A test of the psychosocial vulnerability and health behavior models of hostility: results from an 11-year follow-up study of Mexican Americans

Links between Couples' Cynical Hostility and Mental Health: A Dyadic Investigation of Older Couples

Whereas sharing a life with someone with high cynical hostility can be straining, little is known about how partner's cynical hostility is associated with one's mental health. In this paper, we report the findings from a longitudinal dyadic study using two waves of a large and representative American sample of older adults and their spouses to examine how one's own and their spouse's cynical hostility longitudinally affect anxiety and depressive symptoms. Results from APIM analyses suggest that both husbands' and wives' anxiety and depressive symptoms were negatively associated with their own cynical hostility, both within each time point and longitudinally. Partners' cynical hostility, however, predicted only husbands' mental health cross-sectionally. Furthermore, a moderating effect was identified, although it was not consistently observed across all analyses. Specifically, when a partner's cynical hostility was high, the association between one's own cynical hostility and their mental health was stronger, especially for women. Theoretical and practical implications are discussed.

Older Parents' Cynical Hostility and Their Relationships with Their Adult Children: A Longitudinal Dyadic Study of North American Couples

Older adults' relationships with their children are often a source of reciprocal emotional and instrumental support, but also of strain. Cynical hostility is a cognitive schema, according to which people cannot be trusted. Previous studies showed that cynical hostility has adverse implications for social relationships. Little is known about the possible outcomes of parental cynical hostility on older adults' relationships with their children. Two waves of the Health and Retirement Study and Actor-Partner Interdependence Models were used to examine the way spouses' cynical hostility at Time 1 is associated with their own and their spouse's relationship with the children at Time 2. Both partners' cynical hostility predicts his or her own strain in the relationship with the children, and for husbands, their spouse's cynical hostility also predicts strain. For husbands only, their own cynical hostility is associated with reduced perceived support from their children. Finally, a husband's cynical hostility is associated with both partners' reduced contact with their children. These findings illuminate the social and familial costs of cynical hostility in old age, suggesting that older adults with higher levels of cynical hostility may be more susceptible to strained relationships with their children.

Association between cynical hostility and temporomandibular pain mediated through somatization and depression: an 11-year follow-up study on Finnish adults

BACKGROUND

Hostility is believed to have an adverse effect on physical health through mediating psychosocial factors.

OBJECTIVES

This study aimed to investigate the association of hostility with temporomandibular (TMD) pain. Another aim was to investigate if the association is mediated through increases in depressiveness and somatization in an 11-year follow-up on Finnish adults, based on the Health 2000 and 2011 Surveys (BRIF8901).

MATERIAL AND METHODS

The sample comprised subjects who underwent clinical TMD pain examination (pain on palpation of the masticatory muscles and temporomandibular joints) in 2000 and 2011 and responded to questions on TMD pain symptoms in 2011. Hostility was measured using the Cynical Distrust Scale, somatization was measured using the Symptom Checklist-90, and depressiveness using Beck's Depression Inventory-21. Four subgroups were formed based on the presence of TMD pain: no pain, pain in 2000 only, pain in 2011 only, and pain in 2000 and 2011. Analyses included chi-square test cross-sectionally, and multinomial logistic regression longitudinally with the level of hostility in 2000 as the predictor. Mediation analysis was performed using Hayes' Process v3.5.

RESULTS

Those with higher hostility showed a higher prevalence of TMD pain. Longitudinally, the association of hostility with TMD pain in 2000 only, and with TMD pain in both years, was mediated either by somatization only or by depressiveness that was mediated by somatization. In those with TMD pain in 2011 only, the association was mediated by depressiveness that was mediated by somatization.

CONCLUSION

Hostility increased the risk of TMD pain through increases in depressiveness and somatization.

Development and evaluation of an online intervention for reducing hostile interpretation bias: A randomized controlled trial

Hostility is a trait-level construct characterized by a generally suspicious and cynical view of other people that results in a tendency to interpret ambiguous social situations in hostile or threatening ways. Cognitive behavioral treatments for hostility have high dropout rates, which may be due to hostile beliefs interfering with treatment engagement. As such, there is a need for an alternative approach to prevent dropout and enhance engagement. The current study therefore developed and tested a 1-session, 40-minute online intervention targeting hostility. It was hypothesized that the hostility intervention would be rated as acceptable as indexed by self-report and completion rates. It was also hypothesized that the hostility intervention would be associated with greater reductions in hostility as compared to a control intervention. Finally, it was hypothesized there would be indirect effects of intervention condition on anger and aggression via changes in hostility. Undergraduates (N = 101) who reported elevated hostility and hazardous alcohol use were randomized to complete either the hostility intervention or a control condition targeting physical health habits. Results showed that individuals randomized to the hostility intervention found the intervention to be highly acceptable and all participants completed the intervention in its entirety. The hostility intervention was associated with significantly faster reductions in hostile interpretations than the control condition with medium to large effects. There were significant indirect effects of intervention condition on month one follow-up anger and aggression via changes in hostile cognitions. This proof-of-concept study provides initial evidence that a brief, single-session intervention may be a promising approach for reducing hostility and its correlates.

Psychosocial Underpinnings of Pain and Sleep Disturbance in Safety-Net Primary Care Patients

Objective

The aim of this study was to uncover possible psychosocial underpinnings of pain and sleep disturbance in a safety-net primary care sample.

