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Components of type A, hostility, and anger-in: further relationships to angiographic findings.

In a previous study of patients undergoing angiography at Duke University Medical Center, we reported that of all components of the Type A behavior pattern (TABP), only Potential for Hostility and Anger-In were significantly associated with extent of coronary artery disease (CAD). The present study was undertaken to replicate these findings using a different patient population. Tape-recorded structured interviews from 125 angiography patients at Massachusetts General Hospital were blind scored using the component scoring system employed in the Duke study. The results confirmed our previous findings. Global TABP was completely unrelated to extent of CAD, while Potential for Hostility and Anger-In were significant independent predictors of disease severity. These findings argue for a reconceptualization of the manner in which the TABP is defined and assessed.

Adult↗

Associations of blood pressure with self-report measures of anger and hostility among black and white men and women.

This study examined associations between blood pressure (BP) and dispositional variables pertaining to anger and hostility. Black and White 25- to 44-year old male and female normotensives and unmedicated mild to moderate hypertensives completed four reliable self-report scales--the Cook-Medley Hostility (Ho) Scale, the Trait Anger subscale of the State-Trait Anger Scale (STAS-T), and the Cognitive Anger and Somatic Anger subscales of the Cognitive-Somatic Anger Scale--plus the Framingham Anger Scale and the Harburg Anger Scale. They also engaged in three laboratory tasks--Type A Structured Interview (SI), a video game, and a cold pressor task--that elicit cardiovascular reactivity. Ambulatory BP readings at home and at work were also obtained from most subjects. Blacks had significantly higher Ho and lower STAS-T scores than did Whites. Women reported higher levels of somatic anger than did men. White women showed significant positive correlations between STAS-T and systolic BP (SBP) and diastolic BP (DBP) both at rest in the laboratory and during the SI. Black women revealed significant positive relationships between STAS-T and SBP and DBP at rest in the laboratory and at work as well as with DBP during the cold pressor test. For Black men, cognitive anger and DBP at rest were positively related. In contrast, White men revealed significant negative correlations between Ho scores and SBP at rest and during the video game; these men also showed significant negative relationships between somatic anger and SBP and DBP reactivity during the cold pressor test. Women, but not men, showed significant positive relationships between all four anger measures and ambulatory BP at work. Whereas main effects relating anger and cardiovascular measures were not apparent as a function of race, Blacks demonstrated significantly greater SBP and DBP reactivity than Whites during the cold pressor test, with the converse occurring during the SI. Men demonstrated significantly greater DBP reactivity than women during the video game. The present findings indicate that self-reports on anger/hostility measures and cardiovascular responses to behavioral tasks differ as a function of race but that relationships between anger and BP regulation need to take into account possible race-sex interactions and selection of anger/hostility measures.

Adult↗

Crime, hostility, wife battering, and the heart: on the Meehan et al. (2001) failure to replicate the Gottman et al. (1995) typology.

Comments on the J. C. Meehan, A. Holtzworth-Munroe, and K. Herron (2001) failure to replicate the J. M. Gottman et al. (1995) results of 2 different types of batterers, defined by heart rate reactivity: Type 1 men lowered their heart rate from baseline to the high-conflict marital discussion, and Type 2 men increased their heart rate from baseline to the high-conflict marital discussion. Discussion is about criminality-psychopathy literature associated hypoarousal and hyporeactivity and the hostility-cardiovascular disease literature, which reports associated hyperreactivity and hostility related to cardiovascular disease. The Type 1-Type 2 distinction should be referred to these two venerable literatures. This article proposes the hypothesis that the Meehan et al. study failed to replicate Gottman et al. because it used a low-conflict marital discussion rather than the high-conflict discussion Gottman et al. used. This article reviews a study that did use a high-conflict marital task and found results generally supporting the Gottman et al. findings.

Adult↗

Reasoning about scientific evidence: effects of juror gender and evidence quality on juror decisions in a hostile work environment case.

