Hostile personality traits and coronary artery calcification in middle-aged and older married couples: different effects for self-reports versus spouse ratings

Partialing Alters Interpersonal Correlates of Negative Affective Symptoms and Traits: A Circumplex Illustration

INTRODUCTION

Negative affective symptoms (e.g., anxiety, depression, and anger) are correlated and have parallel associations with outcomes, as do related personality traits (i.e., facets of neuroticism), often prompting statistical control (i.e., partialing) to determine independent effects. However, such adjustments among predictor variables can alter their construct validity. In three studies, the interpersonal circumplex (IPC) and a related analytic approach (i.e., Structural Summary Method) were used to evaluate changes in interpersonal correlates of negative affective characteristics resulting from partialing.

METHODS

Samples of undergraduates (Sample 1 n = 3283; Sample 2 = 688) and married couples (n = 300 couples) completed self-report (three samples) and partner rating (sample 3) measures of anxiety, depression and anger, and IPC measures of interpersonal style.

RESULTS

Anxiety, depression, and anger had expected interpersonal correlates across samples. Partialing depression eliminated interpersonal correlates of anxiety. When anxiety was controlled, depression measures were more strongly associated with submissiveness and less closely associated with low warmth. Adjustments involving anger magnified differences in dominance versus submissiveness associated with the negative affects.

DISCUSSION

Removal of overlap among negative affective measures via partialing alters their interpersonal correlates, potentially complicating interpretation of adjusted associations.

Five-Factor Model Personality Disorder Traits, Health Behaviors, Health Perceptions, and Insomnia Symptoms in Older Adults

Personality traits predict physical health outcomes, including health behaviors, disease, and mortality. Maladaptive traits of personality disorders may predict even more variance in physical health indicators. Dimensional models of maladaptive personality traits are replacing categorical models of personality disorder, and the Five-Factor Model of personality disorder (FFMPD) is a useful dimensional model of maladaptive traits. However, there has been little work investigating the criterion validity of the FFMPD. The present study serves as a broad initial overview of the FFMPD scales in the prediction of health behaviors, heath perceptions, and insomnia symptoms across two time points in a representative community sample of older adults (N = 1,060). Findings indicate that the FFMPD scales explain a significant amount of variance in the physical health variables across time. Exploratory analyses indicate that the FFMPD traits have incremental validity over covariates, normal-range personality traits, and personality disorder criteria.

Physical Aggression and Coronary Artery Calcification: A North Texas Healthy Heart Study

BACKGROUND

The purpose of this study was to determine the association between aspects of hostility and coronary artery calcification (CAC) scores. Specifically, analyses differentiated between subtypes of hostility and their relation to CAC.

METHODS

A sample of 571 patients aged 45 or older with no history of cardiovascular disease completed assessments of demographic, psychosocial, and medical history, along with a radiological CAC determination. Logistic regression was used to determine the association between hostility and CAC. Hostility was measured using the Aggression Questionnaire, which measured total aggression and how aggression is manifested on four scales: Physical, Verbal, Anger, and Hostility Aggression.

RESULTS

Regression analyses indicated that only the physical aggression parameter was related to CAC: a 5% increase in odds of CAC presence was indicated for every point increase in physical aggression. The association remained significant in adjusted analyses. Other factors associated with CAC in adjusted analyses included: age, gender, race/ethnicity, BMI, and dyslipidemia.

CONCLUSIONS

Psychosocial factors, such as physical aggression, are emerging factors that need to be considered in cardiovascular risk stratification.

Should Strengthening Bonds Be a Public Health Priority?

Abstract. Background: Previous research demonstrates the importance of close relationships on our physical health. However, to what extent the quality of our social relationships impacts our health, relative to other important health behaviors (e.g., smoking, drinking alcohol, and physical exercise), is less clear. Aims: Our goal was to use a nationally representative sample of Canadian adults to assess the relative importance of the quality of one’s social relationships (close emotional bonds and negative social interactions), relative to important health behaviors on physical health outcomes previously linked to social relationship quality. Method: Data ( N = 25,113) came from the Canadian Community Health Survey in 2012, a cross-sectional survey administered by Statistics Canada (2013) . The predictor variables were the presence of close emotional bonds, negative social relationships, type of smoker, type of drinker, and weekly hours of physical activity. The outcome variables were a current or previous diagnosis of high blood pressure, cancer, stroke, reports of current illness or injury, pain, and self-reported physical health. Results: Using regressions, we found that negative social interactions were more important than other health behaviors in relation to current injury/illness and pain. Physical activity was most strongly related to self-rated health, followed by negative social interactions and then close emotional bonds. Alcohol consumption was more related to the prevalence of stroke. Conclusions: Our findings suggest that negative social interactions may be more related to acute or minor physical health conditions, but social relationships may not be more strongly related to more chronic, life-threatening health conditions than other health behaviors.