Methods

Patients (n = 210) awaiting care in a safety-net primary care clinic waiting room completed measures of cynical hostility, social support, mental health, sleep disturbance, and pain. This study was cross-sectional and observational.

Results

A structural equation model suggested that higher cynical hostility was associated with lower social support, which in turn was associated with poorer mental health, which then corresponded with higher pain and sleep disturbance. All possible indirect (mediational) effects within this model were statistically significant, suggesting a possible route through which cynical hostility may shape pain and sleep, two common presenting problems in primary care.

Conclusions

These findings illustrate the interplay of psychosocial factors with chronic pain and sleep disturbance in a sample of low-income, predominantly African-American patients seeking care at a safety-net primary care clinic. The findings support integrated primary care as a way to target not only behavioral health issues but also the psychosocial factors entangled with physical health.

An Investigation of Treatment Engagement Among Returning Veterans With Problematic Anger

Anger is a commonly reported problem among returning veterans, yet little attention has been devoted to studying treatment engagement among veterans who report anger problems but do not have posttraumatic stress disorder (PTSD). This study compares Iraq-Afghanistan veterans with anger/no PTSD (n = 159) to others reporting significant PTSD symptoms (n = 285) and those reporting neither anger nor PTSD (n = 716) on rates of treatment utilization, perceived barriers to treatment, and preferences for care. Relative to the PTSD group, the anger/no-PTSD group was significantly less likely to have received mental health treatment in the last year, despite endorsing barriers to treatment at a lower rate. Furthermore, the anger/no-PTSD group endorsed fewer preferences than the PTSD group. Results suggest that the anger/no-PTSD group is a unique subgroup that may be less likely to identify a need for treatment. Implications are discussed.

Hostility and quality of life among Hispanics/Latinos in the HCHS/SOL Sociocultural Ancillary Study

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.

A Longitudinal Study of Perceived Health during Pregnancy

Perceived health was studied longitudinally in a sample of 364 nulliparous women. Psychosocial, contextual, and biomedical factors were taken into account to predict medically relevant versus benign symptoms which were then used to predict perceived health over time. The results of structural equation modeling showed that pregnancy adjustment and medically relevant symptoms which were affected by social support, perceived stress, and negative affect predicted later perceived health. The outcomes of perceived health were examined during the third trimester in terms of medical care utilization and emergency room visits. Perceived health solely accounted for medical care utilization, while emergency room visits were accounted by medical care utilization and perceived stress.

Psychological and cognitive determinants of mortality: Evidence from a nationally representative sample followed over thirty-five years

Growing evidence suggests that psychological factors, such as conscientiousness and anger, as well as cognitive ability are related to mortality. Less is known about 1) the relative importance of each of these factors in predicting mortality, 2) through what social, economic, and behavioral mechanisms these factors influence mortality, and 3) how these processes unfold over long periods of time in nationally-representative samples. We use 35 years (1972-2007) of data from men (ages 20-40) in the Panel Study of Income Dynamics (PSID), a nationally representative sample in the United States, and discrete time event history analysis (n = 27,373 person-years) to examine the importance of measures of follow-through (a dimension of conscientiousness), anger, and cognitive ability in predicting mortality. We also assess the extent to which income, marriage, and smoking explain the relationship between psychological and cognitive factors with mortality. We find that while follow-through, anger, and cognitive ability are all associated with subsequent mortality when modeled separately, when they are modeled together and baseline demographic characteristics are controlled, only anger remains associated with mortality: being in the top quartile for anger is associated with a 1.57 fold increase in the risk of dying at follow-up compared with those in the bottom quartile. This relationship is robust to the inclusion of income, marriage, and smoking as mediators.

Measuring Hostile Interpretation Bias: The WSAP-Hostility Scale

Hostile interpretation biases are central to the development and maintenance of anger, yet have been inconsistently assessed. The Word Sentence Association Paradigm (WSAP) was used to develop a new measure of hostile interpretation biases, the WSAP-Hostility. Study 1 examined the factor structure and internal consistency of the WSAP-Hostility, as well as its relationship with trait anger. Study 2 provided convergent and divergent validity data by examining its associations with trait anger, aggression, depression, and anxiety. Study 3 examined the relationship between WSAP-Hostility and another measure of hostile interpretation biases, as well as another word sentence association measure, in a sample of community participants. Study 4 also used a sample of community participants to offer further evidence of convergent validity. Across the studies, the WSAP-Hostility demonstrated convergent and divergent validity and internal consistency, supporting its use as a measure of hostile interpretation biases.

The relation between hostility and concurrent levels of inflammation is sex, age, and measure dependent

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.

An examination of the relationship between anger and suicide risk through the lens of the interpersonal theory of suicide

Research has implicated a relationship between anger and suicidality, though underlying mechanisms remain unclear. The current study examined this relationship through the lens of the interpersonal theory of suicide (ITS). According to the ITS, individuals who experience thwarted belongingness, perceived burdensomeness, and elevated acquired capability for suicide are at increased risk for death by suicide. The relationships between anger and these variables were examined and these variables were examined as potential mediators between anger and suicidal ideation and behavior. Additionally, exposure to painful and provocative events was examined as a potential mediator between anger and acquired capability. As part of intake at a community mental health clinic, 215 outpatients completed questionnaires assessing depression, suicidal ideation, anger, perceived burdensomeness, thwarted belongingness, and acquired capability. Regression analyses revealed unique relationships between anger and both thwarted belongingness and perceived burdensomeness, covarying for depression. The association between anger and acquired capability trended toward significance. The links between anger and suicidal ideation and behavior were fully mediated by thwarted belongingness and perceived burdensomeness, but this effect was driven by perceived burdensomeness. Additionally, the link between anger and acquired capability was fully mediated by experience with painful and provocative events. In conclusion, results suggest that anger is uniquely associated with perceived burdensomeness and thwarted belongingness. Anger is associated with suicidal ideation and behavior via perceived burdensomeness and with greater acquired capability for suicide via experiences with painful and provocative events. Treatment for problematic anger may be beneficial to decrease risk for suicide.

