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Domain-specific anger expression and blood pressure in an occupational setting.

OBJECTIVE: The purpose of the present study was to extend a previous work in a sample of American undergraduates demonstrating the effects of situational factors on reported anger expression behavior and blood pressure. METHOD: General and domain-specific anger expression behavior and subjective work stress were assessed in 218 nurses from the Frankfurt am Main metropolitan area using the original and three altered versions of the State Trait Anger Expression Inventory (STAXI) and the Job Stress Survey (JSS). The altered versions of the STAXI asked for individuals' anger expression at home, during free time, and at work. Blood pressure and heart rate (HR) were measured in the field during working breaks. RESULTS: Women had higher scores on anger-out and lower on anger-control in the original and in the home version of the STAXI, but no sex difference was found in the work version. Participants scoring high on anger-out at work displayed elevated blood pressures and HR compared with those scoring low on this scale. High job stress was associated with greater reports of anger-in and anger-out behavior. CONCLUSION: The results suggest that the way people express stress at their work place might be an important factor in determining the impact of experienced stress on cardiovascular health.

Adaptation, Psychological↗

A Russian version of the State-Trait Anger Expression Inventory: preliminary data.

Spielberger's (1988) State-Trait Anger Expression Inventory represents a conceptual advance over previous anger measures. It measures both immediate anger experiences and longer term dispositions to experience anger, as well as modes of anger expression. In American samples, the inventory has been shown to be both internally consistent and conceptually valid. This study presents initial data on a Russian version of the inventory. Our subjects were 120 students from St. Petersburg University and 31 psychiatric patients from the St. Petersburg Top Security Hospital. The results provide initial support for Spielberger's factorial model of anger in a Russian sample. All of the scales, with the exception of Anger-In, showed good alpha coefficients, and the means were generally similar to those found in American subgroups. Russian men scored higher on Anger-Out than did Russian women. Determination of subgroup norms in larger samples will allow us to explore further the cross-national similarity of anger in Russia and America.

Anger↗

Hostility and anger expression in African American and European American men is associated with cardiovascular and lipid reactivity.

Physiological stress reactivity has been examined with respect to cynical hostility and anger expression, but primarily among Caucasians. Investigations of African Americans are far fewer and have focused only on the cardiovascular system. This study compared the relationships between hostility and anger expression on the one hand, and both cardiovascular and lipid reactivity on the other, among African Americans and European Americans. Forty-six men participated in a study examining cardiovascular and lipid reactivity to a speech stressor. African American men low in cynical hostility had greater blood pressure reactivity to the stressor; this effect appeared to be due primarily to low cynical men with high Anger In. Independent of ethnicity, those with a general tendency to either always express or always inhibit the expression of anger had higher triglyceride reactivity, relative to those with a more flexible style of anger expression. These results suggest that it is important to examine ethnicity in relationship to measures of hostility and anger expression, to uncover vulnerable individuals.

Adolescent↗

Anger expression and pain: an overview of findings and possible mechanisms.

A tendency to manage anger via direct expression (anger-out) is increasingly recognized as influencing responses to pain. Elevated trait anger-out is associated with increased responsiveness to acute experimental and clinical pain stimuli, and is generally related to elevated chronic pain intensity in individuals with diverse pain conditions. Possible mechanisms for these links are explored, including negative affect, psychodynamics, central adipose tissue, symptom specific muscle reactivity, endogenous opioid dysfunction, and genetics. The opioid dysfunction hypothesis has some experimental support, and simultaneously can account for anger-out's effects on both acute and chronic pain. Factors which may moderate the anger-out/pain link are described, including narcotic use, gender, and genetic polymorphisms. Pain exacerbating effects of trait anger-out are contrasted with the apparent pain inhibitory effects of behavioral anger expression exhibited in anger-provoking contexts. Conceptual issues related to the state versus trait effects of expressive anger regulation are discussed.

Acute Disease↗

Anger expression and blood pressure in adolescents.

The clinical significance of childhood hypertension is important as elevated pressures during childhood are found to follow a progressively increasing track into adulthood. Little work has been done to examine the relationship of emotions and emotional behavioral factors to the development of hypertension in children. Using the Roy Adaptation Model as a guide, this study investigated the relationship of anger expression and blood pressure (BP) among adolescents 16-18 years of age. Participants were 63 urban high school seniors. Measurements included the Anger Expression Inventory, a Demographic Questionnaire, and measures of systolic and diastolic blood pressure. Analysis revealed significant positive relationships between anger expression with blood pressure, and a significant inverse relationship between blood pressure and the control of anger for girls. No significant relationships between anger expression and blood pressure were noted for boys. The majority of students (53%) were found to have high normal or hypertensive blood pressure readings, putting them at increased cardiovascular risk.

