Hostility,Anger, and Marital Adjustment: Concurrent and Prospective Associations with Psychosocial Vulnerability

Hostility may contribute to risk for disease through psychosocial vulnerability, including the erosion of the quality of close relationships. This study examined hostility, anger, concurrent ratings of the relationship, and change in marital adjustment over 18 months in 122 married couples. Wives’ and husbands’ hostility and anger were related to concurrent ratings of marital adjustment and conflict. In prospective analyses, wives’ but not husbands’ hostility and anger were related to change in marital adjustment. In hierarchical regression and SEM models wives’ anger was a unique predictor of both wives’ and husbands’ change in marital adjustment. The association between wives’ anger and change in husbands’ marital satisfaction was mediated by husbands’ ratings of conflict in the marriage. These results support the role of hostility and anger in the development of psychosocial vulnerability, but also suggest an asymmetry in the effects of wives’ and husbands’ trait anger and hostility on marital adjustment.     

Hostility and sex differences in the magnitude, duration, and determinants of heart rate response to forehead cold pressor: Parasympathetic aspects of risk

Recent models hypothesize that hostility confers increased risk of CHD through weaker parasympathetic dampening of cardiovascular reactivity (CVR). We tested this possibility using the forehead cold pressor task, a common maneuver which elicits the “dive reflex” characterized by a reflexive decrease in HR presumably through cardiac-parasympathetic stimulation. Participants were initially chosen from the outer quartiles of a sample of 670 undergraduates screened using the hostility subscale of the Aggression Questionnaire ([Buss, A.H., Perry, M., 1992. The Aggression Questionnaire. Journal of Personality and Social Psychology, 63, 452-459.]). The final sample of 80 participants was evenly divided between men and women and high and low hostility. Following a 10-min baseline, participants underwent a 3-min forehead cold pressor task. The task evoked a significant HR deceleration that was mediated by PNS activation, as assessed by respiratory sinus arrhythmia (RSA). Replicating prior research, men displayed greater decrease in HR. More important, low hostiles maintained larger HR deceleration over time compared to high hostiles although the autonomic basis for this effect was unclear. The findings broaden understanding of hostility and sex-related cardiovascular functioning and support the task as a method for evoking PNS-cardiac stimulation.     

Coping strategies,hostility, and depressive symptoms: A path model

Previous studies of coping, hostility, and depressive symptoms have highlighted the significant relations between all possible pairs of these 3 variables. To more completely explore the nature of depressive symptoms, we link them all together in this study by testing a coping→hostility→depressive symptoms path model. One hundred forty participants completed psychological questionnaires measuring coping strategies, hostility, and depressive symptoms. While controlling age and social class as covariates, SPSS stepwise regression analyses were used to examine relations among these 3 constructs. Results suggest that coping has a direct relation with depressive symptoms as well as an indirect relation mediated by hostility. Passive coping may lead to increased hostility, resulting in depressive symptoms. Active coping may have the opposite effect. These findings suggest that the inclusion of measures of both coping strategies and hostility yields a more thorough understanding of concomitants of depressive symptoms. From a clinical perspective, knowing what coping strategies a person uses and how much anger they experience and express may be useful in guiding the management of depressive symptoms.     

Psychosocial risk factors for cardiovascular disease in women: The role of social support

Lack of social support is becoming increasingly important as a psychosocial risk factor in the study of coronary heart disease (CHD). There may also be an association between vital exhaustion and lack of social support. Because most research has focused on men, we decided to explore the associations between structural and functional social support and first myocardial infarction (MI) in women. Subjects were 79 women hospitalized with a First MI (mean age 59.3; SD = 9.3) and 90 women hospitalized with an acute surgical event (mean age 57.4: SD = 9 1). MI cases reported more vital exhaustion than did controls (p < ,040), and exhausted women reported less structural (p < .001) and functional support (p < .000). After controlling for age, hypertension, diabetes, menopausal status, smoking, nonanginal pain, and vital exhaustion, multiple logistic regression analysis showed that poor structural support was associated with an increased risk for MI. These results suggest that social support is associated with vital exhaustion, which is a well-known risk factor for CHD. Furthermore, it is suggested that women with only a few confidants are more at risk for MI even after adjustment for well-known risk factors for CHD.     