Effects of interpretation training on hostile attribution bias and reactivity to interpersonal insult

Research suggests that individuals high in anger have a bias for attributing hostile intentions to ambiguous situations. The current study tested whether this interpretation bias can be altered to influence anger reactivity to an interpersonal insult using a single-session cognitive bias modification program. One hundred thirty-five undergraduate students were randomized to receive positive training, negative training, or a control condition. Anger reactivity to insult was then assessed. Positive training led to significantly greater increases in positive interpretation bias relative to the negative group, though these increases were only marginally greater than the control group. Negative training led to increased negative interpretation bias relative to other groups. During the insult, participants in the positive condition reported less anger than those in the control condition. Observers rated participants in the positive condition as less irritated than those in the negative condition and more amused than the other two conditions. Though mediation of effects via bias modification was not demonstrated, among the positive condition posttraining interpretation bias was correlated with self-reported anger, suggesting that positive training reduced anger reactivity by influencing interpretation biases. Findings suggest that positive interpretation training may be a promising treatment for reducing anger. However, the current study was conducted with a non-treatment-seeking student sample; further research with a treatment-seeking sample with problematic anger is necessary.

Absence of somatization in non-coeliac gluten sensitivity

OBJECTIVE

In contrast to coeliac disease (CD), the mechanism behind non-coeliac gluten sensitivity (NCGS) is unclear. The aims of the study were to measure the presence of somatization, personality traits, anxiety, depression, and health-related quality of life in NCGS individuals compared with CD patients and healthy controls, and to compare the response to gluten challenge between NCGS and CD patients.

MATERIAL AND METHODS

We examined 22 CD patients and 31 HLA-DQ2+ NCGS patients without CD, all on a gluten-free diet. All but five CD patients were challenged orally for 3 days with gluten; symptom registration was performed during challenge. A comparison group of 40 healthy controls was included. Patients and healthy controls completed questionnaires regarding anxiety, depression, neuroticism and lie, hostility and aggression, alexithymia and health locus of control, physical complaints, and health-related quality of life.

RESULTS

The NCGS patients reported more abdominal (p = 0.01) and non-abdominal (p < 0.01) symptoms after gluten challenge than CD patients. There were no significant differences between CD and NCGS patients regarding personality traits, level of somatization, quality of life, anxiety, and depressive symptoms. The somatization level was low in CD and NCGS groups. Symptom increase after gluten challenge was not related to personality in NCGS patients.

CONCLUSIONS

NCGS patients did not exhibit a tendency for general somatization. Personality and quality of life did not differ between NCGS and CD patients, and were mostly at the same level as in healthy controls. NCGS patients reported more symptoms than CD patients after gluten challenge.

Cognitive hostility predicts all-cause mortality irrespective of behavioural risk at late middle and older age

BACKGROUND

Most but not all evidence supports hostility-related attributes to increase mortality risk. However, studies usually include single attributes, their effects have been studied predominantly in younger populations, and behavioural pathways explaining the mortality effect seem to differ by age. We examined the relationship between all-cause mortality and cognitive hostility, anger, aggression and rebelliousness, and their independence of health behaviours in a late middle-aged and older population.

METHODS

Data were derived from the longitudinal Dutch Study of Medical Information and Lifestyles in the city of Eindhoven, in the Southeast of the Netherlands study among 2679 late middle-aged and older Dutch people. Psychological characteristics were self-reported in 2004/2005, and mortality was monitored from 2005 to 2010. Cox regression analyses were used to calculate the mortality risk by each unique psychological variable with additional adjustments for the other psychological variables and for health behaviours. Baseline adjustments included age, sex, educational level and prevalent morbidity.

RESULTS

Cognitive hostility was associated with all-cause mortality, independent of health behaviours (on a scale ranging from 6 to 30, the hazard ratio (HR) was 1.05; 95% confidence interval [95% CI): 1.01-1.09]. Anger, aggression and rebelliousness were not associated with mortality risk.

CONCLUSIONS

In diminishing excess mortality risks, hostile cognitions might be acknowledged separately and additionally to the risk posed by unhealthy lifestyles.

Delineating a relationship between problematic anger and cigarette smoking: a population-based study

BACKGROUND

Research implicates a potentially important relationship between anger and smoking, though extant work suffers from a number of limitations, including the absence of controls for psychiatric comorbidity and the use of treatment-seeking samples. The current study sought to examine the unique associations between problematic anger and smoking behavior in a large representative sample.

METHODS

Participants included 5,692 adults from the National Comorbidity Survey-Replication, a nationally representative survey. Assessments of psychiatric diagnoses, smoking behavior, and problematic anger were administered.

RESULTS

Results indicated that problems of anger experience were significantly associated with past-year daily smoking, heavy smoking, and nicotine dependence. After controlling for demographics and psychiatric comorbidity, anger experience was uniquely associated with each of these outcomes. Anger experience also was uniquely associated with lifetime history of smoking cessation failure.