This study examined whether participants were sensitive to variations in the quality of an experiment discussed by an expert witness and whether they used heuristic cues when evaluating the expert evidence. In the context of a hostile work environment case, different versions of the expert testimony varied the presence of heuristic cues (i.e., whether the expert's research was generally accepted or ecologically valid) and evidence quality (i.e., the construct validity of the expert's research). Men who heard expert testimony were more likely to find that the plaintiff's workplace was hostile than were men who did not hear the expert testimony; expert testimony did not influence women's liability judgments. Heuristic cues influenced participant evaluations of the expert testimony validity, but evidence quality did not. Cross-examination did not increase juror sensitivity to evidence quality. Implications for science in the legal system are discussed.

Adolescent↗

Mental activation of supportive ties, hostility, and cardiovascular reactivity to laboratory stress in young men and women.

In addition to actual social interactions, internal representations of supportive ties could affect mechanisms linking relationships and health. Undergraduates (41 men, 41 women) wrote about supportive ties or casual acquaintances. Supportive ties were rated as warmer and less controlling than acquaintances, and writing about them evoked reductions in negative affect, especially for low-hostile participants. Compared with the acquaintance condition, the supportive tie condition resulted in reduced heart rate and blood pressure response during a subsequent speech stressor. Among women, the supportive tie condition reduced blood pressure response among low- but not among high-hostile participants. Hence, mental activation of supportive ties altered effects of laboratory stress and might be relevant to the effects of social relations on health.

Adolescent↗

A quantitative analysis of the relationship between the Cook-Medley Hostility Scale and traditional coronary artery disease risk factors.

One possible explanation for the association between Cook-Medley Hostility Scale (Ho Scale; W. W. Cook & D. M. Medley, 1954) scores and premature coronary artery disease (CAD) morbidity and mortality is that hostile persons also have elevations on CAD risk factors. Meta-analyses with fixed and random-effects models were used to evaluate the relationship between Ho Scale scores and CAD risk factors in the empirical literature. Ho Scale scores were significantly related to body mass index, waist-to-hip ratio, insulin resistance, lipid ratio, triglycerides, glucose, socioeconomic status (SES), alcohol consumption, and smoking. Although there was also heterogeneity among study outcomes, the results of conservative random effects models provide confidence in the obtained relationships. On the basis of available evidence, researchers might give attention to obesity, insulin resistance, damaging health behaviors, and SES as potential contributing factors in understanding the association between Ho Scale scores and CAD.

Alcohol Drinking↗

Neighborhood cohesion as a buffer against hostile maternal parenting.

This study explored the moderating effects of children's neighborhoods on the link between hostile parenting and externalizing behavior. Participants were 1st- or 2nd-grade children in an urban northeastern community. Children were administered the Parenting and Neighborhood scales of the Child Puppet Interview, and mothers completed questionnaires on neighborhood quality and parenting practices. Census tract measures of neighborhood quality and teachers' reports of children's externalizing behavior also were obtained. Results indicated that children's and mothers' perceptions of neighborhood involvement-cohesion buffered the link between hostile parenting and externalizing problems. Children's externalizing behavior was unrelated to census tract variables. Findings highlight the protective effect of neighborhood social cohesion and the utility of including young children's perspectives in research on neighborhoods and families.

Adult↗

[The distressed personality (type D)--correlations with anger, aggression and hostility].

Type D (distressed personality) comprises the joint tendency to experience negative emotions (negative affectivity) and to inhibit these emotions in social situations (social inhibition). The distressed personality can be assessed by the Type D scale (DS14). In the present study, the German version of the DS14 was to be validated especially with regard to its interrelation with anger, aggression and hostility. The study included a clinical sample of 90 patients with coronary heart disease and a nonclinical sample of 86 participants. The two-factor structure of the DS14 could be confirmed in both samples. As expected, the subscale negative affectivity correlates highly with neuroticism; the subscale social inhibition correlates highly with extraversion. Negative affectivity also relates to almost every anger and aggression scale applied in this study. Participants classified as Type D report higher anger experience than non-Type D-classified persons. They show both heightened anger-in and anger-out and encounter others with more cynicism and hostility. It seems promising to provide special psychological treatment for these patients.

Adult↗

Adolescent blood pressure, anger expression and hostility: possible links with body fat.

