Change in depression across adolescence: The role of early anger socialization and child anger

The purpose of this longitudinal study was to examine the relations of early socialization of anger with change in adolescent depression, and moderation by child anger. Using a sample of low-income, ethnic minority children at familial risk for psychopathology in the United States (n = 92; ages 3–5; 53% female; 65% African American; 27% Latina/o), early anger socialization (i.e., parent response to child anger) was tested as a predictor of change in depression from preadolescence to adolescence [i.e., age 8 (n = 63), 11 (n = 58), and 13 (n = 44)]. A videotaped parent-child interaction was coded for parental socialization of preschooler anger, and psychiatric interviews of depression were conducted three times across preadolescence and adolescence. Major depression diagnoses increased from preadolescence to adolescence. Latent growth modeling indicated parent discouragement of child anger was a significant predictor of an increase in the child's later depression from preadolescence to adolescence, and child anger intensity was a significant moderator.     

Childhood trauma and anger in adults with and without depressive and anxiety disorders

Background

Childhood trauma (CT) is associated with severe sequelae, including stress-related mental health disorders that can perpetuate long into adulthood. A key mechanism in this relationship seems to be emotion regulation. We aimed to investigate (1) whether childhood trauma is associated with anger in adulthood, and, if so, (2) to explore which types of childhood trauma predominate in the prediction of anger in a cohort that included participants with and without current affective disorders.

Methods

In the Netherlands Study of Depression and Anxiety (NESDA), childhood trauma was assessed with a semi-structured Childhood Trauma Interview (CTI) at baseline, and analyzed in relation to anger as measured at a 4-year follow-up with the Spielberger Trait Anger Subscale (STAS), the Anger Attacks Questionnaire, and cluster B personality traits (i.e., borderline, antisocial) of the Personality Disorder Questionnaire 4 (PDQ-4), using analysis of covariance (ANCOVA) and multivariable logistic regression analyses. Post hoc analyses comprised cross-sectional regression analyses, using the Childhood Trauma Questionnaire-Short Form (CTQ-SF) also obtained at a 4-year follow-up.

Results

Participants (n = 2271) were on average 42.1 years (SD = 13.1), and 66.2% were female. Childhood trauma showed a dose–response association with all anger constructs. All types of childhood trauma were significantly associated with borderline personality traits, independently of depression and anxiety. Additionally, all types of childhood trauma except for sexual abuse were associated with higher levels of trait anger, and a higher prevalence of anger attacks and antisocial personality traits in adulthood. Cross-sectionally, the effect sizes were larger compared with the analyses with the childhood trauma measured 4 years prior to the anger measures.

Conclusions

Childhood trauma is linked with anger in adulthood, which could be of particular interest in the context of psychopathology. Focus on childhood traumatic experiences and adulthood anger may help to enhance the effectiveness of treatment for patients with depressive and anxiety disorders. Trauma-focused interventions should be implemented when appropriate.     

Factors associated with anger and anger expression in caregivers of elderly relatives

Objectives: Anger is a common feeling among family caregivers of elderly dependents. However, this feeling has received less attention than other emotional effects of caring. This study measures anger in caregivers and analyzes its predictors.

Method: Trait anger and anger expression (expression-in, expression-out and expression index), caregiver and care recipient features, stressors (e.g. care demands and support), appraisal (e.g. burden) and resources (e.g. coping, self-efficacy) were assessed in 111 caregivers of elderly dependent relatives. Staged stepwise multiple linear regression analyses were carried out for each of the four anger scores.

Results: Caregivers presented mild anger levels and showed expression-in rather than expression-out of anger. Stepwise multiple linear regression analyses showed that a bad relationship between caregiver and care recipient, the presence of disruptive behaviors and caregivers’ low efficacy to handle them, and mostly the use of emotion-focused coping were the significant predictors of trait anger, anger expression index and anger expression-out. Explained variance for each of these regression models was 38%, 33% and 27%, respectively. Burden was the only significant predictor for internal anger expression (8% explained variance).

Conclusion: Results highlight that interventions aimed to improve caregivers’ strategies to address memory and behavior problems and to promote the use of effective coping strategies could be helpful to prevent anger and expression-out of anger. Reducing burden in caregivers might result in reductions of anger expression-in. Data underscore the need to consider anger feeling and both in-expression and out-expression of anger separately in order to understand anger experience in caregivers.     