CONCLUSIONS

Overall, these population-based data suggest an important relationship between problematic anger and numerous aspects of smoking behavior.

Negative aspects of close relationships as a predictor of increased body mass index and waist circumference: the Whitehall II study

OBJECTIVES

We investigated whether exposure to negative aspects of close relationships was associated with subsequent increase in body mass index (BMI) and waist circumference.

METHODS

Data came from a prospective cohort study (Whitehall II) of 9425 civil servants aged 35 to 55 years at baseline (phase 1: 1985-1988). We assessed negative aspects of close relationships with the Close Persons Questionnaire (range 0-12) at phases 1 and 2 (1989-1990). We measured BMI and waist circumference at phases 3 (1991-1994) and 5 (1997-1999). Covariates at phase 1 included gender, age, marital status, ethnicity, BMI, employment grade, smoking, physical activity, fruit and vegetable consumption, and common mental disorder.

RESULTS

After adjustment for sociodemographic characteristics and health behaviors, participants with higher exposure to negative aspects of close relationships had a higher likelihood of a 10% or greater increase in BMI and waist circumference (odds ratios per 1-unit increase 1.08 [95% confidence interval (CI) =1.02, 1.14; P = .007] and 1.09 [CI = 1.04, 1.14; P ≤ .001], respectively) as well as a transition from the overweight (25 ≤ BMI  < 30) to the obese (BMI  ≥ 0) category.

CONCLUSIONS

Adverse social relationships may contribute to weight gain.

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 9years 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.

Hostility now, depression later? Longitudinal associations among emotional risk factors for coronary artery disease

BACKGROUND/PURPOSE

Given that emotional risk factors for coronary artery disease (CAD) tend to cluster within individuals, surprisingly little is known about how these negative emotions might influence one another over time. We examined the longitudinal associations among measures of depressive symptoms and hostility/anger in a cohort of 296 healthy, older adults.

METHODS

Participants completed the Beck Depression Inventory-II (BDI-II), Cook-Medley Hostility (Ho) scale, and Anger-In and Anger-Out subscales of the State-Trait Anger Expression Inventory at baseline and 6-year follow-up. We conducted a series of path analyses to evaluate the directionality of the depression-hostility/anger relationship.

RESULTS

Baseline Ho scale was a predictor of 6-year increases in BDI-II (beta = 0.15, p = 0.004), Anger-In (beta = 0.14, p = 0.002), and Anger-Out (beta = 0.11, p = 0.01). In contrast, baseline BDI-II, Anger-In, and Anger-Out did not predict change in any of the emotional variables. Additional path analytic models revealed that the pattern of relationships was not altered after controlling for demographic, biomedical, and behavioral covariates; anxiety symptoms; social support; and subjective sleep quality.

CONCLUSIONS

The present results suggest that the cognitive aspects of hostility/anger may precede and independently predict future increases in depressive symptoms but not vice versa. Our findings lead us to speculate that (a) hostility may exert part of its cardiotoxic influence by acting to precipitate and/or maintain symptoms of depression and that (b) the potency of depression interventions designed to improve cardiovascular outcomes might be enhanced by incorporating treatments addressing hostility.

Posttraumatic stress disorder, cardiovascular, and metabolic disease: a review of the evidence

BACKGROUND

Posttraumatic stress disorder (PTSD) is a significant risk factor for cardiovascular and metabolic disease.

PURPOSE

The purpose of the current review is to evaluate the evidence suggesting that PTSD increases cardiovascular and metabolic risk factors, and to identify possible biomarkers and psychosocial characteristics and behavioral variables that are associated with these outcomes.

METHODS

A systematic literature search in the period of 2002-2009 for PTSD, cardiovascular disease, and metabolic disease was conducted.

RESULTS

The literature search yielded 78 studies on PTSD and cardiovascular/metabolic disease and biomarkers.

CONCLUSIONS

Although the available literature suggests an association of PTSD with cardiovascular disease and biomarkers, further research must consider potential confounds, incorporate longitudinal designs, and conduct careful PTSD assessments in diverse samples to address gaps in the research literature. Research on metabolic disease and biomarkers suggests an association with PTSD, but has not progressed as far as the cardiovascular research.

The moderating effects of gender on the associations between multidimensional hostility and psychosomatic symptoms: a Chinese case

The purpose of this study was to examine the effects of gender on the relationship between multidimensional hostility and psychosomatic symptoms in Chinese culture. The participants in this study were 398 Chinese college students (40% female) recruited from Taiwan. Four dimensions of multidimensional hostility-hostility cognition, hostility affect, expressive hostility behavior, and suppressive hostility behavior-were measured by the Chinese Hostility Inventory. After controlling for the effects of depression and anxiety, the results of path analysis revealed that the multidimensional hostility predicted psychosomatic symptoms directly, and predicted psychosomatic symptoms indirectly through negative health behavior. Furthermore, gender moderated the relationships between multidimensional hostility and health outcomes. Expressive hostility exacerbated psychosomatic symptom in females but buffered it in males, while affective hostility exacerbated psychosomatic symptoms in males. Additionally, suppressive hostility behavior was correlated to psychosomatic symptoms indirectly through negative health behavior in females. Moreover, expressive hostility was correlated to psychosomatic symptoms indirectly through negative health behavior more in males than in females.