Adaptation, Psychological↗

Factor structure of the Spielberger Anger Expression scales when used with Australian prisoners.

The State-Trait Anger Expression Inventory administered to prison inmates has supported the factor structure of the three anger expression scales although this structure has not been verified with Australian participants. Data collected from 397 Western Australian male prisoners produced a factor structure consistent with the scale structure outlined in the 1991 manual. Scale means and standard deviations were similar to those reported for U.S. and Canadian prisoners. It is therefore appropriate to use the standard scoring procedures with Australian male prisoners.

Adolescent↗

[Anger expressive behaviors and its inhibitory factors in Japanese junior high school students: from the aspect to narcissism and norms].

This study investigated inhibitory factors in anger expressive behaviors among Japanese junior high school students. It also examined the relations between anger experiences and personality traits: verbal expression and narcissism. The result indicated that the factors of "friend relationships" and "cost-reward consciousness" were selected as those which inhibited anger expressive behaviors. Results of a covariance structure analysis were as follows. First, narcissistic personality elicited feelings of anger and depression and cognitions of inflating and calming, which all facilitated aggressive behavior, social sharing, and object-displacement as anger expressive behaviors. Second, verbal expression elicited cognitions of objectifying and self-reproaching, and the former inhibited anger expressive behaviors, though the latter facilitated them. Finally, "cost-reward consciousness" inhibited anger expressive behaviors for boys, while "normative consciousness" inhibited them for girls.

Adolescent↗

Job strain and anger expression predict early morning elevations in salivary cortisol.

OBJECTIVE: The objectives of this study were to test the hypothesis that high job demands and low job control (job strain) are associated with elevated free cortisol levels early in the working day and with reduced variability across the day and to evaluate the contribution of anger expression to this pattern. METHODS: One hundred five school teachers (41 men and 64 women) classified 12 months earlier as high (N = 48) or low (N = 57) in job strain according to the demand/control model sampled saliva at 2-hour intervals from 8:00 to 8:30 hours to 22:00 to 22:30 hours on a working day. Anger expression was assessed with the Speilberger State-Trait Anger Expression Inventory, and negative affect was also measured. RESULTS: Free cortisol was significantly elevated at 8:00 to 8:30 hours in the high job strain group but not at later times of the day or evening. After adjustment for age and negative affect, cortisol was an average of 21.7% higher early in the working day in the high job strain group. This effect was significantly greater in high job strain teachers, who also reported high anger-out. The cortisol decline from morning to evening was greater in the high than low job strain individuals. Independently of job strain, women had a higher cortisol concentration at 8:00 to 8:30 hours than men, whereas cortisol concentration was greater in men than women in the middle of the working day between 12:00 and 16:30 hours. CONCLUSIONS: Job strain is associated with elevated free cortisol concentrations early in the working day but not with reduced cortisol variability. The interaction with outward anger expression suggests that individual characteristics modulate the impact of chronic work stress on the hypothalamic-pituitary-adrenocortical system.

Adult↗

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↗

Peer and family influences on adolescent anger expression and the acceptance of cross-gender aggression.

Past research has examined the relative impact of family and peers on adolescent behavior, but very little research has examined it in relation to youth dating violence. Eight hundred and sixty-five adolescents, primarily urban Latino youth, completed self-administered surveys at school. Multivariate analyses indicated that exposure to prior family violence was not significantly associated with adolescents' aggressive expression of anger or their acceptance of cross-gender aggression. However, current conflict--either family or peer--was associated with adolescent behavior and attitudes, with the exception that current peer conflict was not significantly associated with adolescents' acceptance of male on female aggression. Parental monitoring and attachment were not found to be moderators of these relationships. Implications for dating violence interventions and future directions for research are explored.

Adolescent↗

Anger expression and lifestyle incongruity interactions on blood pressure in Samoan adults.

Prior research on psychosocial stress and blood pressure (BP) in adult Samoans identified the separate influences of lifestyle incongruity and anger expression within the context of societal modernization. The objective of this cross-sectional study was to determine the interactions between lifestyle incongruity and anger expression on BP in 376 men and women 25-65 years of age from Samoa. Participants were randomly selected from nine villages. Body mass index (BMI) and BP were measured by standard techniques. Anger expression was measured with an adapted version of the Spielberger Inventory. Material lifestyle was assessed by inventory of household items, exposure to news media, and off-island travel. Occupation and education lifestyle incongruities were calculated by subtracting the standardized lifestyle scale from the standardized occupation and education scales, respectively. Two-factor analysis of variance models with interactions were estimated within specific subgroups, with age- and BMI-adjusted BP as outcomes. In women <40 years of age with a material lifestyle relatively lower than their educational rank, anger suppression is associated with higher adjusted systolic BP. In young men whose material lifestyle is relatively lower than their occupational rank, those who report frequent experiences of Samoan culture-specific anger feelings have higher adjusted diastolic BP. We hypothesize that among young women, the higher BP may be due to stress arising from both a normative proscription against emotional expression, and a mismatch between their relatively higher educational level and lower material lifestyle. For young men, higher BP levels may be attributed to expected donations of earnings to the extended family that exceed their own material lifestyle, in combination with more frequent Samoan-specific feelings of anger.