Antagonistic behavior, dominance, hostility, and coronary heart disease

PURPOSE: This study investigated the relationship between antagonistic behavior, dominance, attitudinal hostility, and coronary heart disease (CHD). METHODS: One hundred one men and 95 women referred for thallium stress testing were administered the Structured Interview and the Cook-Medley Hostility Scale. The Hostile Behavior Index, derived from the Structured Interview and developed by Haney et al., served as an index of antagonism, and the frequency with which interviewees interrupted their interviewer served as a measure of dominance. On the basis of their medical history and thallium stress test results, patients were classified as having (N = 44) or not having (N = 99) CHD. RESULTS AND CONCLUSIONS: Multivariate logistic regressions (with age, gender, disease, and lifestyle risk factors in the model) revealed that both the Hostile Behavior Index and dominance were significant independent risk factors for CHD (relative risk [RR] = 1.22 and 1.47, p < .03). Of the two Hostile Behavior Index component scores, indirect challenge and irritability, only the latter correlated significantly with CHD (RR = 1.27, p < .03). Separate logistic regressions for men and women suggest that subtle, indirect manifestations of antagonism confer CHD risk in women and that more overt expressions of anger confer risk in men. A significant univariate correlation between hostility scale scores and CHD became not significant when we adjusted for socioeconomic status.     

A psychosocial comparison of 35- and 55-year-old men and women in sweden and estonia: The swestonia cardiovascular risk factor study

During the past decade, the incidence ofcoronary heart disease (CHD) has declined in the United States and in Western Europe, but has increased in Eastern Europe and in many non-European countries. This study is a baseline comparison of psychosocial factors in a random sample of 35-year-old and 55-year-old men and women from Tartu, Estonia and Sollentuna, Sweden, who will be followed longitudinally to investigate CHD risk. One hundred men and women from each country in each age group were invited by letter to participate in a study of risk factors for CHD. Complete data were available for 279 Estonians and 272 Swedes. All participants were given the same physical examination and answered the same self-report questionnaires concerning demographics, lifestyle, and psychosocial factors. In general, Swedish men and women in both age groups rated their quality of life higher than Estonians. Self-reported health and depressive symptoms, both of which have predicted CHD risk, were also worse in Estonians than in Swedes. The psychosocial differences found here, together with the lack of major differences in traditional risk factors, reflect the results found in other East-West comparisons. Implications for CHD risk are discussed.     

Suppressed Hostility Predicted Hypertension Incidence Among Middle-Aged Men: The Normative Aging Study

This study tested whether suppressed hostility predicted incident hypertension (HTN) in initially nonhypertensive men, using prospective data from the Normative Aging Study. Six hundred twenty-seven men who completed the MMPI and participated in a subsequent laboratory assessment were included in the study. The Cook–Medley Hostility scale (Ho), a suppression factor, and other risk factors were used to predict incident HTN over a 3-year period. Logistic regression showed a significant three-way interaction among Ho, suppression, and age in predicting incident HTN. Among middle-aged men (≤60 years) with higher suppression, a 1-point decrease in the Ho score was associated with an 18% increase in HTN risk. This relationship remained significant after controlling for relevant risk factors. Among older participants, the Ho × Suppression interaction was not predictive of HTN incidence. These results provide support for the Suppressed Hostility hypothesis in middle-aged men.     