Sense of coherence and recovery from major depression: a 4-year follow-up

The aim of this longitudinal exploratory study was to identify and follow persons with the first episode of major depression (MD) to determine whether sense of coherence (SOC) changes over time. An additional purpose was to assess whether SOC is associated with depressive symptoms, aggression, and functional status either immediately after diagnosis or at 4 years postdiagnosis. The study design was longitudinal; participants participated in semistructured interviews and completed surveys every 6 months starting at diagnosis and concluding 4 years later. The sample consisted of 33 adult patients who were being treated for the first episode of MD according to the Diagnostic and Statistical Manual of Mental Disorders. Twenty-two participants completed all nine sessions. SOC was measured using the SOC scale; depressive symptoms using the Montgomery Asberg Depression Rating Scale; aggression, including the total score and subscales of anger and hostility, using the Aggression Questionnaire-revised Swedish version; and functional status using the Global Assessment of Functioning (GAF) scale and the 36-item Short-Form Health Survey (SF-36). At baseline, SOC was significantly correlated with total aggression (r = -45) and the hostility subscale (r = -.73); baseline SOC was unrelated to depressive symptoms or functional status. SOC increased significantly over time (P < .0001). At the 4-year follow-up, SOC was significantly related to depressive symptoms (r = -.60), the aggression summary score (r = -.65), the anger subscale (r = -.52), the hostility subscale (r = -.77), the GAF (r = .64), and the physical and mental health components of the SF-36 (r = .74 and .72, respectively). The finding that SOC increases as patients recover from MD suggests that treatment of depression may also bolster the patient's ability to cope, in addition to lowering depressive symptoms. The relationship between SOC and aggression in MD, with higher SOC correlated with lower aggression, needs to be examined further.

The INSPIRE study: do personality traits predict general quality of life (Short form-36) in distressed patients with ulcerative colitis and Crohn's disease?

OBJECTIVE

To assess the role of personality as a predictor of Short form-36 (SF-36) in distressed patients (perceived stress questionnaire, PSQ) with ulcerative colitis (UC) and Crohn's disease (CD).

MATERIAL AND METHODS

Fifty-four patients with CD and 55 with UC (age 18-60 years) who had relapsed in the previous 18 months, i.e. with an activity index (AI) for UC or CD> or =4, PSQ> or =60, and without severe mental or other major medical conditions, completed the Buss-Perry Aggression Questionnaire (BPA), the Neuroticism and Lie scales of the Eysenck Personality Questionnaire (EPQ-N and -L), the Multidimensional Health Locus of Control Scale (LOC) (Internal (I), Powerful Other (PO), Chance (C)), the Toronto Alexithymia Scale (TAS) and the SF-36.

RESULTS

Multiple linear regression analyses controlling for gender, age and clinical disease activity (AI) in separate analyses for UC and CD showed that the mental and vitality subscales were predicted by neuroticism in both UC and CD. The highest explained variance was 43.8% on the "mental" subscale in UC. The social function subscale was related to alexithymia only in UC, while the role limitation and pain subscales were related to personality in CD only. The physical function subscale related differently to personality in UC and CD.

CONCLUSIONS

While mental and vitality subscales were predicted by neuroticism in both UC and CD, other subscales had different relationships to personality, suggesting different psychobiological interactions in UC and CD.

The psychosocial vulnerability model of hostility as a predictor of coronary heart disease in low-income African Americans

The current study examined social support and stress as mediators of the hostility-coronary heart disease (CHD) relationship as suggested by the psychosocial vulnerability model in a sample of low-income African Americans. Among 95 CHD patients and 30 healthy controls, hostility was negatively correlated with social support, but was not related to minor stress. CHD patients endorsed higher levels of hostility; however, the relationship between hostility and CHD status was diminished once stress and social support were included in the model. This study lends partial support for the psychosocial vulnerability model of hostility in African Americans, but suggests that the relationship between hostility and stress may be impacted by socioeconomic status.

The INSPIRE study: are different personality traits related to disease-specific quality of life (IBDQ) in distressed patients with ulcerative colitis and Crohn's disease?

BACKGROUND

To explore the relationship between personality and disease-specific quality of life [Inflammatory Bowel Disease Questionnaire (IBDQ)] in distressed [Perceived Stress Questionnaire (PSQ)] patients with ulcerative colitis (UC) and Crohn's disease (CD).

METHODS

Included in the study were 56 patients with UC and 54 patients with CD ranging in age from 18 to 60 years with a relapse in the previous 18 months, a UC or CD activity index 4, a PSQ 60, and without serious mental or other serious medical condition. The patients completed the Buss-Perry Aggression Questionnaire, the Neuroticism and Lie (social conformity/desirability) scales of the Eysenck Personality Questionnaire, the Multidimensional Health Locus of Control (LOC) Scale [Internal (I), Powerful Other (PO), Chance (C)], the Toronto Alexithymia Scale, and the IBDQ.

RESULTS

In linear regression controlling for sex, education (years), and clinical disease activity (AI) in separate analyses of UC and CD patients, higher IBDQ score was related to less social conformity in CD and less neuroticism in UC; higher emotional function score was related to less neuroticism in both CD and UC and less PO-LOC in UC. Higher social function score was related to less social conformity in CD and lower I-LOC and PO-LOC in UC. Bowel function and systemic symptoms were unrelated to personality in either UC or CD.

CONCLUSIONS

Although the emotional function subscale was related to neuroticism in both UC and CD, the social function subscale and total IBDQ were related to different personality traits in UC and CD. Personality traits should be taken into account when using IBDQ in studies.

