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Cynicism, hostility, and suicidal ideation in depressed outpatients.

Differences between depressed patients with and without suicidal ideation were examined, focusing on anger, aggression, and hostility. The Adult Suicide Ideation Questionnaire was used to compare 42 outpatients with major depression in relationship to measures of anger, aggression, hostility, cynicism, life events, and depression. There were no differences on measures of anger, aggression, hostility, and on most measures of severity of depression, but the suicidal group demonstrated more evidence of cynicism. Suicidal ideation is associated with cynicism but is unrelated to measures of hostility, anger, or aggression or to severity of depression in outpatients.

Adult↗

Components of Type A, hostility, and anger-in: relationship to angiographic findings.

Previous research has linked the Type A coronary-prone behavior pattern to angiographically documented severity of coronary atherosclerosis (CAD). The present study sought through component scoring of the Type A Structured Interview (SI) to determine what elements of the multidimensional Type A pattern are related to coronary disease severity in a selected group of patients with minimal or severe CAD. Multivariate analyses controlling for the major risk factors showed no relationship between global Type A and extent of disease. Of all attributes measured, only Potential for Hostility and Anger-In were significantly and positively associated with the disease severity, including angina symptoms and number of myocardial infarctions. Further analysis revealed that Potential for Hostility and Anger-In were interactive in their association, such that Potential for Hostility was associated with disease endpoints only for patients who were high on the Anger-In dimension. These findings support previous research in suggesting that anger and hostility may be the critical aspects of the Type A pattern in predisposing individuals to risk of CAD.

Anger↗

Biobehavioral basis of coronary-prone behavior in middle-age men. Part II: Serum cholesterol, the Type A behavior pattern, and hostility as interactive modulators of physiological reactivity.

Prior research suggests that the Type A behavior pattern, Cook and Medley Hostility (Ho) scores, and Total Serum Cholesterol (TSC) are positively associated with physiological changes to behavioral stressors. The objective of the present study was to determine whether TSC interacts with the Type A behavior pattern and hostility to affect cardiovascular and neurohormonal responses to a mental arithmetic task (MATH). For Type A individuals, elevated TSC was associated with larger catecholamine and cortisol responses to MATH. In contrast, for Type B subjects, cholesterol was negatively associated with neurohormonal responses. The interaction between Ho score and TSC predicted a similar pattern of responses whereby, in high hostile men only, TSC was positively associated with MATH-induced changes in catecholamines and heart rate. While the mechanisms responsible for the differences in the lipid-reactivity association as a function of coronary-prone behavior measures remain to be elucidated, this differential association may play a role in the heightened risk of coronary disease among hostile Type A men.

Adult↗

Effects of hostility on platelet reactivity to psychological stress in coronary heart disease patients and in healthy controls.

Previous studies have demonstrated a potential relationship between psychological stress and platelet activation, which may serve as a link between stress and myocardial infarction (MI). However, the possibility that personality traits associated with coronary heart disease may affect platelet activation has not been adequately investigated. The effect of a laboratory stressor (Type A Structured Interview (SI) and speech task) on platelet activation was assessed in 14 stable post-MI patients and 15 age-matched healthy men, using a standardized method of measuring plasma beta-thromboglobulin (BTG) levels. BTG levels were increased after the stressor (average change = 2.0 ng/ml, p = .005). Increases in BTG with stress were related to higher SI ratings of Potential for Hostility (r = .53, p = .004) and Type A behavior (r = .43, p = .02) but not to Cook-Medley-rated hostility scores. Increases in norepinephrine levels and in diastolic blood pressure were nonsignificantly related to increases in BTG levels (ps < .10), whereas increases in epinephrine levels were unrelated. Despite ceasing aspirin and other platelet inhibitors for 10 days before testing, individuals taking platelet inhibitors before the study had less change in BTG with stress (p = .05). However, after statistical adjustment for this factor, SI ratings of Potential for Hostility were still strongly related to increases in BTG with stress (adjusted r = .56, p = .002). Contrary to expectations, healthy men tended to have greater change in BTG with stress than post-MI patients (p = .06). These results indicate that acute stress increases BTG levels and that hostility is related to greater platelet reactivity, independent of any long term effects of platelet inhibition.

Coronary Disease↗

Hostility is associated with increased platelet activation in coronary heart disease.