Fenfluramine challenge in unipolar depression with and without anger attacks

We have previously hypothesized that patients with major depression and anger attacks may have a greater central serotonergic dysregulation than depressed patients without such attacks. We wanted to compare the prolactin response to fenfluramine challenge, as an indirect measure of central serotonergic function, in depressed patients with and without anger attacks. We recruited 37 outpatients (22 men and 15 women; mean age: 39.5+/-10.5) with DSM-III-R major depressive disorder, diagnosed with the SCID-P. Their initial 17-item Hamilton Rating Scale for Depression score was >/=16. Patients were classified as either having or not having anger attacks with the Anger Attacks Questionnaire. All patients received a single-blind placebo challenge followed by a fenfluramine challenge (60 mg orally) the next day. Plasma prolactin measurements were obtained with double antibody radioimmunoassay before and after both placebo and fenfluramine challenges, and fenfluramine and norfenfluramine blood levels after each challenge were determined by gas chromatography. Of the 37 study participants, 17 (46%) were classified as having anger attacks. There were no significant differences in age, gender, fenfluramine, or norfenfluramine blood levels between depressed patients with and without anger attacks. Depressed patients with anger attacks showed a significantly blunted prolactin response to fenfluramine challenge compared to patients without anger attacks. As previous studies have shown blunted prolactin responses to fenfluramine in impulsive aggression among patients with personality disorders, our results support our hypothesis that depressed patients with anger attacks may have a relatively greater serotonergic dysregulation than depressed patients without these attacks.     

Anger Attacks in Depressed Turkish Outpatients

Anger attacks have been described as sudden spells of anger accompanied by symptoms of autonomic activation and have been experienced by patients as uncharacteristic of them and inappropriate to the situations in which they had occurred. The aim of this study was to assess the prevalence of anger attacks in a non-Western depressed population. We also wanted to see whether depression in patients with anger attacks was qualitatively different from depression without anger attacks. The Anger Attacks Questionnaire, designed by Fava et al. to assess these attacks, was administered to 88 medication-free consecutive outpatients diagnosed as major depression according to DSM-IV criteria by two psychiatrists. The patients also were assessed by the Beck Depression Inventory, the Beck Anxiety Inventory, the Beck Hopelessness Scale, and the Spielberger's State-Trait Anger Expression Inventory. Forty-three (49%) of these patients had reported having anger attacks. The patients with anger attacks were significantly more depressed and anxious than patients without anger attacks. Anger-out and trait anger measures were significantly higher in depressed patients with anger attacks than patients without anger attacks. Patients with anger attacks also scored higher in hopelessness measure and there was a trend toward statistical significance. Our results are in line with previous literature which show, that anger attacks are prevalent in depressed patients. We also conclude that patients with anger attacks constitute a more depressed population than those without anger attacks. Severity of depression emerges as the strongest predictor of the presence of anger attacks in our study.     

An exploration of anger phenomenology in multiple sclerosis

Background and purpose: Multiple sclerosis (MS) patients are often emotionally disturbed. We investigated anger in these patients in relation to demographic, clinical, and mood characteristics. Patients and methods: About 195 cognitively unimpaired MS patients (150 relapsing–remitting and 45 progressive) were evaluated with the State Trait Anger Expression Inventory, the Chicago Multiscale Depression Inventory, and the State Trait Anxiety Inventory. The patients’ anger score distribution was compared with that of the normal Italian population. Correlation coefficients among scale scores were calculated and mean anger scores were compared across different groups of patients by analysis of variance. Results: Of the five different aspects of anger, levels of withheld and controlled Anger were respectively higher and lower than what is expected in the normal population. Although anger was correlated with anxiety and depression, it was largely independent from these mood conditions. Mean anger severity scores were not strongly influenced by individual demographic characteristics and were not higher in more severe patients. Conclusions: The presence of an altered pattern of anger, unrelated to the clinical severity of MS, suggests that anger is not an emotional reaction to disease stress. An alteration of anger mechanisms might be a direct consequence of the demyelination of the connections among the amygdale, the basal ganglia and the medial prefrontal cortex.     

