index, fasting albumin, and race and ethnicity. CONCLUSIONS: These data suggest that in women, but not men, higher plasma levels of TRP, the precursor to 5-HT, are associated with anger-hostility-aggression and that these associations are independent of various potential confounds. Implications of these observations to studies employing acute TRP depletion studies are discussed.

Adolescent↗

PubMed2002

Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders.

OBJECTIVE: The object of this study was to make a comparison regarding various dimensions of anger between depressive disorder and anxiety disorder or somatoform disorder. METHOD: The subjects included 73 patients with depressive disorders, 67 patients with anxiety disorders, 47 patients with somatoform disorders, and 215 healthy controls (diagnoses made according to DSM-IV criteria). Anger measures--the Anger Expression Scale, the hostility subscale of the Symptom Checklist-90-Revised (SCL-90-R), and the anger and aggression subscales of the Stress Response Inventory--were used to assess the anger levels. The severity of depression, anxiety, phobia, and somatization was assessed using the SCL-90-R. RESULTS: The depressive disorder group showed significantly higher levels of anger on the Stress Response Inventory than the anxiety disorder, somatoform disorder, and control groups (p < .05). The depressive disorder group scored significantly higher on the anger-out and anger-total subscales of the Anger Expression Scale than the somatoform disorder group (p < .05). On the SCL-90-R hostility subscale, the depressive disorder group also scored significantly higher than the anxiety disorder group (p < .05). Within the depressive disorder group, the severity of depression was significantly positively correlated with the anger-out score (r = 0.49, p < .001), whereas, in the somatoform and anxiety disorder groups, the severity of depression was significantly positively correlated with the anger-in score (somatoform disorder: r = 0.51, p < .001; anxiety disorder: r = 0.57, p < .001). CONCLUSION: These results suggest that depressive disorder patients are more likely to have anger than anxiety disorder or somatoform disorder patients and that depressive disorder may be more relevant to anger expression than somatoform disorder.

Adult↗

PubMed1998

Anger management style and the prediction of treatment outcome among male and female chronic pain patients.

Anger is a prominent emotion experienced by chronic pain patients. Anecdotes suggest that anger predicts poor outcome following multidisciplinary pain programs, but no empirical evidence documents this link. We expected that patient anger expression or suppression would predict poor outcome following a pain program and that gender differences would emerge. Pre- to posttreatment measures of lifting capacity, walking endurance, depression, pain severity and activity level were collected from 101 chronic pain patients. An 'anger expression x gender' interaction was found such that anger expression among males was correlated negatively with lifting capacity improvements. 'Anger suppression x gender' interactions emerged such that anger suppression among males was correlated negatively with improvements in depression and general activities. These effects remained significant after controlling for trait anger. Thus, how anger is managed may exert unique influence on outcomes apart from the effects of mere anger proneness, at least among male pain patients.

Adult↗

PubMed1989

Anger and hostility in depression.

The present study examined the relationship between depression and various dimensions of anger using multiple measures of anger and hostility and comparing depressed subjects with both a normal sample and a clinical sample with predominant anger difficulties. Three groups of subjects were obtained: a normal sample of 120 parents of elementary school children, 36 psychiatric inpatients meeting Research Diagnostic Criteria for major depressive episode, and 54 hospitalized veterans meeting Diagnostic Interview Schedule criteria for posttraumatic stress disorder (PTSD). The three groups differed significantly on all measures of anger experience, hostility, anger suppression, and anger expression. The depressed group reported greater levels of hostility and anger experience than the normal group but less than the PTSD group. On measures of anger suppression and expression, the depressed group exhibited more suppression than either the normal or the PTSD group and generally reported levels of anger expression comparable with the normal group's. The PTSD group reported the highest levels of anger expression. Within the depressed group, severity of depression was positively associated with levels of hostility and anger experience but was not related to measures of anger expression and was only partially related to anger suppression. These results are discussed as they relate to the "anger turned in" hypothesis of psychodynamic theories of depression, and directions for future research are noted.

Adult↗