The natural history of late-life depression: results from the Amsterdam Study of the Elderly (AMSTEL)

BACKGROUND: This study examines whether risk factors related to incidence of depression are also related to prognosis, and whether a vulnerability-stress model can be established for prognosis. METHODS: A prospective model for prognosis of depression (chronic or remitted course) in later life was studied in 236 depressed community-living elderly. Subjects were interviewed at baseline, and at follow-up 3 years later. Bivariate and multivariate relationships between risk factors and chronic depression (GMS-AGECAT) were assessed. Effect modification was studied between stressors and two types of vulnerability: vulnerability through a personal history of depression, and gender. RESULTS: A personal history of depression, baseline functional limitations and incident anxiety syndrome predicted chronic depression, whereas life-events occurring between assessments, and changes in physical, functional or cognitive status did not. In subjects without a previous history, functional disabilities, male gender and receiving instrumental support correlated with a poor prognosis. The prognosis for subjects with a personal history of depression was not affected by other factors. In women, the development of chronicity was more strongly associated with a personal history than in men, whereas in men recent psychosocial and health-related characteristics were more important than in women. LIMITATIONS: Because the study consisted of two measurements with a 3-year interval, depressive episodes with a short duration may be under-represented. CONCLUSIONS: In the elderly, the impact of risk factors on the course of depression is modified by longstanding vulnerability characteristics, such as a personal history of depression and gender. More recent life stresses are related to prognosis in subjects without a personal history, and in men.     

Psychosocial factors at home and at work and four-year progression in intima media thickness

This study analyzed the relationship between psychosocial factors and progression in intima media thickness (IMT). In 1998 and 2002, 95 healthy participants underwent a clinical examination, including ultrasound of the arteria carotis communis (ACC). IMT progression in women was 0.033 mm/year (SD = 0.033) and in men 0.048 mm/ year (SD = 0.033). For cohabiting women as opposed to single women, the means for total IMT progression over the 4 years were, respectively, 0.137 (SE = 0.019) and 0.016 (SE = 0.048) mm. For women with above average as opposed to below average mean scores of effort, IMT progression were 0.149 (SE = 0.026) and 0.098 (SE = 0.024) mm, respectively. For men without children as opposed to men with children, mean scores for IMT progression were 0.231 (SE = 0.029) and 0.137 (SE = 0.028) mm, respectively. For men above average as opposed to those below average, scores of effort—reward imbalance IMT progression were 0.216 (SE = 0.030) and 0.155 (SE = 0.027) mm, respectively. Adjustment for confounders did not change the results significantly. We found that psychosocial factors were independent significant predictors of IMT progression. The associations were different between the genders.     

The Influence of Hostility and Family History of Cardiovascular Disease on Autonomic Activation in Response to Controllable versus Noncontrollable Stress,Anger Imagery Induction,and Relaxation Imagery

Autonomic activation in response to controllable versus noncontrollable stress, anger imagery induction, and relaxation imagery was studied among 80 participants between the ages of 18 and 34 years. Participants differed in level of trait hostility and family history of cardiovascular disease. Results were obtained through power spectral analyses of electrocardiograph R-R intervals, which produced an index of autonomic nervous system activation. For both male and female populations, parasympathetic regulation was diminished during anger induction for individuals with high levels of trait hostility and having a family history of cardiovascular disease. Similar results were obtained for women during the uncontrolled stress condition. Based on family history of cardiovascular disease and trait hostility, men responded differentially to relaxation imagery induction, whereas no differences were found among females.     

Effects of anger/hostility, defensiveness, gender, and family history of hypertension on cardiovascular reactivity

In this study, we examined the combined effects of anger/hostility and defensiveness on reactivity to three stressors (math, handgrip, cold pressor) and how these effects are moderated by gender and family history of hypertension. The subjects were 209 college students. Low compared with high Spielberger anger-out scores were associated with greater diastolic blood pressure (DBP) reactivity in low-but not high-defensive women with a negative family history. High compared with low hostility scores were associated with greater heart rate reactivity in low-defensive men with an opposite effect in high-defensive men. Gender, family history, and defensiveness each affected differential DBP reactivity to the three tasks. Combined study of biological factors and coping styles can improve our understanding of cardiovascular reactivity and disease.     