Antecedents, concomitants and consequences of anger attacks in depression

Anger attacks are episodes of intense anger with autonomic arousal, which occur in response to often trivial provocations. This study explores some of the antecedents, concomitants, and consequences of anger attacks in patients with depression. The sample comprised three groups: depression with anger attacks (n=20), depression without anger attacks (n=20) and normal controls (n=20). Subjects were administered the Mini International Neuropsychiatric Interview, the Anger Attack Questionnaire, Irritability, the Depression Anxiety Scale, the State-Trait Anger Expression Inventory, the Psychoticism Extraversion Neuroticism Inventory, the Hassles Scale, the World Health Organization Quality of Life-BREF Version and the Dysfunctional Analysis Questionnaire. Depressed patients with anger attacks exhibited more suicide-related phenomena and dysfunction scores in comparison to depressed patients without anger attacks. Depressed patients with anger attacks also had higher scores of anxiety, irritability, trait-anger, anger-out, anger expression, psychoticism, hassles, and poor quality of life in comparison to the other two groups. In conclusion, anger attacks adversely affect the lives of depressed patients and their family members and may serve as a qualifier for partially distinct syndrome of depression.     

Prevalence of anger attacks in depressive and anxiety disorders: Implications for their construct?

Aims: The present study explores anger attacks in depressive and anxiety disorders for their prevalence and some of the clinical and psychosocial correlates. Methods: The sample comprised of patients with ICD‐10‐diagnosed depressive and anxiety disorders (n = 328). All the subjects were given a demographic and clinical profile sheet, the Irritability Depression Anxiety Scale, World Health Organization Quality of Life – BREF Version and the Anger Attack Questionnaire. Using the Anger Attack Questionnaire they were divided into two groups – with anger attacks (n = 170) and without anger attacks (n = 158) – in order to study the differential profile of the two groups. Results: Anger attacks were associated with more anxiety and irritability, and poorer quality of life. Frequency of anger attacks had a positive correlation with depression, irritability and aggression, and a negative correlation with education, income, and quality of life. Panic attacks, somatic anxiety and psychological domain of quality of life predicted the categorization of subjects into those with and without anger attacks. Conclusion: Anger attacks are common among depressive and anxiety disorder cases and have a negative impact on quality of life. Status of anger attacks as either linked to anxiety and/or depression, or as an independent syndrome needs further study.     

Impact of mindfulness training on attentional control and anger regulation processes for psychotherapists in training

Abstract

Objectives: Little empirical literature focuses on psychotherapists' cultivation of internal states of mind necessary for controlling attention and responding empathically to the client. We explore the effects of mindfulness training on emotional and attentional measures in Spanish resident intern psychiatrists and clinical psychologists. Method: One hundred and three residents were assigned to an experimental group (n = 60) that completed an 8-week mindfulness training versus a wait-list control group (n = 43). We evaluated emotional variables (sadness, anxiety, and anger, using standard instruments), state of mindfulness (using the Mindfulness Awareness Attention Scale), and attentional control variables using objective measures such as a continuous performance task and the Stroop task before and after mindfulness training. Results: Our study provides data that suggest that mindfulness training significantly improves measures of trait anger and attentional control. Conclusions: Further research is needed to replicate these findings, explore the effects of mindfulness training on other aspects of emotional regulation and cognition, and evaluate the impact of these effects within clinical situations.     

Can cannabis trigger recurrent panic attacks in susceptible patients?

Cannabis has been reported to produce acute psychiatric reactions, among these panic anxiety and derealization, which are self-limited. We report on three patients who experienced an initial panic attack during cannabis intake. Anxiety attacks reoccurred after the cessation of intake. Two of these patients had a current depressive disorder, one of them had a single Grand Mal seizure before the onset. We suggest that cannabis may trigger the emergence of recurrent panic attacks and uncover latent panic disorders in vulnerable persons.     

Predictors of cognitive level and depression severity are different in patients with left and right hemispheric stroke within the first year of illness

Causes of cognitive impairment after stroke are not yet clear because a large number of sociodemographic and clinical variables complicate the understanding of the phenomenon. We aim to evaluate sociodemographic and clinical predictors of cognitive level and depression in subjects with different lesion laterality. We assessed 153 right (n = 87) and left (n = 66) unilateral first-ever stroke patients within the first year of illness with the Structured Clinical Interview for DSM-IV-Patient Edition, the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the State Trait Anger Expression Inventory, the Barthel Index, and the Mini Mental State Examination (MMSE). Sociodemographic variables were also measured. Sixty-two (41 %) patients suffered from Major Depression (MDD), and 26 (17 %) suffered from Minor Depression (MIND). An univariate analysis of variance showed that MMSE scores were different throughout the groups of left and right stroke patients with MDD, MIND and without depression. Left stroke patients with MDD were more cognitively impaired than all the other groups. This result was valid after controlling for the effect of lesion location on cognitive level difference between the groups. A series of stepwise multiple regression analyses indicated that depression severity was a predictor of cognitive level and vice-versa in left hemispheric stroke patients only. Moreover, educational level in right hemispheric stroke patients and state-anger and number of regions affected in left hemispheric stroke patients were other predictors of cognitive level. The study confirms the hypothesis that predictors of cognitive level and depression severity are different in subjects with different laterality of lesion and that MDD is associated with cognitive impairment in left stroke patients. Received: 4 February 2002, Received in revised form: 14 May 2002, Accepted: 22 May 2002 Correspondence to Gianfranco Spaletta, MD     