Adolescent↗

Anger expression and cardiovascular reactivity to mental stress: a spectral analysis approach.

The cardiovascular reactivation to a recently described videogame task i.e. a maze test was evaluated in the time and frequency-domain using finger blood pressure (BP) measurement in 25 subjects on no medication, including 6 subjects with mild hypertension. Prior to BP measures subjects completed the items of the State-Trait Anger Expression Inventory questionnaire corresponding to the trait anger and anger expression scales. The BP recording session was divided into resting, test and recovery periods. A detrending procedure was applied to each recording prior to the fast Fourier transform. Systolic BP (SBP) and heart rate (HR) were increased during the test. The mid-frequency (MF, 0.1 Hz) components of SBP and HR variability were also elevated during the stressful period. In resting conditions SBP levels of subjects with low trait anger was lower than in subjects with high trait anger (128 +/- 4 mmHg, n = 14 versus 148 +/- 4 mmHg, n = 11, P < 0.01, Student t test). Nevertheless the average SBP increase due to the stress was of similar magnitude in these two subgroups (14 mmHg). A significant negative relationship was observed between anger-out expression score and the MF SBP variation (r = 0.46, P < 0.05). A significant negative relation was found between anger-in mode of expression and the HR peak during the test (r = 0.43, P < 0.05). In conclusion, our data suggest that individuals who are often in anger-provoking situations (high trait anger) should have heightened BP. Two different patterns of cardiovascular responses (SBP variability and HR levels) were observed for the outward and inward mode of expression of anger. This may reflect a different psychological control of HR levels and BP variability.

Adult↗

Effectiveness of the anger-control program in reducing anger expression in patients with schizophrenia.

The purpose of this study was to evaluate the anger control program in reducing anger expression in patients with schizophrenia. The study had an interrupted time series with nonequivalent comparison group design. Data were collected before the intervention, at the end of the 5th and 10th group sessions, and 2 weeks after the 10th (or last) session. A total of 78 patients were assigned to experimental (the anger control program) or comparison groups. The Generalized Estimating Equation (GEE) was used to analyze the longitudinal data. The program was found to reduce anger expression in patients with schizophrenia effectively and to increase their anger control ability.

Adaptation, Psychological↗

Anger expression and lipid concentrations.

We used 2 different strategies to examine the relation between anger expression and lipid concentrations in 116 middle-aged men. Using the common analytic method used in the literature, the group crossing approach, we examined whether Anger-In. Anger-Out, and their interaction were related to lipids. Regression analyses revealed that Anger-In and Anger-Out were marginally related to total cholesterol. These associations disappeared after controlling for hostility, anger, and anxiety. Using a new intraindividual difference approach, we determined individuals' relative dominance of Anger-In and Anger-Out and examined linear and quadratic associations with lipids. Regression analyses revealed the quadratic was related to both total cholesterol and low-density lipoprotein-cholesterol (LDL-c), indicating that individuals who almost always express their anger or almost never express their anger had both elevated total cholesterol and LDL-c. The curvilinear association with total cholesterol persisted even after controlling for hostility, anger, and anxiety.

Journal Article↗

[A correlational study among perceived stress, anger expression, and depression in cancer patients].

PURPOSE: This study was to identify the relationship between perceived stress, anger expression, and level of depression in cancer patients. METHOD: A cross-sectional descriptive study design was used. Data was collected by questionnaires from 185 in- and out-patients who were diagnosed with cancer at 3 university hospitals and the National Cancer Center using Spielberger et al.'s Anger Expression Scale, Cohen, Kamarch & Mermelstein's Perceived Stress, and Derogatise's SCL-90. The data was analyzed using descriptive statistics, Pearson correlation coefficient, and stepwise multiple regression with SAS/PC. RESULT: The perceived stress in cancer patients indicated a significant positive correlation to anger-in(r=.288, p=.000), anger-out(r=.232, p=.001), and depression(r=.68, p=.000), but no significant correlation to anger-control. The anger-in of cancer patients showed a significant positive relationship to anger-out(r=.53, p=.000), and depression(r=.383, p=.000), but no significant correlation to anger-control. Anger-out showed a significantly negative correlation to anger-control(r=-.248, p=.001) and a positive correlation to depression(r=.240, p=.001). The most significant predictor which influenced depression in cancer patients was perceived stress, followed by anger-in and hobby, and these factors explained their depression with a variance of 54%. CONCLUSION: These results suggested that cancer patients with a high degree of perceived stress are likely to be high in anger-out and anger-in. Perceived stress and anger-in are major factors which affect depression in cancer patients.