An uncertain relation between health and angry/hostile behaviour exists in the literature on adolescents. With data from a pilot study, one possible reason for this is explored: health measures such as blood pressure as well as angry/hostile behaviours may change with, or depend upon physical maturity, body size and body fatness. The sample consists of 60 African-, Hispanic-, and Anglo-American adolescents (15 to 16 years of age) drawn from a public school in Houston, TX. Using resting diastolic blood pressure as a model, in a sex stratified analysis, the following conclusions were reached: Physical maturity in girls and body height in boys were related to ethnicity in the sample and were confounders of the blood pressure and anger relationship. In girls secretive anger ('anger-in') and hostility were associated with increased body fat; expressive anger ('anger-out') in boys is associated with increased conicity (central body fat distribution) (p < 0.01). These associations were independent of height and physical maturity. Hostility was not significantly related to diastolic blood pressure in boys after adjusting for height and conicity. 'Anger-in' was significantly and positively related to diastolic blood pressure in girls (p < 0.01). This relationship was strongly mediated by per cent body fat, because the association of 'anger-in' and blood pressure was no longer statistically significant when the model included body fat. The results suggest that measures of physical maturity and more refined measures of body fat and body fat distribution should be considered in studies attempting to link adolescent blood pressure with anger expression.

Adolescent↗

Hostility and the response to diuretic in mild-to-moderate hypertension.

Forty-two patients with mild-to-moderate hypertension between the ages of 35 and 65 (23 men, 19 women) were studied to determine whether psychological characteristics can help differentiate between responders and nonresponders to diuretic (hydrochlorothiazide 25 mg and triamterene 50 mg). To qualify for inclusion in the study, the subjects were required to have a mean unmedicated clinic diastolic blood pressure (DBP) between 95 and 110 mm Hg. Positive response to diuretic was defined as a reduction in clinic DBP < or = 90 mm Hg. Of the 42 subjects, 22 were responders to diuretic, achieving a BP level of 129/86 mm Hg, a reduction of 16/11 mm Hg from their unmedicated level. Nonresponders achieved a reduction of 8/4 mm Hg. Compared with nonresponders, responders were characterized by slightly lower initial BP levels and significantly lower scores on the Buss-Durkee Hostility Inventory and several subscales of this test. The pattern of results indicated higher levels of suppressed hostility in the nonresponders. Ambulatory BP data paralleled the clinic BP changes.

Adult↗

Hostile words and assaultive behavior on an acute inpatient psychiatric unit.

This report analyzes the relationship of hostile verbalizations to assaultive acts committed by 110 male schizophrenic patients on an acute psychiatric unit. It was found that patients who were verbally assaultive and threatening also tended to be physically assaultive. Assaults rarely occurred in the absence of verbal threats or abuse, and 32 per cent of violent patients could be identified on the basis of the occurrence of hostile verbalizations.

Acute Disease↗

Hostility, CHD incidence, and total mortality: a 25-year follow-up study of 255 physicians.

High levels of hostility as assessed by a MMPI scale (Ho) have been found associated with increased levels of arteriographically documented coronary atherosclerosis. In this study we examined the relationship between hostility and subsequent health status in a 25-year follow-up of 255 medical students who completed the MMPI while in medical school. High Ho scores were found to be predictive of both clinical coronary disease incidence and total mortality.

Adult↗

The role of type A behavior and hostility in an elevation of plasma lipids in adult women and men.

Hostility, Type A behavior, and plasma lipids were assessed in a community sample of 352 women and men. After the contribution of age and body mass index to the variation in plasma lipid and lipoproteins were controlled for, persons scoring high on Type A behavior as well as hostility had elevated levels of plasma and low-density lipoprotein (LDL) cholesterol. These findings were replicated in a 1-year follow-up, suggesting that psychosocial factors may have an effect on plasma lipids in typical adults living in the United States.

Adolescent↗

Cook-Medley Hostility scale and subsets: relationship to demographic and psychosocial characteristics in young adults in the CARDIA study.

This report describes the relationships between scores obtained on the Cook-Medley Hostility (Ho) scale and race, education, gender, and age in a sample of 5115 young adult participants in a prospective study of coronary heart disease (CHD) risk factors. Large differences were observed in total Ho scale scores and in six recently identified subsets according to race, education, gender, and age. Young black males with limited education had the highest Ho scale levels (mean = 26.2) while older white females with more education had the lowest levels (mean = 15.5). In all subgroups, education was inversely associated with hostility. The findings suggest a possible mechanism whereby CHD risk is higher in males than females, in the less educated than the more educated, and in blacks than whites. In all race and gender subgroups, total Ho scale scores and the six subsets were positively correlated with negative life events and negatively correlated with social support, supporting a pattern of psychosocial vulnerability found in other studies.