OBJECTIVE: To determine whether Potential for Hostility is related to platelet activation (PA) among patients with coronary heart disease (CHD) and healthy controls. Increased PA has been associated with adverse secondary events after myocardial infarction or coronary angioplasty. METHODS: We tested 32 CHD patients and 23 healthy men and women, aged 45 to 73 years, for PA by using whole blood flow cytometry. PA was measured in blood exiting a bleeding time wound (wound-induced platelet activation) and also in venous blood stimulated in vitro with collagen. Monoclonal antibodies were used to test for fibrinogen receptor activation and fibrinogen receptor binding. All subjects refrained from taking aspirin for at least 14 days before testing; CHD patients stopped nitrates and calcium channel blockers for 24 hours, while continuing to take lipid-lowering medications. Potential for Hostility was assessed, using the Type A Structured Interview. RESULTS: Among the CHD patients only, all four of the wound-induced fibrinogen receptor activation indicators (activation and binding) were related to hostility; the relationships were significant for receptor activation at 2 minutes, and for receptor binding at 1 minute (r values = .46, p values = .02). Subjects on lipid-lowering medications had lower PA for most measures. Healthy subjects had higher wound-induced fibrinogen receptor activation at 2 minutes and fibrinogen receptor activation in vitro than the CHD patients (p = .04), but after statistical adjustment for lipid-lowering medications, there were no significant differences between the patients and controls. CONCLUSIONS: PA was related to hostility among CHD patients, consistent with previous studies indicating a relationship between PA and psychological factors among CHD patients. However, PA was not increased in nonsmoking, nondepressed CHD patients relative to controls.

Adult↗

Are hostility and anxiety associated with carotid atherosclerosis in healthy postmenopausal women?

OBJECTIVE: In this article, we evaluated the prospective association between measures of trait anger, hostility, and anxiety and indices of carotid atherosclerosis in 200 healthy middle-aged postmenopausal women. METHODS: Starting in 1983, 541 premenopausal women were evaluated for their levels of standard cardiovascular risk factors and psychosocial attributes, including their scores on Spielberger Trait Anger, Anxiety, and Anger-in, and Public Self-Consciousness. Starting in 1991, the Cook-Medley Hostile Attitudes Scale was also administered. Starting in 1993, 200 women who had been menopausal for at least 5 years were scanned for carotid atherosclerosis using B-mode ultrasound. The scans were scored for average intima-media thickness (IMT) and plaque index. RESULTS: Women who had high Trait Anger, Anger-In, and Public Self-Consciousness scores had high IMT scores on average 10 years later. Women who had high Cook-Medley scores also had high IMT scores on average 1.5 years later. Multivariate analyses adjusting for the standard cardiovascular risk factors that most highly predicted IMT scores indicated that holding anger in, being self aware, and having hostile attitudes were significant predictors of IMT. Women with higher plaque scores also tended to report holding in their anger. CONCLUSIONS: Anger suppression and hostile attitudes do predict women's carotid IMT in midlife. Ultrasound measures of carotid atherosclerosis can be used to advance our understanding of the early development of atherosclerosis in women.

Adult↗

Social support and hostility as predictors of depressive symptoms in cardiac patients one month after hospitalization: a prospective study.

OBJECTIVE: Hospitalization for cardiac disease is associated with an increased risk for depression, which itself confers a poorer prognosis. Few prospective studies have examined the determinants of depression after hospitalization in cardiac patients, and even fewer have examined depression within the weeks after hospital discharge. The present study assessed the prospective relations among perceptions of social support and trait hostility in predicting symptoms of depressive symptoms at 1 month after hospitalization for a diagnostic angiography in 506 coronary artery disease (CAD) patients. METHOD: A series of structural equation models 1) estimated the predictive relations of social support, hostility, and depressive symptoms while in the hospital to symptoms of depression 1 month after hospitalization, and 2) compared these relations across gender, predicted risk classification, and age. RESULTS: Social support assessed during hospitalization was independently negatively associated with depressive symptoms 1 month after hospitalization, after controlling for baseline symptoms of depression, gender, disease severity, and age. Hostility was an indirect predictor of postdischarge depressive symptomology by way of its negative relation with social support. This pattern of relations did not differ across gender, predicted risk classification, and age. CONCLUSIONS: Our findings suggest that a patient's perceived social support during hospitalization is a determinant of depressive symptoms 1 month later. The relation of social support and hostility to subsequent depressive symptoms was similar across a variety of populations.

Adult↗

Joint effect of hostility and severity of depressive symptoms on plasma interleukin-6 concentration.