Does personality predict mortality? Results from the GAZEL French prospective cohort study

BACKGROUND

Majority of studies on personality and physical health have focused on one or two isolated personality traits. We aim to test the independent association of 10 personality traits, from three major conceptual models, with all-cause and cause-specific mortality in the French GAZEL cohort.

METHODS

A total of 14,445 participants, aged 39-54 in 1993, completed the personality questionnaires composed of the Bortner Type-A scale, the Buss-Durkee Hostility Inventory (for total, neurotic and reactive hostility) and the Grossarth-Maticek-Eysenck Personality Stress Inventory that assesses six personality types [cancer-prone, coronary heart disease (CHD)-prone, ambivalent, healthy, rational, anti-social]. The association between personality traits and mortality, during a mean follow-up of 12.7 years, was assessed using the Relative Index of Inequality (RII) in Cox regression.

RESULTS

In models adjusted for age, sex, marital status and education, all-cause and cause-specific mortality were predicted by 'total hostility', its 'neurotic hostility' component as well as by 'CHD-prone', 'ambivalent' 'antisocial', and 'healthy' personality types. After mutually adjusting personality traits for each other, only high 'neurotic hostility' remained a robust predictor of excess mortality from all causes [RII = 2.62; 95% confidence interval (CI) = 1.68-4.09] and external causes (RII = 3.24; 95% CI = 1.03-10.18). 'CHD-prone' (RII = 2.23; 95% CI = 0.72-6.95) and 'anti-social' (RII = 2.13; 95% CI 0.61-6.58) personality types were associated with cardiovascular mortality and with mortality from external causes, respectively, but CIs were wider. Adjustment for potential behavioural mediators had only a modest effect on these associations.

CONCLUSIONS

Neurotic hostility, CHD-prone personality and anti-social personality were all predictive of mortality outcomes. Further research is required to determine the precise mechanisms that contribute to these associations.

The Cognitive Basis of Trait Anger and Reactive Aggression: An Integrative Analysis

Cognitive processing approaches to personality have gained momentum in recent years, and the present review uses such a cognitive approach to understand individual differences in anger and reactive aggression. Because several relevant cognitive models have been proposed in separate literatures, a purpose of this review is to integrate such material and evaluate the consistency of relations obtained to date. The analysis reveals that processes related to automatic hostile interpretations, ruminative attention, and effortful control appear to be important contributors to individual differences in angry reactivity. Memory accessibility processes, by contrast, failed to exhibit a consistent relationship with trait anger. This review concludes with the proposal of an integrative cognitive model of trait anger and the discussion of several broader issues, including the developmental origins of cognitive processing patterns and plausible links to temperament-based perspectives.

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.

Posttraumatic stress disorder, hostility, and health in women: a review of current research

A large body of evidence indicates that hostility is related to increased morbidity and mortality and evidence is growing that posttraumatic stress disorder (PTSD) is associated with poorer health outcomes. The majority of this research, however, has been conducted in male samples. As a result, the connections between PTSD and hostility and the ramifications of these variables on health in women are less clear. We review the current literature examining PTSD, hostility, and health in women and discuss possible mechanisms underlying the relationship between PTSD and hostility on health outcomes in the context of a proposed theoretical model. Although the current literature suggests that hostility and PTSD are related to health in women, more rigorous, focused research is lacking. A number of suggestions for future research are provided.

Understanding the association between socioeconomic status and physical health: do negative emotions play a role?

In this article, the authors evaluate the possible roles of negative emotions and cognitions in the association between socioeconomic status (SES) and physical health, focusing on the outcomes of cardiovascular diseases and all-cause mortality. After reviewing the limited direct evidence, the authors examine indirect evidence showing that (a) SES relates to the targeted health outcomes, (b) SES relates to negative emotions and cognitions, and (c) negative emotions and cognitions relate to the targeted health outcomes. The authors present a general framework for understanding the roles of cognitive-emotional factors, suggesting that low-SES environments are stressful and reduce individuals' reserve capacity to manage stress, thereby increasing vulnerability to negative emotions and cognitions. The article concludes with suggestions for future research to better evaluate the proposed model.

Self-assessed health and mortality: could psychosocial factors explain the association?

BACKGROUND

The single-item question of self-assessed health has consistently been reported to be associated with mortality, even after controlling for a wide range of health measurements and known risk factors for mortality. It has been suggested that this association is due to psychosocial factors which are both related to self-assessed health and to mortality. We tested this hypothesis.

METHODS

The study was carried out in a subsample (n = 5667) of the GLOBE-population, a prospective cohort study conducted in the southeastern part of the Netherlands. Data on self-assessed health, sociodemographic variables, various aspects of health status, behavioural risk factors, and a number of psychosocial factors (social support, psychosocial stressors, personality traits, and coping styles) were collected by postal survey and structured interview in 1991, and mortality data were collected between 1991 and 1998. Cox proportional hazards analyses were used to calculate the association between self-assessed health and mortality, before and after controlling for the psychosocial variables.

RESULTS

After controlling for sociodemographic variables, various aspects of health status, and behavioural risk factors, self-assessed health is still strongly associated with mortality in our dataset (Relative Risk [RR] of dying for 'poor' versus 'very good' self-assessed health = 3.98; 95% CI: 1.65-9.61). After controlling for the same set of confounders, many of the psychosocial variables are statistically significantly associated with a 'less-than-good' self-assessed health, particularly instrumental social support, long-lasting difficulties, neuroticism, and locus of control. However, only 'disclosure of emotions'-coping style has a statistically significant relationship with mortality. Adding the psychosocial variables to a model already containing self-assessed health does not attenuate the association between self-assessed health and mortality.

