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Kaway P, Wada K, Yamakawa M, Koda S, Uji T, Oba S, Nagata C. Association Between Anger and Mortality in Women and Men: A Prospective Cohort Study in a Japanese Community. J Womens Health (Larchmt) 2021; 30:1597-1603. [PMID: 33728985 DOI: 10.1089/jwh.2020.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Anger is a common problem in society, and anger's relationship with mortality, in particular with cardiovascular mortality, has been studied mainly in male western population. There are no prospective studies in Japan, about the association between anger and mortality. Materials and Methods: This study examined the association of anger with all-cause and cause-specific mortality in a Japanese community. Data came from the Takayama Study, which recruited residents aged ≥35 years in 1992 from Takayama City in Gifu, Japan. The current study used information on anger that was obtained from the second survey in 2002. A total of 11,902 healthy participants aged ≥45 years completed a self-administered questionnaire. Anger was assessed using the Spielberger Trait Anger Scale. Results: The main causes of deaths during the follow-up period from 2002 to 2013 were 460 for neoplasm, 254 for cardiovascular, and 435 for other causes. After adjusting for potential confounders, we found a significant positive association between the trait anger score and the risk of cardiovascular mortality for women, with a hazard ratio for high versus low score of trait anger of 1.81 (95% confidence interval 0.91-3.63, p for trend = 0.04), but not for men. Conclusions: Data suggest that for Japanese women, high trait anger score may be associated with an increased risk of cardiovascular mortality. Potential gender differences in the association between trait anger and mortality should be further studied from the cultural context.
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Affiliation(s)
- Patricia Kaway
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Keiko Wada
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Michiyo Yamakawa
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Sachi Koda
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takahiro Uji
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shino Oba
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.,Graduate School of Health Sciences, Gunma University, Gunma, Japan
| | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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Gassen J, Hill SE. Why inflammation and the activities of the immune system matter for social and personality psychology (and not only for those who study health). SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019. [DOI: 10.1111/spc3.12471] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Schmidt KES, Quadros ASD, Moura MR, Gottschall CAM, Schmidt MM. Anger and Coronary Artery Disease in Women Submitted to Coronary Angiography: A 48-Month Follow-Up. Arq Bras Cardiol 2018; 111:410-416. [PMID: 30281687 PMCID: PMC6173346 DOI: 10.5935/abc.20180165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 04/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background Anger control was significantly lower in patients with coronary artery
disease (CAD), regardless of traditionally known risk factors, occurrence of
prior events or other anger aspects in a previous study of our research
group. Objective To assess the association between anger and CAD, its clinical course and
predictors of low anger control in women submitted to coronary
angiography. Methods This is a cohort prospective study. Anger was assessed by use of
Spielberger’s State-Trait Anger Expression Inventory (STAXI). Women were
consecutively scheduled to undergo coronary angiography, considering CAD
definition as ≥ 50% stenosis of one epicardial coronary artery. Results During the study, 255 women were included, being divided into two groups
according to their anger control average (26.99). Those with anger control
below average were younger and had a family history of CAD. Patients were
followed up for 48 months to verify the occurrence of major cardiovascular
events. Conclusion Women with CAD undergoing coronary angiography had lower anger control, which
was associated with age and CAD family history. On clinical follow-up,
event-free survival did not significantly differ between patients with anger
control above or below average.
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Affiliation(s)
| | | | - Mauro Regis Moura
- Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
| | | | - Márcia Moura Schmidt
- Instituto de Cardiologia / Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS - Brazil
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Moncrieft AE, Llabre MM, Gallo LC, Cai J, Gonzalez F, Gonzalez P, Ostrovsky NW, Schneiderman N, Penedo FJ. Hostility and quality of life among Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study. Psychol Health 2016; 31:1342-58. [PMID: 27456582 DOI: 10.1080/08870446.2016.1208820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if hostility is associated with physical and mental health-related quality of life (QoL) in US. Hispanics/Latinos after accounting for depression and anxiety. METHODS Analyses included 5313 adults (62% women, 18-75 years) who completed the ancillary sociocultural assessment of the Hispanic Community Health Study/Study of Latinos. Participants completed the Center for Epidemiological Studies Depression Scale, Spielberger Trait Anxiety Scale, Spielberger Trait Anger Scale, Cook-Medley Hostility cynicism subscale and Short Form Health Survey. In a structural regression model, associations of hostility with mental and physical QoL were examined. RESULTS In a model adjusting for age, sex, disease burden, income, education and years in the US., hostility was related to worse mental QoL, and was marginally associated with worse physical QoL. However, when adjusting for the influence of depression and anxiety, greater hostility was associated with better mental QoL, and was not associated with physical QoL. CONCLUSIONS Results indicate observed associations between hostility and QoL are confounded by symptoms of anxiety and depression, and suggest hostility is independently associated with better mental QoL in this population. Findings also highlight the importance of differentiating shared and unique associations of specific emotions with health outcomes.
