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PubMedDate not supplied

Gender, anger expression style, and opportunity for anger release determine cardiovascular reaction to and recovery from anger provocation.

This study represents an extension of Hokanson's research, which showed that for men anger release after provocation tends to accelerate cardiovascular recovery. The objective of this study was to investigate how gender and habitual style for anger-in or anger-out behavior modulate the effect of anger provocation and release. Male and female subjects (N = 105) were classified as anger-in/anger-out only when a double criterion (i.e., self-report and peer evaluation) was satisfied. Following a state anger rating at pre-test, subjects were harassed during the performance of a 12-minute math task. After task completion, subjects were randomly assigned to one of two 10-minute recovery protocols a) having an opportunity to release negative affect, and b) not not having such an opportunity. All groups (including the anger-ins) that had an opportunity to express negative affect did in fact express similar levels of anger. Men reacted more strongly to the math task performed under anger provocation on all cardiovascular indices. Anger expression style as a trait-type disposition was important for the recovery process in women whereas the situational manipulation (i.e., the opportunity to release anger) had specific effects on the recovery process of men. Opportunity to release anger facilitated heart rate recovery (and to a lesser degree diastolic pressure recovery) in men but not in women. Women with anger-in tendencies on the other hand displayed better systolic pressure recovery than female anger-outs whereas no such effects were observed in men.

Adjustment Disorders↗

PubMed2001

Further evidence of reliability and validity for the driving anger expression inventory.

This study provided evidence of reliability and validity for the four scales of the Driving Anger Expression Inventory. Alpha reliabilities for scales ranged from .84 to .89. Measures of aggressive anger expression while driving (Verbal Aggressive Expression, Personal Physical Aggressive Expression, and Use of the Vehicle to Express Anger scales) correlated positively with each other and negatively with the Adaptive/Constructive Expression scale. Scores on the three aggressive forms of anger expression correlated positively with trait anger and measures of driving-related anger, aggression, and risky behavior, whereas scores on the Adaptive/Constructive Expression scale correlated negatively with these variables. Reports of aggressive and risky behavior correlated most strongly with the Use of the Vehicle to Express Anger scale. Forms of anger expression were minimally or uncorrelated with rated trait anxiety and reports of moving violations, close calls, and accidents. Findings replicated earlier findings and provided further evidence for the reliability and validity of the Driving Anger Expression Inventory.

Accidents, Traffic↗

PubMed1987

The relationship of anger expression to health problems among black Americans in a national survey.

This study examined the relationship between anger expression, other psychosocial measures, and health problems in a nationally representative, cross-sectional sample of 1277 black adults. Subjects indicating a high level of outwardly expressed anger during a period in which they experienced a severe personal problem had a significantly higher number of health problems than their counterparts who expressed low and moderate levels of anger. Anger expression also significantly interacted with a measure of life strain (employment status) to predict health problems. Blacks who were unemployed were more likely to have a higher number of health problems if anger was expressed outwardly at a high level. The relationship was found to be independent of age, gender, urbanicity, smoking, and drinking problems. The overall pattern of the findings suggests that blacks who are at increased risk for health problems may be identified by how often anger is experienced and expressed during periods of emotional distress.

Adult↗

PubMed1989

Relations between anger expression and cardiovascular reactivity: reconciling inconsistent findings through a matching hypothesis.

Previous psychophysiological research has demonstrated that both anger expression and anger suppression are related to cardiovascular responses, but in an inconsistent fashion. The present study tested the following hypotheses: (a) that the influence of anger expression style on psychophysiological responses would be limited to Ss exposed to an anger instigation, and (b) that the specific pattern of psychophysiological responses would vary as a function of whether Ss were induced to use their preferred vs. nonpreferred mode of anger expression style in response to the instigation. Seventy-eight male college undergraduates were randomly assigned to work on a task with either an annoying or a pleasant confederate and subsequently to write either a negative or a positive evaluation of the confederate. Blood pressure was measured intermittently and heart rate continuously throughout task performance and a subsequent 15-min rest period. Ss' preferred method of anger expression had been previously assessed by a self-report questionnaire. Systolic blood pressure results generally were consistent with the hypotheses. Implications of the findings for the etiology of cardiovascular diseases are discussed.