Anger and long-term mortality and ventricular arrhythmias in patients with a first-time implantable cardioverter-defibrillator: data from the MIDAS study

Aims

Psychosocial factors increase risk for incident heart disease and poor prognosis. In patients with an implantable cardioverter-defibrillator (ICD), negative emotions have been associated with increased mortality risk, although the association with ventricular arrhythmias (VAs) is less consistent. Anger has been linked to incident ICD shocks, but no prospective study has examined the association of anger (state and trait) with mortality or VAs in the ICD population. In a consecutively recruited cohort of first-time ICD patients, we examined the association of state and trait anger with 7-year mortality risk and time to first VA.

Methods and results

A consecutive cohort of patients implanted with a first-time ICD (n = 388; 80% men) between 2003 and 2010 completed the State-Trait Anger Scale and were followed for 7 years. Outcomes were mortality and time to first appropriate ICD therapy. State anger at the time of implant was associated with increased mortality risk in adjusted analyses, with a 1-point increase in score on the state anger measures associated with a 5% [hazard ratio 1.05; 95% confidence interval 1.01–1.09; P = 0.015] increased 7-year mortality risk. We found no statistically significant differences in mortality risk for trait anger, nor an effect for state or trait anger on time to first treated VA (all ps > 0.05).

Conclusion

This is the first study to examine the association of state and trait anger with long-term clinical outcomes in ICD patients. Evaluating anger reduction strategies in newly implanted ICD patients, such as self-regulation or mindfulness techniques, may be warranted for reducing mortality risk.

Association of psychosocial traits with coronary artery calcium development and progression: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Coronary artery calcium (CAC) is a well-established quantifiable risk factor for cardiovascular disease (CVD). We examined the association of anger, hostility, anxiety, and depression with the development and progression of CAC.

METHODS

We studied the association of these psychosocial traits with CAC among participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Anger was measured using the Spielberger Trait Anger questionnaire, hostility using a modified Cook-Medley Hostility questionnaire, anxiety using the Spielberger Trait Scale, and depression using the Center for Epidemiological Studies Depression Scale (CES-D). Among the subsample of participants with CAC = 0 at the beginning of the study period, Poisson regression models were used to determine the relative risk of developing CAC>0 over the study period. In the subsample that developed CAC>0, we used linear regression models to estimate the average increase in CAC associated with a unit increase in psychosocial trait.

RESULTS

Median time of follow-up was 9.4 years (range 8.0-11.4 years). Cross-sectional analyses at baseline revealed no association of any of the psychosocial traits with the presence or magnitude of CAC (anger: RR 0.98, p < 0.01; hostility: RR 1.01, p = 0.25; anxiety: RR 0.99, p < 0.01; depression: RR 0.99, p < 0.01 [not statistically significant after adjustment for covariates]). No association was detected between the traits and development of CAC (anger: RR 0.99, p = 0.23; hostility: RR 1.01, p = 0.68, anxiety: RR 1.00, p = 0.49; depression: RR 1.00, p = 0.51). We also found no association between any of the traits and progression of CAC (anger: beta -3.21, p = 0.08; hostility: beta 2.28, p = 0.43; anxiety: 3.45, p = 0.02 [not statistically significant after adjustment for covariates]; depression: beta -1.46, p = 0.11).

CONCLUSIONS

We found no association between anger, hostility, anxiety, or depression and CAC, suggesting these personality traits are not independent risk factors for CVD.

Neighborhood Stress and Life Satisfaction: Is there a Relationship for African American Adolescents?

This study identified associations between perceived neighborhood stress and adolescents' perceptions of life satisfaction. African American adolescents aged 13-18 (n=1,658) from four matched, mid-sized cities in the northeastern and southeastern USA, completed a self-report questionnaire using an audio computer-assisted self-interview (ACASI). Analyses examined relationships between perceived neighborhood stress and perceived life satisfaction, while controlling for socioeconomic status (SES). Life satisfaction was found to be related to neighborhood stress for both males and females, with variability in neighborhood stress characteristics and in the magnitude of associations by gender. Further research should identify the particular characteristics of youth and specific aspects of adolescent life satisfaction associated with perceived neighborhood stress to develop community-based and culturally-sensitive quality of life improvement/health promotion programs.