CONCLUSIONS

We did not find indications that the association between self-assessed health and mortality is due to the psychosocial factors included in this analysis. It seems likely that the unexplained mortality effects of self-assessed health are due to the fact that self-assessed health is a very inclusive measure of health reflecting health aspects relevant to survival which are not covered by other health indicators.

Psychosocial vulnerability, hostility, and family history of coronary heart disease among male and female college students

This study evaluated the utility of the psychosocial vulnerability model for understanding the hostility-coronary heart disease (CHD) relationship among college students at risk for CHD. Interrelationships of cognitive, affective, and behavioral hostility with structural and functional social support were examined. College undergraduates with a parental history of CHD (n = 121) and a control group of 125 students with no CHD family history completed measures of hostility and social support. Among women, a significant negative correlation was found between affective-experiential hostility and functional support. Among men, a significant negative correlation was observed between cognitive-experiential hostility and structural support. Path analyses revealed a significant positive effect of expressive hostility on functional support for CHD-negative men and CHD-positive women. CHD family history was not associated with hostility or family environment. CHD-positive participants reported less support satisfaction than did CHD-negative participants. Thus, results indicated qualified support for the psychosocial vulnerability model of the hostility-CHD relationship.

Psychosocial influences on the development and course of coronary heart disease: current status and implications for research and practice

Psychosocial characteristics predict the development and course of coronary heart disease (CHD). In this review, the authors discussed human and animal research on psychophysiological mechanisms influencing coronary artery disease and its progression to CHD. They then reviewed literature on personality and characteristics of the social environment as risk factors for CHD. Hostility confers increased risk, and a group of risk factors involving depression and anxiety may be especially important following myocardial infarction. Social isolation, interpersonal conflict, and job stress confer increased risk. Psychosocial interventions may have beneficial effects on CHD morbidity and mortality, although inconsistent results and a variety of methodological limitations preclude firm conclusions. Finally, they discussed implications for clinical care and the agenda for future research.

Mental disorders as possible intrapsychic routes to remission. Part I: delusional and psychotic disorders

It is hypothesized in this article that delusional and psychotic disorder may be a route to survive and finally to remission when completed successful. The intrapsychic mechanism, or navigation system, that outlines this route takes into account (a) the mental and emotional limitations and vulnerabilities of the patients, and (b) hopelessness of the situation. It was speculated that cognitive and emotional capacities and associated neurobiological dysfunctions that are necessarily linked to delusional/psychotic disorders could be brought about by this intrapsychic mechanism in order to create an escape route which avoids the unbearable reality. When the patient has completed this traject successfully and the circumstances are favourable, the intrapsychic navigation system might restore his or her relevant cognitive and emotional abilities and related neurobiological functions so that the patient is ready for healthy development and remission.

Sense of coherence as a mediator between hostility and health: seven-year prospective study on female employees

OBJECTIVE

We proposed and tested a model in which low sense of coherence (SOC) was hypothesized to underlie the association between hostility and health problems.

METHODS

Structural equation modeling was based on cross-lagged 7-year follow-up data, relating to five measurement points in 433 female municipal employees.

RESULTS

The mediated model fitted well with the data. After adjustment for baseline characteristics, hostility was associated with increased risk of health problems, as indicated by records of sickness absences and poor self-rated health. Incorporating SOC into the model attenuated this association by 33-50%, depending on the indicator of health. The mediated effect of SOC was stronger than that of an alternative mediator, depressive symptoms.

CONCLUSION

Low SOC may be a psychological background factor partially underlying the adverse effect of hostility on ill health.

Effects of antisocial or social attitudes on neurobiological functions

Antisocial personality disorder is characterized by triats like a failure to conform to social norms, impulsivity, hostility, irritability and aggressiveness, recklessness, irresponsibility, criminality, a lack of guilt or remorse, and deceitfulness. A large number of investigations revealed that there is evidence for a neurobiological underpinning of antisocial behavior. The precise nature and causal aspects of the relationship between neurobiological abnormalities and antisocial behavior is still unknown. There is, however, some evidence that some antisocial patients are able to influence their neurobiological functions, which are related to sensation seeking, aggressiveness, impulsivity, criminality and a lack of fear (associated with an inability to learn from experiences). The author hypothesizes that a reduction of antisocial behavior/attitude, may consequently result in normalization of neurobiological functions, which are linked to specific attitudes and behavioral dimensions.