Adolescent↗

PubMed2005

The relation between anger expression, depression, and somatic symptoms in depressive disorders and somatoform disorders.

BACKGROUND: In previous studies, the relationship between either anger suppression and depression or anger suppression and somatic symptoms was examined. However, the relationship between anger expression, depression, and somatic symptoms was not examined in depressive disorders and somatoform disorders. METHOD: The DSM-IV-diagnosed subjects included 73 patients with depressive disorders and 47 patients with somatoform disorders. The Anger Expression Scale was used to assess the level of anger expression or suppression. The severity of depression was assessed using the Symptom Checklist-90-Revised (SCL-90-R). The Somatization Rating Scale and the SCL-90-R somatization subscale were used to assess the severity of somatic symptoms. Data were collected from March 2000 to March 2001. RESULTS: The results of the path analyses showed that in depressive disorder patients, anger expression had a stronger effect on somatic symptoms through depression than did anger suppression, although both anger expression and anger suppression had a significant indirect effect on somatic symptoms. The depressive disorder group also showed a significant but negative direct effect of anger suppression on anger expression in the path from anger suppression to anger expression to depression to somatic symptoms. However, only anger suppression had an indirect effect on somatic symptoms through depression in somatoform disorder patients. CONCLUSIONS: The results suggest that anger expression might play a more predominant role in depression and somatic symptoms of depressive disorder patients than anger suppression, but only anger suppression might be associated with depression and somatic symptoms of somatoform disorder patients. In addition, incomplete anger suppression followed by anger expression is likely to be associated with depression and somatic symptoms in depressive disorders.

Adult↗

PubMedDate not supplied

Anger expression and ambulatory blood pressure: a comparison of state and trait measures.

OBJECTIVES: The goals of this study were (1) to compare trait and state measures of anger expression, (2) to examine associations between situational variables and anger expression, and (3) to examine relationships between trait and state anger expression and ambulatory blood pressure. METHODS: One hundred college students completed state and trait versions,of the Spielberger (1) anger expression scale. State measures were completed in response to specific anger-provoking situations as they occurred over a 7-day period. Ambulatory blood pressure was recorded on one of these days. RESULTS: Moderate correlations were observed between trait and state anger expression. Significant associations were found between a number of situational variables and state anger expression scales. Neither trait nor state anger expressions scales were related to blood pressure levels. CONCLUSIONS: These results indicate that trait and state measures of anger expression are not equivalent and that situational factors play an important role in anger expression. Situational variability may be an important factor in determining the health consequences of anger expression.

Adaptation, Psychological↗

PubMed2001

Assessment of mode of anger expression in adolescent psychiatric inpatients.

Anger can play an important role in depression and suicide risk among adolescents. The present study evaluated internalized and externalized anger in 92 adolescent psychiatric inpatients. Results indicated that adolescents who internalized their anger were more likely to be depressed and to experience feelings of hopelessness. In addition, adolescents who internalized their anger made more serious suicide attempts than did those who externalized their anger. In contrast, adolescents who externalized their anger were more likely to have alcohol-related problems. Thus, different modes of anger expression appear to be related to different manifestations of psychopathology. It was concluded that assessment of mode of anger expression in adolescents may enhance our understanding of suicide and its risk factors.

Adolescent↗

PubMedDate not supplied

Anger expression and risk of stroke and coronary heart disease among male health professionals.