Teaching healthy anger management

TOPIC: Teaching anger management in the community. PURPOSE: To describe anger management and offer guidelines for assessing potential participants and teaching healthy behaviors. SOURCES: Drawing from the literature, more than 10 years of quantitative and qualitative studies by our research team, and 5 years of experience in conducting anger management groups, the author presents basic principles of teaching anger management. A model is described for a 4-week group for women. CONCLUSIONS: Anger management has wide applicability to a variety of constituencies for both primary and secondary prevention. Advanced practice psychiatric nurses are well-qualified to provide this psychoeducational intervention.     

Negative symptoms,anger, and social support: response of an inpatient sample to news coverage of the September 11 terrorist attacks

We examined the reactions of 17 male inpatients on a secure psychiatric unit to television news coverage of the September 11 attacks. All had psychotic diagnoses. We hypothesized that self-exposure and affective response to the news coverage and use of social support would be influenced by predominance of negative symptoms. Additionally, we examined for the emergence of common stress symptoms and exacerbations of psychosis. Results showed a dose-response relationship between amount of viewing and magnitude of response to the coverage. Anger was the emotion most clearly tied to coverage exposure and the other response variables. A wide range of stress symptoms was reported. Hypotheses concerning the influence of negative symptoms were partially supported. A significant minority of the patients disclosed exacerbation of psychotic symptoms in response to the attacks. Patients who reported a negative emotional reaction were more likely to talk to others about the attacks, but social contact did not predictably lead to affective relief.     

Panic attacks as risk markers for mental disorders*

Abstract Objective This paper extends previous epidemiological findings linking panic attacks with future episodes of depression and examines whether this relationship is independent of the effects of gender and neuroticism. Methods Composite International Diagnostic Interview (CIDI) DSM-IV diagnoses from a stratified multi-stage population survey of 10,641 Australian adults were analysed using logistic regression to examine the relationship between lifetime panic attacks, gender, neuroticism and mental disorders. Results People who experienced full CIDI DSM-IV panic attacks more than 12 months ago were 4 times more likely to meet criteria for current Depressive Disorder than those who reported no attacks. Those with panic attacks in the past 12 months were 13.3 times more likely to report current Depressive Disorders. A similar pattern was also present for non-panic Anxiety Disorders (odds ratio=7.5 for lifetime, but not 12-month panic attacks, and 21.46 for 12-month panic attacks) and for Substance Use Disorders (2.1 and 4.6, respectively) suggesting a broader relationship with psychopathology than previously reported. For each of these groupings of mental disorders, panic attacks accounted for significant variability over and above the effects of gender, neuroticism, and comorbid Anxiety Disorders. Conclusions Panic attacks are associated with current and future Anxiety, Depressive, and Substance Use Disorders, and this relationship is not solely accounted for by differences in gender and neuroticism.* Previous Presentation: An earlier version of this paper was included in an unpublished PhD thesis by Andrew Baillie under the supervision of Prof Ron Rapee.     

Three-year neuropsychological follow-up of patients with reversible ischemic attacks

A short neuropsychological test battery designed to measure language, memory and visuospatial abilities was administered to 217 patients with reversible ischemic attacks. Patients were tested twice: the first time more than one month, but less than one year, from the last ischemic episode, and the second time three years later. A comparison between the first and the second testing session did not disclose any significant worsening. The degree of atherosclerosis and the occurence of further ischemic episodes during the follow-up period were found to be unrelated to change in performance at the test battery. These results seems to challenge the hypothesis that multi-infarct dementia may follow apparently reversible, or even clinically silent, ischemic episodes.