OBJECTIVE: Although interleukin (IL)-6 plays a significant role in cardiovascular disease, little is known about its relation to psychological risk factors, such as hostility and severity of depressive symptoms. The current study examined the joint effects of severity of depressive symptoms and hostility on plasma IL-6 in a sample of 90 healthy, nonsmoking men. METHODS: After an overnight fast, blood samples for plasma IL-6 and fasting lipids were collected on the same day that the Beck Depression Inventory (BDI) and the Cook-Medley hostility (Ho) scale were administered. Plasma IL-6 was determined using enzymatic-linked immunosorbent assay (ELISA). RESULTS: Analyses of logarithmically normalized plasma IL-6 adjusting for age, body mass index (BMI), fasting total cholesterol, high density lipoprotein (HDL), and resting diastolic blood pressure (DBP) revealed a significant BDI by Ho interaction (p =.026). Post hoc decomposition revealed that Ho was correlated with log-normalized plasma IL-6 (r = 0.59, p =.025) but only among men with BDI scores of 10 and above. Alternatively, BDI was correlated with log-normalized plasma IL-6 (r = 0.61, p =.003) but only among men with Ho scores of 23 and higher. Comparisons among BDI/Ho groups indicated that men with high scores on both the BDI and the Ho exhibited the highest median levels of plasma IL-6. CONCLUSION: Hostile men who exhibited above normal levels of depressive symptoms had higher plasma levels of IL-6 suggestive of a subpopulation at increased risk for future cardiac events.

Adolescent↗

Relationships between hostility, anger expression, and blood pressure dipping in an ethnically diverse sample.

OBJECTIVE: The purpose of this study was to examine relationships between hostility, anger expression, and blood pressure (BP) dipping. METHODS: A 24-hour ambulatory BP was obtained from 34 African Americans and 52 white Americans who were enrolled in a study of sleep, stress, and BP. Self-report measures were used to assess anger expression and hostility. RESULTS: After controlling for body mass index and BP status, African Americans were more likely to be classified as nondippers than white Americans. However, when hostility and anger expression were included in the model, there was no longer a significant relationship between ethnicity and BP dipping. Irrespective of race, high levels of hostility and anger were associated with less nocturnal dipping. CONCLUSIONS: These findings suggest that psychological factors may be important in understanding ethnic differences in nocturnal BP decline.

Adult↗

Hostility and the medical student: how a trait measure influences perception of medical specialties.

This paper describes the influence of hostility as a trait on medical students' perception of medicine and its specialties. By means of Repertory Grid analysis, the authors compare the preferences of students having internally and externally directed hostility. The findings suggest that students with low levels of internal hostility are attracted to the popular image of the surgeon as a highly achieving and successful individual who is oriented towards cure. In contrast, those with high levels of internally directed hostility show an interest in specialties which allow for close human contact, particularly within general medicine. A psychological interpretation of these findings is offered.

Attitude of Health Personnel↗

Examination of anxiety, hostility and psychiatric disorders in patients with migraine and tension-type headache.

The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate anxiety, depression, hostility and psychological symptoms in patients with migraine and tension-type headache (TTH) and to compare the results with healthy controls. Seventy-five subjects with migraine and 55 subjects with TTH (according to the criteria of the International Headache Society classification) and a control group including 73 healthy subjects were studied. The Buss-Durkee Hostility Inventory, Brief Symptom Inventory, State-trait Anxiety Inventory, Trait form were administered to the subjects. Compared with healthy controls, the patients with headache had significantly higher scores on measures of anxiety, depression and hostility and lower scores on psychological symptoms. The present results indicate the need to distinguish the unique dimensions of anxiety, depression and hostility that should be assessed in the population with headaches.

Adult↗

Effects of hostility on alcohol stress-response-dampening.

The purpose of this study was to compare the stress-response-dampening (SRD) effect of alcohol in hostile and nonhostile men based on a combined score of four subscales of the Cook-Medley Hostility Scale. Subjects were 72 male social drinkers. Subjects' cardiac interbeat-interval, and systolic and diastolic blood pressure reactivity to a situational stressor were measured following the consumption of either alcohol, no alcohol, or an active placebo beverage. Results demonstrated that hostile men evinced lower heart rate and systolic blood pressure (SBP) reactivity to the stressor when given alcohol, compared with intoxicated nonhostile subjects, and lower reactivity relative to all other groups, with the exception of SBP in the nonhostile controls. These results allow for speculation that hostile men may be more likely than controls to experience possible SRD effects of alcohol and thus, perhaps, be predisposed to increased alcohol consumption when under stress.