Assessment of hostility in patients with coronary heart disease

One of the problems in efforts to more clearly conceptualize hostility is the amount of method variance, which ranges from self-report techniques to interview-based methods and mirrors the multidimensional nature of hostility and related constructs. In addition, rather few studies concerned with the assessment of hostility have specifically used samples of coronary heart disease (CHD) patients. The purpose of this study was, therefore, to examine the multidimensionality of the construct of hostility in a sample of male coronary patients with some frequently used instruments. Factor analysis was used to detect the relevant underlying constructs, which were assessed using a variety of hostility measures in a sample of cardiac patients undergoing baseline assessment in an ongoing health-education intervention study. Measurement included both questionnaires and interviews. Participants (N = 235) were divided into 3 diagnostic groups: patients who had recently undergone (a) a myocardial infarction, (b) coronary artery bypass grafting, or (c) percutaneous transluminal coronary angioplasty. A 4-factor solution appeared to provide the best fit, and the following factors were isolated: Anger-Out, Negative Affect, Coping, and Anger-In. All intercorrelations were less than .50. Medical diagnosis did not differ with regard to the 4 factors found. The total hostility construct as measured by the structured interview (SI) did not fit into the 4-factor model. This study was the first to show that dimensions of anger and hostility constitute valid and relevant aspects of the general construct of hostility for a representative group of CHD patients. The 4 aspects of hostility isolated using some well-known hostility questionnaires and the SI explained most of the observed variance. Although the SI appeared to tap more general state anger, the 4 aspects of hostility may be differentially related to health in those who are coronary prone. Future studies on the role of hostile or negative emotions in CHD patients should, therefore, pay greater attention to the multidimensional nature of hostility and may clearly benefit from the use of the 4-factor model described in this article.

Social conditions and distress in elderly persons: findings from the MacArthur Studies of Successful Aging

The purpose of this study was to determine separate and joint associations of race/ethnicity and socioeconomic status (SES) with psychological distress among older high-functioning adults and to examine 2 psychosocial resources that may explain these associations. Participants were 70-79-year-old individuals (n = 1,189) participating in the MacArthur Studies of Successful Aging program, a 3-site study of community-dwelling men and women. Participants represented the top third of their peers in terms of functional ability in 1988. Additive and interactive models were used to examine cross-sectional associations among race/ethnicity, SES, and distress. Although decreases in distress generally occur with aging, findings suggest that social structural factors can influence distress even among elderly people. Blacks were less distressed than Whites when SES was controlled. There was a gradient between education and distress among Whites but not among Blacks. Measures of social support and control did not mediate effects of race/ethnicity on distress. These results differ from those of previous studies and indicate that age and functional status should be considered in examinations of relationships among race/ethnicity, SES, and distress.

Socioeconomic status, hostility, and risk factor clustering in the Normative Aging Study: any help from the concept of allostatic load?

OBJECTIVE

To examine the relationships between socioeconomic status (SES), psychosocial vulnerability (hostility), and allostatic load. Allostatic load refers to the cumulative physiological cost of adaptation to stress.

METHOD

We examined the relationships between SES (as measured by educational attainment), hostility, and allostatic load in the Normative Aging Study, a longitudinal study of community-dwelling men aged 21 to 80 years and free of known chronic medical conditions at entry in the 1960s. In 1986, the revised Minnesota Multiphasic Personality Inventory was administered by mail, from which a hostility measure was derived by summing the scores from three Cook-Medley subscales: Hostile Affect, Hostile Attribution, Aggressive Responding. An index of allostatic load was constructed from data collected during physical exams conducted between 1987 and 1990 (i.e. measures reflecting "wear and tear" on the cardiovascular, endocrine, and metabolic systems). Cross-sectional relationships between education, hostility, and allostatic load were examined in 818 men.

RESULTS

Separate linear regression analyses indicated that lower levels of educational attainment and greater hostility were both associated with higher allostatic load scores (p < .05 and p < .01, respectively). Less education was also associated with higher hostility (p < .001). When allostatic load was regressed simultaneously on education and hostility, the effect of education was attenuated, while hostility (p < .05) maintained an independent effect.

CONCLUSIONS

Our findings suggest that lower levels of education and greater hostility are associated with greater "wear and tear" on the body. The effects of education on allostatic load may be mediated by hostility.

Do negative emotions mediate the association between socioeconomic status and health?

In this chapter, we examine the possibility that negative emotions contribute to the relationship between socioeconomic status (SES) and health. A model of the associations among SES, emotion, and health is presented first. We then review the evidence for this model, showing associations of SES with depression, hopelessness, anxiety, and hostile affect and cognition, and of these negative emotions with disease. Notably, most of the data supporting the model provide only indirect evidence that negative emotions serve as a key contributor to the proposed associations. We, therefore, conclude with recommendations for longitudinal research, especially in children, that will more directly and comprehensively examine negative emotions as possible mediators of the SES and health relationship.

Hostility and cardiovascular reactivity during marital interaction

OBJECTIVE

Prior studies demonstrate that hostile persons respond to social stressors with heightened cardiovascular responses. This study examined the effects of individual differences in hostility and two experimentally manipulated social stressors on cardiovascular reactivity during marital interaction.

METHODS

Sixty couples participated in a discussion task under conditions of high or low evaluative threat and while either agreeing or disagreeing with each other. Individual differences in hostility were assessed with the Buss-Perry Aggression Questionnaire. Participants' appraisal of their spouses' behavior during the interaction task was assessed with a standardized measure. Systolic and diastolic blood pressure and heart rate responses were recorded.

RESULTS

Among husbands, hostility was associated with greater systolic blood pressure reactivity under high, but not low, threat. Appraisals suggested that this might be due to husbands' efforts to assert dominance in the interaction. Wives' hostility scores were unrelated to cardiovascular reactivity, but wives disagreeing with hostile husbands showed greater heart rate reactivity.

CONCLUSIONS

Heightened cardiovascular reactivity to stressful marital interactions among hostile men provides additional evidence of the viability of this psychophysiologic mechanism as a link between hostility and health. The lack of effects among wives suggests sex differences in the social psychophysiology of hostility. Interpersonal concepts and methods are useful in the study of psychosocial risk factors and mechanisms.