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Sommario Una breve batteria di test neuropsicologici finalizzata alla valutazione del linguaggio, della memoria e delle abilità visuo-spaziali è stata somministrata ad un gruppo di 217 pazienti con ischemia cerebrale reversibile. Ciascun paziente è stato esaminato due volte: in una prima occasione a più di un mese, ma a meno di unano di distanza dall'ultimo episodio ischemico; la seconda volta dopo tre anni. Il paragone fra il primo e il secondo esame non ha rivelato un significativo peggioramento. Il grado di arteriosclerosi e il ripetersi di episodi ischemici nell'intervallo fra i due esami non sono risultati in relazione con la variazione delle prestazioni ai test neuropsicologici. Questi risultati sembrano smentire l'ipotesi che la demenza multi-infartuale possa essere una conseguenza di episodi di ischemia cerebrale apparentemente reversibili o clinicamente silenti.

     

The expression of anger and its relationship to symptoms and cognitions in obsessive-compulsive disorder

We compared the association between obsessive-compulsive disorder (OCD) and the expression of anger in a sample of 71 patients and 71 college students. Some authors [Rubenstein et al., J Anxiety Disord 1995;9:1-9] have proposed that anger and hostility underlie the symptoms of OCD; however, there has been little empirical study of this relationship. One recent study [Whiteside and Abramowitz, Cog Therapy Res 2004;28:259-268] with college undergraduates found that the association between OCD symptoms and anger was attributable to depressive symptoms. In the present study, we compared the expression of anger in a sample of patients diagnosed with OCD and nonclinical volunteers. Consistent with the previous study, we found increased levels of anger in patients with OCD as compared to control participants; however, these differences could be attributed to between-group differences in general distress. These results were discussed within the framework of the cognitive theory of OCD.     

低年级大学生中与愤怒特质相关联的躯体化:家庭亲密度和适应性的调节作用

背景:22%至58%的患者在初级保健机构主诉躯体症状.既往研究发现躯体化与愤怒特质和家庭功能相关.然而,有关研究却非常缺乏,特别是评估家庭功能在愤怒特质如何成为躯体主诉中的调节作用.目的:本研究的目的是验证家庭亲密度和适应性的变化是否调节愤怒特质和躯体化之间的关系强度.方法:采用横断面研究设计并从上海一所综合性大学招募2008名大学生.所有参加者完成问卷,包括采用症状自评量表(SCL-90)、状态-特质愤怒表达量表2(STAXI-2中文版)、家庭亲密度和适应性量表第二版(FACES II中文版)来评估其当前的躯体化程度、愤怒特质与家庭功能.采用分层线性回归分析(进入)分别对男性和女性验证家庭亲密度和适应性对愤怒和躯体化之间的关联性的调节作用.结果:躯体症状在男性女性中均与抑郁和愤怒特质以预期的方向显著相关.家庭亲密度和家庭适应性与躯体症状呈负相关.女大学生家庭亲密度对愤怒特质和躯体化之间的联系起到调节作用,而男大学生家庭亲密度的调节作用是轻微的.变量目前抑郁症状矫正后,家庭适应能力的调节作用在男性和女性中均没有显著性.结论:容易愤怒是躯体化的一个独立预测因素.对于女性来说,较高的家庭凝聚力是一种保护因素,可以减少愤怒特质对躯体症状的影响.没有当前抑郁的共病的话,家庭适应性在一定程度上可以避免有愤怒倾向的个体发展为躯体化.家庭凝聚力培养、家庭灵活性培养和抑郁治疗相结合的干预措施可能对有愤怒特质的躯体化患者更有效.     

Major depressive disorder with anger attacks and cardiovascular risk factors

OBJECTIVE: Depression and anger have been separately associated with cardiovascular risk factors. We investigated if major depressive disorder (MDD) with concomitant anger attacks was associated with cardiovascular risk factors. METHOD: We measured total serum cholesterol, glycemia, resting blood pressure, and smoking parameters in 333 (52.9% women) MDD nonpsychotic outpatients, mean age of 39.4 years. MDD was diagnosed with the Structured Clinical Interview (SCID) in accordance with the Diagnostic and Statistic Manual of Mental Disorders, Third Edition, Revised (DSM-III-R). The presence of anger attacks was established with the Massachusetts General Hospital Anger Attacks Questionnaire. RESULTS: In a logistic regression analysis, anger attacks were independently associated with cholesterol levels > or = 200 mg/dL (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.18-3.94) and years of smoking > 11 (OR, 2.59; 95% CI, 1.32-5.04). CONCLUSIONS: MDD with anger attacks was significantly associated with increased cholesterol levels and years of smoking.