OBJECTIVE: Anger expression is a dimension of anger that may be strongly related to coronary heart disease and stroke. To date few cohort studies have evaluated the role of anger coping style in the development of cardiovascular disease. This study prospectively examined the effects of anger expression on incidence of cardiovascular disease. METHODS: Participants were male health professionals (N = 23,522), aged 50 to 85 years old and without previous cardiovascular disease, who responded to a mailed questionnaire incorporating the Spielberger Anger-Out Expression Scale in 1996. The cohort was followed for 2 years (1996-1998). RESULTS: Men with moderate levels of anger expression had a reduced risk of nonfatal myocardial infarction compared with those with lower levels of expression (relative risk: 0.56; 95% confidence interval: 0.32-0.97), controlling for coronary risk factors, health behaviors, use of psychotropic medication, employment status, and social integration. Anger expression was also inversely associated with risk of stroke. The multivariate relative risk of stroke was 0.42 (95% confidence interval: 0.20-0.88), comparing men with higher anger-out scores to men with lower scores. A protective dose-response relationship was observed between anger-out score and risk of stroke (p for multivariate trend test: 0.04). CONCLUSIONS: Among this cohort of older men with high socioeconomic status and relatively low level of anger expression on average, moderate anger expression seemed to be protective against cardiovascular disease over a limited follow-up period.

Adaptation, Psychological↗

PubMed1997

Factor structure of the State-Trait Anger Expression Inventory.

The assessment of anger has received increased attention because of growing evidence that anger and hostility are related to heart disease. Research on anger assessment has also been stimulated by the development of psychometric measures for evaluating different facets of anger, such as the State-Trait Anger Expression Inventory (STAXI). In this study, factor analyses of the responses of a large sample of university students to the 44 STAXI items identified 7 factors. Of these, the first 6 factors closely corresponded with the 6 STAXI scales and subscales: State Anger (S-Anger); Trait Anger Temperament and Reaction; and Anger-In, Anger-Out, and Anger-Control. All 10 STAXI S-Anger items had salient loadings on the 1st factor for both sexes; the 7th factor also consisted primarily of S-Anger items. Factor analyses of responses to the 10 S-Anger items clearly confirmed two S-Anger factors for both sexes: Feeling Angry (e.g., "I am furious") and Feel Like Expressing Anger (e.g., "I feel like hitting someone").

Adult↗

PubMed2006

Differences in trait anger among children with varying levels of anger expression patterns.

PROBLEM: Little research has been done with children to determine effects of using various patterns of anger expression on trait anger. The purpose was to examine differences in trait anger of children who indicated high, moderate, or low use of three patterns of anger expression. METHODS: A convenience sample of 1,060 third through sixth graders completed trait anger and patterns of expressing anger instruments. FINDINGS: High users of anger-out (anger expressed outwardly) had the highest trait anger for every grade while high users of anger-reflection/control had the lowest. CONCLUSIONS: Anger-reflection/control may be more effective than anger-out in reducing trait anger in school-age children.

Adaptation, Psychological↗

PubMed1999

Anger expression and incident stroke: prospective evidence from the Kuopio ischemic heart disease study.

BACKGROUND AND PURPOSE: High levels of anger are associated with an increased risk of coronary heart disease and hypertension, but little is known about the role of anger in stroke risk. METHODS: Anger expression style and risk of incident stroke were examined in 2074 men (mean age, 53.0+/-5.2 years) from a population-based, longitudinal study of risk factors for ischemic heart disease and related outcomes in eastern Finland. Self-reported style of anger expression was assessed by questionnaire at baseline. Linkage to the FINMONICA stroke and national hospital discharge registers identified 64 first strokes (50 ischemic) through 1996. Average follow-up time was 8.3+/-0.9 (mean+/-SD) years. RESULTS: Men who reported the highest level of expressed anger were at twice the risk of stroke (relative hazard, 2.03; 95% CI, 1.05 to 3.94) of men who reported the lowest level of anger, after adjustments for age, resting blood pressure, smoking, alcohol consumption, body mass index, low-density and high-density lipoprotein cholesterol, fibrinogen, socioeconomic status, history of diabetes, and use of antihypertensive medications. Additional analysis showed that these associations were evident only in men with a history of ischemic heart disease (n=481), among whom high levels of outwardly expressed anger (high anger-out) predicted >6-fold increased risk of stroke after risk factor adjustment (relative hazard, 6.87; 95% CI, 1.50 to 31.4). Suppressed anger (anger-in) and controlled anger (anger-control) were not consistently related to stroke risk. CONCLUSIONS: This is the first population-based study to show a significant relationship between high levels of expressed anger and incident stroke. Additional research is necessary to explore the mechanisms that underlie this association.