Adult↗

Direct and indirect hostility and self-destructive behavior by hospitalized depressives.

Suicidal and other self-destructive behavior was correlated with self-report (Buss-Durkee) and observer rated (Lion Scale) measures of hostility and violence in 45 male inpatients with major depressive episodes by DSM III criteria (296.2, 296.3, 296.5). Self-destructive acts were significantly correlated with a Buss-Durkee Indirect Hostility factor. Measures of directly expressed hostility and violence correlated with seclusion and restraint for self-protection. None of the Lion or Buss-Durkee measures correlated with depression measures, nor did self-destructive acts correlate with degree of depression in these severe patients. Thus our data indicate that, in patients with moderate to severe depression, self-destructive acts in hospital may be better correlated with feelings of anger and hostility than with depression itself.

Adult↗

Hostility and deliberate self-poisoning.

Patients admitted to hospital following deliberate self-poisoning have been shown to have high levels of hostility, but the exact role of hostility in self-poisoning is not clear. It was hypothesized that those subjects with marked depression would have high intro-punitive scores whereas those deliberately poisoning themselves who did not have marked depression would have high extra-punitive scores. Seventy young adults admitted to hospital following deliberate self-poisoning completed the Hostility and Direction of Hostility Questionnaire and half of these subjects had an identifiable depressive syndrome. Very high intro-punitive scores were found in the depressed subjects but high extra-punitive scores were found in all deliberate self-poisoning subjects irrespective of depression. This suggests that extra-punitiveness might distinguish self-poisoners from other psychiatric patients. Within the self-poisoning group, high intro-punitive scores were associated with greatest suicidal intent but further studies are needed to see if these are an aspect of the depression or part of the personality.

Adolescent↗

Trait hostility and prolactin response to tryptophan enhancement/depletion.

This study investigated the relationship between trait hostility and aspects of serotonergic function by assessing the prolactin (PRL) response to acute tryptophan depletion and enhancement in 28 healthy male volunteers. Serum PRL was assessed immediately before, and 4.5 h after, administration of an amino acid drink enhanced with, or depleted of, the 5-HT precursor tryptophan. Trait hostility and DeltaPRL (value at 4.5 h minus baseline) correlated negatively following enhancement and positively following depletion, indicating that the higher the hostility the smaller the change in PRL in either direction. This is consistent with previous research reporting an association between aggression and blunted neuroendocrine responses to serotonergic agents. The results indicate the possibility that, in people high on hostility, part of the serotonergic pathway that leads to modulation of PRL release is characterised by a stage with either low capacity relative to input availability or a strong negative feedback component.

Adolescent↗

Defensiveness, cynical hostility and cardiovascular reactivity: a moderator analysis.

We examined the interaction of a defensive need for approval with cynical hostility, in the prediction of pressor and heart rate reactivity to a stressful mental arithmetic task. For both systolic blood pressure and heart rate, analyses revealed the predicted interaction between defensiveness and cynical hostility; subsequent analyses showed significant correlations of defensiveness with systolic blood pressure and heart rate reactivity only among the high cynical hostility subjects. These analyses support the theory and empirical findings linking the conflicting traits of cynical hostility and defensiveness to cardiovascular reactivity and, quite possibly, to stress-related coronary disease.

Adolescent↗

Dimensions of anger and hostility in cardiac patients, hypertensive patients, and controls.

Anger and hostility have long been considered important factors in the etiology of essential hypertension (EH) and coronary heart disease (CHD). This case-control study investigates the association of hostility, as measured by the Cook and Medley Hostility Scale (HO), and anger, as measured by the Multidimensional Anger Inventory (MAI), with CHD and EH in 80 CHD patients, 80 EH patients, and a control group of 80 healthy adults from Italy. Cases revealed significantly higher scores than controls in two subsets of HO and in two subscales of MAI. Some of these subscales appeared to be age-dependent. The results indicate that particular components of anger-hostility could be taken into consideration when studying psychological risk factors for CHD and EH.

Adult↗

Marijuana and hostility in a small-group setting.

The authors used several indices to assess the relationship between marijuana and hostility as both inner affect and verbal behavior in a small-group setting. Marijuana subjects reported a small but statistically significant decrease in hostile feelings after the introduction of a frustration stimulus. They also showed significantly less verbal hostility than placebo subjects both before and after introduction of a frustration stimulus. The authors note that research findings on marijuana and hostility are not consistent and suggest a multidetermined relationship based on dose, environment, nature of the frustration stimulus, and intraindividual factors.

Adult↗