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Affiliation(s)
- Ashley E Moncrieft
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Maria M Llabre
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Linda C Gallo
- b Department of Psychology , San Diego State University , San Diego , CA , USA
| | - Jianwen Cai
- c Department of Biostatistics , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Franklyn Gonzalez
- c Department of Biostatistics , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Patricia Gonzalez
- b Department of Psychology , San Diego State University , San Diego , CA , USA
| | - Natania W Ostrovsky
- d Department of Epidemiology and Population Health , Albert Einstein College of Medicine , Bronx , NY , USA
| | - Neil Schneiderman
- a Department of Psychology , University of Miami , Coral Gables , FL , USA
| | - Frank J Penedo
- e Department of Medical Social Sciences , Northwestern University , Chicago , IL , USA
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Lemche AV, Chaban OS, Lemche E. Anger Traits Associated With Cardiovascular Risk Biomarkers in the Metabolic Syndrome. J Cardiovasc Nurs 2016; 31:336-42. [PMID: 27299759 DOI: 10.1097/jcn.0000000000000264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recent studies have shown that different personality traits contribute to mortality in different subtypes of cardiovascular disease (CVD). Anger traits have been shown to promote the constellation of the metabolic syndrome (MetS), which in turn increases CVD risks. OBJECTIVE To determine covariation of anger traits with CVD biomarkers, we examined patients (N = 101; 34 men and 67 women; age, 45.6 ± 13.96 years) in a nationally sampled treatment cohort for MetS in the Ukrainian governmental healthcare system. METHODS Data collection was conducted in 2007. Laboratory data of single components of the MetS according to International Diabetes Federation Consensus were dependent measures in regression models with self-reported overt aggressivity and covert hostility in the Buss-Durkee Hostility Inventory and sociodemographic data. Structural equation models (SEMs) were tested. RESULTS The SEM results are in favor of a sex-adjusted 2-factor solution R = 0.723), as indicated by equation-level Bentler-Raykov goodness-of-fit coefficients of 0.81 to 0.97 for paths to biological variables. Two latent components, 1 relating to aggressivity and the other to hostility, combine lipid/obesity-related measures and cholesterol-related measures, respectively. CONCLUSIONS The SEM results suggest that CVD-risk biomarker variables in this MetS sample (a) associate into 2 distinct profiles and (b) that 1 profile associates with overt anger, whereas the other associates with covert hostility. These results could contribute to more personalized prevention and care in CVD patients.
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Affiliation(s)
- Alexandra V Lemche
- Alexandra V. Lemche, MD Researcher, Department of Psychosomatic Medicine, Charité-University Medicine, Berlin, Germany.Oleg S. Chaban, MD, PhD, DSc Full Professor, Section of Neuroses and Somatoform Disorders, Bogomolets National Medical University, Kiev, Ukraine.Erwin Lemche, PhD Senior Researcher, Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom
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The Effect of Hostility Reduction on Autonomic Control of the Heart and Vasculature: A Randomized Controlled Trial. Psychosom Med 2016; 78:481-91. [PMID: 26867075 PMCID: PMC5020896 DOI: 10.1097/psy.0000000000000296] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hostility is associated with coronary artery disease. One candidate mechanism may be autonomic nervous system (ANS) dysregulation. In this study, we report the effect of cognitive behavioral treatment on ANS regulation. METHODS Participants were 158 healthy young adults, high in hostility measured by the Cook-Medley Hostility and Spielberger Trait Anger scales. Participants were also interviewed using the Interpersonal Hostility Assessment Technique. They were randomized to a 12-week cognitive behavioral treatment program for reducing hostility or a wait-list control group. The outcome measures were preejection period, low-frequency blood pressure variability, and high-frequency heart rate variability measured at rest and in response to and recovery from cognitive and orthostatic challenge. Linear-mixed models were used to examine group by session and group by session by period interactions while controlling for sex and age. Contrasts of differential group and session effects were used to examine reactivity and recovery from challenge. RESULTS After Bonferroni correction, two-way and three-way interactions failed to achieve significance for preejection period, low-frequency blood pressure variability, or high-frequency heart rate variability (p > .002), indicating that hostility reduction treatment failed to influence ANS indices. CONCLUSIONS Reduction in anger and hostility failed to alter ANS activity at rest or in response to or recovery from challenge. These findings raise questions about whether autonomic dysregulation represents a pathophysiological link between hostility and heart disease.