Anger↗

PubMed2006

[Association of anger expression patterns and health status in health care workers].

PURPOSE: The purpose of this study was to examine anger-expression patterns and their association with state and trait anger and physical and psychological health status in health care workers. METHOD: Four hundred and forty eight nurses, physicians and technicians from a large medical center completed standardized questionnaires of anger, anger-expression patterns and mood. They also had blood pressure, cholesterol, blood glucose and body mass index measured during their annual physical examinations. Data was analyzed using descriptive statistics, independent t-test, chi-square and ANOVA. RESULTS: Subjects showed two major clusters of anger-expression patterns: anger-control and anger-in/out. Subjects with the anger-in/out pattern reported higher state and trait anger and more anxiety, depression and fatigue than subjects with the anger-control pattern. Physical health indicators, however, were not significantly different between the two clusters of anger-expression patterns. CONCLUSION: Anger-expression patterns are associated with psychological health status but not with physical health status. Anger-expression patterns, however, need to be examined over time to assess their long-term effects on the physical and psychological health status in future studies.

Adult↗

PubMed2002

The relation of anger expression with blood pressure levels and hypertension in rural and urban Japanese communities.

OBJECTIVE: To examine the relation of anger expression with blood pressure and hypertension among Japanese. DESIGN: A cross-sectional study. METHODS: Subjects were 4374 men and women aged 30-74 years from rural and urban communities. Anger expression was estimated using the anger-out and anger-in scores of the Spielberger Anger Expression Scale. Multiple linear regression analyses were performed to estimate the associations of anger expression scores with blood pressure. Proportions of hypertensives among the tertiles of anger expression scores and the relative odds of hypertension for low versus high tertiles of anger expression scales were calculated using logistic regression models. RESULTS: The anger-out score was inversely associated with systolic and diastolic blood pressure levels for men; a four-point (one standard deviation) lower anger-out score was associated with 1.6 mmHg [95% confidence interval (CI), 0.6-2.6] greater systolic blood pressure and 0.6 mmHg (95% CI, -0.03 to 1.2) greater diastolic pressure after adjustment for age, body mass index, alcohol intake, smoking category, and parental history of hypertension. The adjusted relative odds of hypertension for low versus high tertiles of anger-out was 1.60 (95% CI, 1.19-2.15). These inverse associations were more evident among men with low coping behavior than among those with high coping behavior. For women, the anger-out score was not associated with blood pressure. There was no relation between the anger-in score and either blood pressure or hypertension in either men or women. CONCLUSIONS: This study suggests that Japanese men who do not express their anger, especially when they have low coping behavior, may have an increased risk of high blood pressure.

Adult↗

PubMedDate not supplied

Anger expression, age, and blood pressure in modernizing Samoan adults.

OBJECTIVE: Relationships among anger expression, age, and blood pressure (BP) were studied in a cross-sectional sample of 593 American and Western Samoan adult men and women, 25 to 55 years of age. Prior studies indicated that anger coping is an important psychosocial domain in modernizing Samoans. METHODS: Anger expression was assessed using a modified 24-item version of the State-Trait Anxiety Inventory composed of anger-in, anger-out, and anger-control, along with 4 Samoan culture-specific anger items. Age and sex stratified analyses were performed. Body-mass adjusted BP was regressed on the anger expression subscales and age. RESULTS: In women < or = 40 years of age, anger-out was significantly (p < 0.01) and negatively related to adjusted diastolic BP. Young women from American and Western Samoa who outwardly expressed anger least frequently had higher adjusted diastolic BP. CONCLUSION: The significant influence of anger expression on BP in young modernizing Samoan women may be because: a) increased stress from the interaction of traditional gender role-related domestic demands and more opportunities for individual socioeconomic activities; and b) the culturally normative pattern of suppressed emotional expression.