Adolescent↗

Cynical hostility in adult male twins.

The heritability of hostility as measured by the Cook and Medley Ho scale was assessed in an adult male sample of 60 monozygotic and 61 dizygotic twin pairs. For the total Ho scale, as well as its health predictive component, the results were consistent with a moderate genetic effect. Results are discussed in terms of genetic and environmental influences on the development of this trait, and possible genetic contributions to the association between hostility and subsequent health.

Hostility↗

Hostile behavior during marital conflict alters pituitary and adrenal hormones.

We evaluated hormonal changes and problem-solving behaviors in 90 newlywed couples who were admitted to a hospital research unit for 24 hours. The subjects were selected on the basis of stringent mental and physical health criteria, and admissions were scheduled during the follicular phase of the woman's menstrual cycle. For frequent, unobtrusive endocrine sampling during the interaction tasks, a long polyethylene tube was attached to a heparin well, allowing nurses to draw blood samples at set intervals, out of subjects' sight. Five blood samples were obtained before, during, and after a 30-minute structured problem-solving or conflict task. The conflict session was recorded on videotapes that were later scored for problem-solving behaviors using the Marital Interaction Coding System (MICS). Marital conflict and MICS-coded hostile or negative behavior during conflict was closely linked to changes in serum hormonal levels across five of the six hormones we studied, in spite of the high marital satisfaction of our newlywed couples and the healthy lifestyles demanded by our exclusion criteria. Hostile behavior was associated with decreased levels of prolactin (PRL) and increases in epinephrine (EPI), norepinephrine (NEPI), ACTH, and growth hormone (GH), but not cortisol. These data suggest that the endocrine system may be an important mediator between personal relationships and health.

Adrenocorticotropic Hormone↗

Hostility and the progression of carotid atherosclerosis.

We studied prospectively the association of hostility and anger suppression by the use of ultrasonographically assessed 2-year progression of carotid atherosclerosis (PCA) in a sample of 119 middle-aged men from eastern Finland. Based on measures of cynical distrust, impatience-irritability, anger-in, and anger-control, four variants of hostility-by-anger suppression model were tested with multiple regression analysis. In addition to the previously established risk factors (i.e., serum low-density lipoprotein cholesterol concentration, smoking, and old age), cynical distrust and anger-control significantly predicted PCA. There was about a two-fold accelerated PCA in the group with high cynical distrust and high anger-control even after we controlled for the established biological risk factors and possible confounding background variables. The impact of the independent variables on PCA seemed to be additive rather than synergistic. These results, based on a relatively small, but nonselected population sample, extend previous results of angiographic studies.

Adult↗

Effects of cynical hostility, anger out, anxiety, and defensiveness on ambulatory blood pressure in black and white college students.

This study asked whether individual differences in four personality traits (cynical hostility, anger out, anxiety, and defensiveness) would predict waking and sleeping ambulatory blood pressure and heart rate and whether information about these traits would provide a source of racial and gender differences in these measures. Ambulatory blood pressure and heart rate were recorded over a 24-hour period in 58 black and 86 white college students equally divided by gender. Waking and sleeping values were examined as a function of gender, race, and personality factors. Independent of personality factors, women had lower ambulatory blood pressure and higher heart rate than men, and black subjects had higher blood pressure levels and less of a decrease in heart rate from waking to sleeping than white subjects. The above differences were associated with personality factors. Black subjects scoring high on cynical hostility had elevated daytime and nighttime systolic pressure. Black subjects scoring high on both anxiety and defensiveness had higher waking diastolic blood pressure. Additional effects were shown for heart rate as a function of anger out, anxiety, and defensiveness. Given the special significance of ambulatory blood pressure for cardiovascular disease, these findings underscore the importance of personality factors for cardiovascular risk and their relevance for race and gender differences in this risk.

Adult↗