Hostility and Social Support Explain Physical Activity beyond Negative Affect among Young Men,but not Women,in College

We examined social support as a moderator of cynical hostility in relation to physical activity and body mass index among college students (n = 859; M = 18.71 years (SD = 1.22); 60% women, 84% White). After controlling for negative affect in hierarchical linear regression models, greater hostility was associated with lesser physical activity among those with low social support, as expected. Greater hostility was also associated with greater physical activity among those high in social support, ps < .05. Effects were observed for men only. Hostility and social support were unrelated to body mass index, ps > .05. Young men with a hostile disposition and low social support may be at risk for a sedentary lifestyle for reasons other than negative affect.     

Late middle-aged and older men living with HIV/AIDS: race differences in coping, social support, and psychological distress

Although AIDS mental health research has recently devoted more attention to the psychosocial needs of older adults living with human immunodeficiency virus (HIV) disease, studies of this population have typically combined older African-American and white participants into one large sample, thereby neglecting potential race differences. The current study examined race differences in stressor burden, ways of coping, social support, and psychological distress among late middle-aged and older men living with HIV/AIDS. Self-administered surveys were completed by 72 men living with HIV/AIDS in New York City and Milwaukee, WI (mean age = 53.4 years). Older African-American and white men experienced comparable levels of stress associated with AIDS-related discrimination, AIDS-related bereavement, financial dilemmas, lack of information and support, relationship difficulties, and domestic problems. However, in responses to these stressors, older African-American men more frequently engaged in adaptive coping strategies, such as greater positive reappraisal and a stronger resolve that their future would be better. Compared to their African-American counterparts, HIV-infected older white men reported elevated levels of depression, anxiety, interpersonal hostility, and somatization. African-American men also received more support from family members and were less likely to disclose their HIV serostatus to close friends. As AIDS becomes more common among older adults, mental health-interventions will increasingly be needed for this group. The development of intervention programs for this group should pay close attention to race-related differences in sociodemographic, psychosocial, and behavioral characteristics.     

Gender differences in the relation between tnterview-derived hostility scores and resting blood pressure

We examined the correlations between Structured Interview (SI)-derived hostility scores and resting blood pressure (BP) to see if they would be the same or different for healthy men and women. Standard risk factor information and resting BP measures were obtained from 193 undergraduates (109 men, 84 women), who underwent the SI. Subjects were rated for Potential for Hostility, Hostile Style, Intensity and Content, and completed Antagonism and Neuroticism scales. As expected, SI hostility scores were related to higher resting SBP in men, however, in women, they were related to lower resting SBP and Neuroticism. Regression analyses controlling for standard CHD risk factors indicated that SI-derived hostility predicted resting SBP and hypertensive status in both men and women, though in opposite directions. Thus, SI-derived hostility may assess a different construct in women than in men.     

Construct validation of health-relevant personality traits: Interpersonal circumplex and five-factor model analyses of the aggression questionnaire

The general literature on personality traits as risk factors for physical illness—as well as the specific literature on health consequences of anger, hostility, and aggressive behavior— often suffers from incomplete or inconsistent construct validation of personality measures. This study illustrates the utility of two conceptual tools in this regard— the five-factor model and the interpersonal circumplex. The similarities and differences among anger, hostility, verbal aggressiveness, and physical aggressiveness as measured by the Buss and Perry (1992) Aggression Questionnaire were identi fied. Results support the interpretation of anger and hostility as primarily reflecting neurotic hostility and antagonistic hostility to a lesser extent. In contrast, verbal and physical aggressiveness can be seen as primarily reflecting antagonistic hostility, and to a lesser extent neurotic hostility. Further, verbal aggressiveness was associated with hostile dominance, whereas hostility was associated with hostile submissiveness. These findings identify potentially important distinctions among these related constructs and illustrate the potential integrative value of standard validation procedures.     

Hostility, metabolic syndrome, inflammation and cardiac control in young adults: The Young Finns Study

We studied whether there is an association between hostility and cardiovascular heart disease (CHD) risk factors, such as the metabolic syndrome, systemic inflammation and autonomic cardiac control. Participants were 912 women and 712 men aged 15-30 when hostility was measured in 1992. Metabolic syndrome was assessed 9 years later in 2001 using 3 definitions: the National Institute of Health Adult Treatment Panel III criteria (NCEP), the European Group for the Study of Insulin Resistance criteria (EGIR), and the International Diabetes Federation criteria (IDF). C-reactive protein (CRP) defined in 2001 was the marker of inflammation. Cardiac control indices were from EGC recording. In women, hostility predicted increased risk of metabolic syndrome (EGIR, and the IDF definitions, ORs = 1.34, 1.35, p < 0.05), and higher levels of inflammation (β = 0.09, p < 0.01). We concluded that hostility is associated with metabolic syndrome and systemic inflammation in women and these conditions may be factors linking hostility to CHD.     