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Boylan JM, Lewis TT, Coe CL, Ryff CD. Educational Status, Anger, and Inflammation in the MIDUS National Sample: Does Race Matter? Ann Behav Med 2016; 49:570-8. [PMID: 25715901 DOI: 10.1007/s12160-015-9687-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Racial differences in anger frequency and expression styles have been found. Further, African Americans receive fewer health benefits from higher education than Whites. PURPOSE This study seeks to investigate racial differences in how anger moderates the association between education and inflammation. METHODS Midlife in the US participants (n = 1,200; 43.0 % male; 18.5 % African American) provided education and anger data via survey assessments. Interleukin-6 (IL-6) and fibrinogen were determined from a fasting blood sample following an overnight clinic visit. RESULTS African Americans reported higher anger-out, IL-6, and fibrinogen and lower anger-control than Whites. Anger-out predicted higher IL-6 and fibrinogen among African Americans with higher education; whereas, trait anger and anger-out predicted lower fibrinogen among Whites with higher education. Anger-out marginally predicted higher IL-6 in less educated Whites. CONCLUSIONS Findings underscore racial differences in the benefits and consequences of educational attainment, and how social inequities and anger are manifested in inflammatory physiology.
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Affiliation(s)
- Jennifer Morozink Boylan
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA,
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Hendy HM, Joseph LJ, Can SH. Repressed anger mediates associations between sexual minority stressors and negative psychological outcomes in gay men and lesbian women. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2016. [DOI: 10.1080/19359705.2016.1166470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Boisclair Demarble J, Moskowitz DS, Tardif JC, D'Antono B. The relation between hostility and concurrent levels of inflammation is sex, age, and measure dependent. J Psychosom Res 2014; 76:384-93. [PMID: 24745780 DOI: 10.1016/j.jpsychores.2014.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 02/20/2014] [Accepted: 02/23/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Hostility may be associated with greater systemic inflammation. However, contradictory evidence exists. Certain individuals or dimensions of hostility may be more susceptible to these effects. Main and interactive effects of hostility with sex and/or age were evaluated on markers of inflammation, independently of traditional risk factors for coronary artery disease. METHODS 199 healthy men (81) and women (118), aged 20-64 years (M=41 ± 11 years) were recruited. Hostility was assessed using the Cook-Medley Hostility Inventory (CMHo) and ecological momentary assessments (EMA) of quarrelsome behavior and angry affect in daily living. Blood samples were drawn to measure inflammatory activity (Il-6, TNF-α, hsCRP, Il-8, Il-10, Il-18, MCP-1) and lipid oxidation (Myeloperoxidase; MPO). Correlations and hierarchical regression analyses were performed controlling for pertinent behavioral, psychological, medical, and socio-demographic factors. RESULTS Significant univariate associations emerged between CMHo and Il-6, TNF-α, MCP-1 (p<.05). Hierarchical regressions showed interactions of hostility with sex (Il-6, TNF-α; p<.05) and age (hsCRP, Il-6, TNF-α; p<.05). For example, in simple slope analyses, hostility was positively related to TNF-α in women (b=0.009, p=0.006) but not men. Greater hostility was also related to greater Il-6 levels among younger women (b=. 027, p=0.000). CONCLUSION Hostility, particularly cynical hostility, may be detrimental to (younger) women. The TNF-α, Il-6, CRP triad appears vulnerable to psychological and behavioral factors, and may be one mechanism by which cynical hostility (CMHo) contributes to increased cardiovascular risk in women. Prospective research is needed to verify this.
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Affiliation(s)
- Julie Boisclair Demarble
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - D S Moskowitz
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Bianca D'Antono
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychology, Université de Montréal, Montreal, Quebec, Canada.
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Abstract
OBJECTIVE To examine multiple aspects of anger experience and expression (frequency, outward expression, suppression, and control) as moderators of the association of social inequality, as measured by educational status, with inflammation and coagulation markers. METHODS After survey assessments via telephone and mail, Midlife in the United States respondents (N = 1054) participated in an overnight clinic visit, where they completed anger questionnaires and provided a fasting blood sample to measure interleukin-6 (IL-6), C-reactive protein (CRP), and fibrinogen. RESULTS Educational status was linked to higher anger control among men (B = 0.14, p = .001). Significant inverse correlations emerged between education and IL-6, CRP, and fibrinogen (r values ≥ -0.09, p values <.004) and between anger control and IL-6 and CRP (r values = -0.07, p values < .03). Controlling for demographic and health status covariates, anger-in predicted lower fibrinogen (p = .03). Interactions between education and anger measures were significant for education and trait anger as related to fibrinogen (p = .02) and education and anger-out as related to IL-6 (p = .05) and fibrinogen (p = .05). As predicted, the inverse relationships between education and IL-6 and fibrinogen were stronger among individuals reporting high anger. Anger control also moderated the association of education with IL-6 in women (p = .026), such that the link between education and IL-6 was attenuated among women with high anger control. CONCLUSIONS Varieties of anger moderated educational gradients in inflammation: The inverse relationships between education and inflammation markers were strongest among individuals with high anger and were attenuated among those with high anger control.
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