Adult↗

Anger experience, styles of anger expression, sadistic personality disorder, and psychopathy in juvenile sexual homicide offenders.

Sexual homicide by juveniles is a rare phenomenon, and information regarding the psychological and behavioral characteristics of this group is limited. No studies exist which have investigated anger experience and styles of anger expression, and the relationship between anger, sadistic personality disorder, and psychopathy, in this type of youthful offender. These areas were explored by evaluating 14 juvenile sexual homicide offenders through clinical assessment, the State-Trait Anger Expression Inventory (STAXI), the Schedule for Nonadaptive and Adaptive Personality (SNAP), the Revised Psychopathy Checklist (PCL-R), and review of correctional records. Descriptive information for the STAXI scales and internal consistency data are presented. Trait Anger was significantly higher than State Anger for the youth, but still comparable to adolescent norms. The difference between Anger-In and Anger-Out scale scores was not significant. Unexpectedly, Anger Control scale scores were significantly higher than Anger Out scale scores, clinically consistent with efforts by some of these boys to resist sadistic impulses. Those four (31%) participants who met criteria for sadistic personality had significantly higher Anger-Out scale scores than those without the disorder, and were also higher on Trait Anger to a marginally significant degree. Psychopathy was significantly negatively associated with Anger Control. This study is intended to contribute to the scant literature on juvenile sexual homicide, and lends some support to the validity and utility of sadistic personality disorder as a diagnosis in younger forensic populations. The findings did not support the contention that this form of violence is necessarily an outgrowth of excessive anger.

Adolescent↗

Differences in anger expression between individuals with and without headache after controlling for depression and anxiety.

OBJECTIVE: To evaluate whether anger and anger expression are different between persons with and without headache after controlling for depression and anxiety. BACKGROUND: Persons with headache may experience more problems with anger and its expression when compared with persons without headache. It is important to establish whether differences exist for persons with and without headache on trait anger and anger expression independent of depression and anxiety. To date, however, this issue has received little attention in the empirical literature. The current study measured trait anger, anger-in, hostility, anxiety, and depression among persons with and without headache, and evaluated whether trait anger and anger-in differentiated groups independent of depression and anxiety. METHODS: Participants were 422 adults recruited from a larger study within a university setting. Of those, 171 suffered from headache (mean age, 21 years; 81% were female; 69% were white; mean years with pain, 7.53). Another 251 sex-matched individuals (mean age, 21 years; 81% female; 62% white) met criteria for the headache-free group. Participants provided information regarding their headache characteristics and were administered affective trait measures (Trait version of the State-Trait Anxiety Inventory, Brief Symptom Inventory-Depression), trait anger measures (Trait Anger Scale, Cook-Medley Hostility Scale), and a measure of the extent to which individuals hold their anger in. RESULTS: Multivariate analysis of variance revealed significant differences between the 2 groups (Wilks lambda =.86, P <.001, eta2 =.14). Step-down analysis revealed that even after controlling for all other variables, those in the headache group had higher levels of anger-in (P <.001, eta2 =.08; mean, 18.98 versus 15.68). Trait anger and hostility did not differ between groups after controlling for depression and anxiety. Logistic regression revealed that anger-in contributed most to predicting headache status (P <.001; partial r =.23). CONCLUSIONS: The current findings indicate that persons with headache hold their anger in more than those without headache even after controlling for levels of trait anger, depression, and anxiety. However, after controlling for depression and anxiety, individuals no longer differed on trait anger. Also, anger-in was the strongest predictor of headache. The current findings suggest that holding anger in is more common among headache sufferers. Given recent findings regarding the negative effect of holding anger in among persons with pain conditions, this may be an important factor to evaluate when considering psychological/emotional factors affecting headache.

Adult↗

Response styles in the assessment of anger expression.

This study demonstrates how mixture distribution item response models can be used to detect different response styles in the clinical assessment of anger expression. Analyses of 3 subscales of the State-Trait Anger Expression Inventory in a clinical sample of 4,497 patients revealed that there are different response styles that manifest themselves in 2- and 3-class solutions. These solutions are robust across subsamples. Response styles reflect both psychologically meaningful biases (i.e., social desirability) and nonmeaningful response category preferences. Person parameters that correct for class membership (and thus, for response styles) are computed and compared with raw scores. The implications of these results for research on clinical assessment are discussed.

Affect↗