Cynical Hostility,Anger Expression Style,and Acute Myocardial Infarction in Middle-aged Japanese Men

Studies using American and European populations have demonstrated that high levels of anger/ hostility are predictive of coronary heart disease (CHD) mortality. However, Japanese studies did not show consistent relationship between anger/hostility and CHD. This study examines the association of cynical hostility and anger expression style with acute myocardial infarction (AMI) in middle-aged Japanese men through a case-control study. The patients with acute myocardial infarction (N = 96, mean age = 50.8 years) and the healthy participants in a health check-up program (N = 77, mean age = 50.3 years) were studied. Both groups completed the Cynicism Questionnaire (CQ) and the State-Trait Anger Expression Inventory (STAXI). The patients exhibited higher scores on CQ than the healthy controls. Logistic regression analyses controlling for biological risk factors revealed that the CQ score was associated with increased risk of AMI (OR = 1.11 [95% CI 1.00–1.22]). In addition, the score of Anger-control, a subscale of STAXI, was associated with decreased risk of AMI (OR = 0.75 [95% CI 0.62–0.92]). These results indicated that higher levels of cynical hostility increased the risk of AMI and that anger-control strategies could have some benefit in reducing the risk of AMI in middle-aged Japanese men.     

Hostility in Marital Dyads: Associations with Depressive Symptoms

We examined the relations of hostility (of self and spouse) with self-ratings of depressive symptoms in 898 spouse pairs. Self-ratings of hostility were initially examined as predictors of depression. Next, spouse self-ratings of hostility were added to the model. Finally, the interaction of self × spouse hostility was investigated. These relations were explored for three components of hostility (Cynicism, Aggressive Responding, and Hostile Affect). Age and education were controlled in all models and effects were examined separately for women and men. Self-ratings of Hostile Affect were positively related to depressive symptoms for both women and men. Self-ratings of Cynicism were also significantly related to depression, but only for men. All three components of spouse's hostility were positively related to one's own symptoms of depression for women. For men, however, spouse's hostility was not related to symptoms of depression. These findings highlight the need to study psychosocial risk factors in social units and have potential implications for intervention.     

Influence of Depression and Hostility on Exercise Tolerance and Improvement in Patients with Coronary Heart Disease

Purpose

Although hostility and depression have been linked to higher cardiac risk and poor prognosis of patients with coronary heart disease (CHD), there is a lack of research that studies how they may influence the short-term outcomes among patients participating in cardiac rehabilitation (CR). This study aimed to investigate the influence of hostility and depression on patients’ exercise tolerance and improvement trajectory in a CR program over 6 weeks.

Method

Participants were 142 patients with CHD, with a mean age of 62 years. Latent growth curve modeling was conducted to determine whether hostility and depression predicted patients’ baseline exercise tolerance and rates of improvement on treadmill, while controlling for age and severity of illness. In addition, analysis was conducted to examine whether depression mediated the influence of hostility on exercise outcomes.

Results

Patients with CHD with higher hostility scores had a lower baseline exercise tolerance and slower rates of improvement over 6 weeks. Depressive symptom severity mediated the influence of hostility on exercise baseline and improvement. Patients with higher hostility were more likely to have more severe depressive symptoms, which in turn were associated with lower baseline exercise tolerance and slower improvement.

Conclusion

While both hostility and depression predicted the exercise outcomes in CR, depression explained the influence of hostility. The findings underscore the importance of addressing psychosocial issues in treatment of CHD patients and provide support for psychosocial interventions in CR to facilitate patients’ recovery.