Adult↗

PubMed2001

Anger expression and hypertension in transit workers.

One hypothesis in the literature on anger and hypertension is that a chronic tendency to suppress anger is an etiological factor in the development of hypertension. The present study assessed the relationship between anger expression and hypertension in a multicultural sample of 1,407 San Francisco bus drivers. Simple and multiple regression analyses revealed no significant differences between suppressed or expressed anger and hypertension. Thus, the results of this study do not support the hypothesis that suppressed anger is an etiological factor in hypertension.

Adult↗

PubMed2000

[Japanese anger expression styles and their interpersonal influence].

The purpose of the present study was to investigate Japanese anger expression styles and their influence on interpersonal relationships. In the initial study, 239 undergraduates were asked to complete a questionnaire which assessed seven distinct anger expression styles. The results indicated that the participants most often employed three anger expression styles including hyojo-kucho (nonverbal), tohmawashi (implicit), and itsumodori (none). In the second study, 162 undergraduates were asked to watch these three anger expression styles portrayed on videotape. Participants rated the degree to which the actor in the videotape felt angry and their impressions toward male or female actors in either higher, lower, or equal status, same-sex situations. The findings indicated that the effect on interpersonal relationships varied across the three different expression styles. This study has important implications for understanding Japanese anger expression in interpersonal, and perhaps cross-cultural, relationships.

Adult↗

PubMed2005

[The relation of trait anger and anger expression to cardiovascular responses and depression in middle-aged Korean women].

PURPOSE: This study was designed to examine the relation of trait anger and anger expression to blood pressure, cholesterol, and depression in middle-aged Korean women. METHODS: This descriptive correlational design was conducted using a convenient sample taken from the health center of K University Hospital located in Kyungki province, Korea. The subjects were 252 women aged 40 to 64 years. Spielberger's state trait anger expression inventory--Korean version and Beck's depression inventory were used for measuring trait anger, state anger, anger expression and depression. Data was analyzed by descriptive statistics, t-test, Pearson correlation, two-way ANOVA, and cluster analysis using a pc-SAS program. RESULTS: The anger expression types by cluster analysis were Anger out/in type, Low anger expression type, and Anger control type. The level of cholesterol and depression were significantly higher in women with high anger in and high trait anger. In addition, the level of depression was significantly higher in women with a high anger temperament. CONCLUSIONS: Trait anger and anger in might be related to cholesterol and depression in women. However, this study does not reveal the relation between blood pressure and trait anger and anger expression.

Adult↗

PubMedDate not supplied

Anger expression, body fat, and blood pressure in adolescents: Project HeartBeat!

This study explores the potential influence of growth, body/composition, and sexual maturity on the relation of anger expression and blood pressure in adolescents. Baseline data from Project HeartBeat! (82 boys and 85 girls, 14 years of age) examined the ability of anger expression (STAXI scale) to predict blood pressure, after controlling for the effects of ethnicity (African-American/ non-African-American), height, weight, percentage body fat, and sexual maturity. Blood pressures were unrelated to anger expression in models that included the above developmental variables. However, girls scoring high on healthy anger expression ("anger-control") had significantly lower levels of percentage body fat (P = 0.015) independent of the above factors. The literature suggests that body fat or body mass is often, though not unanimously, associated with unhealthy forms of anger expression in adolescents. Research is required into the biological, social, and behavioral origins of the association between body fat and anger expression. Height and sexual maturity, virtually ignored in this literature, should be included in future research.

Adolescent↗