Borderline personality pathology and physical health: The role of employment

Borderline personality disorder (BPD) is associated with negative physical health outcomes. Clinical case studies suggest that employment status may buffer against the negative effects of BPD on physical health. The goal of the current study was to examine the interaction between BPD features and employment status in predicting subjective perceptions of physical health. We hypothesized that employment status would moderate the relationship between BPD features and physical health, such that individuals who are employed would exhibit a weaker negative relationship between BPD features and self- and informant ratings of physical health. We investigated this question using data from a community sample of 1,630 middle-aged to older adults participating in the St. Louis Personality and Aging Network, an ongoing study of personality, health, and aging. Results indicated that employment status and BPD features were significant predictors of both self- and informant ratings of physical health. Confirming our hypothesis, the interaction term contributed to a significant increase in the proportion of explained variance, suggesting that employment is associated with a weaker negative relationship between BPD features and physical health. These findings highlight the importance of examining occupational functioning in the long-term course of BPD and offer avenues for further research into moderators of the relationship between BPD features and physical health. (PsycINFO Database Record

The Role of Agonistic Striving in the Association Between Cortisol and High Blood Pressure

OBJECTIVE

A social action theory of chronic stress proposes that agonistic striving (seeking to influence or control others) impairs cardiovascular health by magnifying the impact of high adversity-induced cortisol levels on blood pressure. We tested three predictions of social action theory: (1) the social action theory taxonomy of regulatory strivings characterizes young adults from high-adversity neighborhoods; (2) high cortisol levels predict high blood pressure more reliably in the subgroup with the agonistic striving profile than in subgroups with other profiles; (3) the association of higher cortisol and higher blood pressure with agonistic striving is not explained by negative affect (depressive symptoms/dysphoria, anger, hostility).

METHODS

Participants were young adults (N = 198, mean [SD] age = 32 [3.4] years); 71% female; 65% black) from disadvantaged urban neighborhoods. Motive profiles (including agonistic strivings) were assessed using the Social Competence Interview. Cortisol levels were derived from saliva samples; blood pressure level was obtained during two days of ambulatory monitoring. Psychological measures of negative affect were assessed using questionnaires.

RESULTS

The predicted taxonomy of regulatory strivings was replicated in this sample; the interaction between cortisol and motive profile was significant (F(2, 91) = 6.72, p = .002); analyses of simple effects disclosed that higher cortisol levels predicted higher ambulatory blood pressure only in individuals who exhibited agonistic striving. Depressive symptoms/dysphoria, trait anger, and hostility were not correlated with agonistic striving, cortisol, or blood pressure.

CONCLUSIONS

Agonistic striving may represent a distinctive (and novel) social-cognitive mechanism of toxic stress and cardiovascular risk.

Incremental Validity of Self- and Informant Report of Personality Disorders in Later Life

Research shows moderate agreement between different sources of information when assessing personality disorders (PDs) in older adults. The differences between measurement methods appear to be not only the result of measurement error, but also an indication that each source holds nonredundant information relevant to PD diagnosis. The current article examines three sources of diagnostic information (self-report, informant report, and clinical interview) and the utility of these instruments in predicting important outcomes in older adulthood. We analyzed data from 1,630 adults between the ages of 55 and 64 years participating in a longitudinal study of later life. PD symptomatology was assessed using multiple methods, which were then used to predict health, marital satisfaction, and cognitive decline. All three sources contributed significantly to the prediction of these outcomes, with important implications for the assessment of older adults in research and clinical settings.

Marriage and Weight Loss Surgery: a Narrative Review of Patient and Spousal Outcomes

Long-term weight maintenance following weight loss surgery (WLS) may be challenging for patients without supportive spouses. The health behaviors and relationship quality of spouses pre- and post-WLS have rarely been explored, leaving providers with little guidance on how to engage spouses in treatment. The purpose of this review is to synthesize the empirical research on relationship factors and WLS among married couples. The identified articles (N = 13) reported that the amount of weight lost post-WLS tended to be lower for married patients, couples' relationship quality tended to decline from pre- to post-WLS, and sexual contact increased post-WLS. Future research should explore how the relationship factors and quality of couples may influence patients' WLS outcomes over time to identify ways that interventions can enhance the couple's relationship and health.

The Relationship between Expressive/Suppressive Hostility Behavior and Cardiac Autonomic Activations in Patients with Coronary Artery Disease

BACKGROUND

Hostility is an important psychosocial risk factor in coronary artery disease (CAD). Expressive and suppressive hostility behaviors are related to cardiovascular response in healthy adults. However, the relationships of these behavioral dimensions to cardiac autonomic activations in CAD remain unclear.

METHOD

This study involved 76 patients with CAD to whom a hostility inventory was administered, who were instructed to recall a neutral event and an anger-related event. Heart rate and blood pressure were obtained for each patient as the indices of cardiovascular response; heart rate variability was transformed from electrocardiograph and as the indices of cardiac autonomic activation.

RESULTS

The results showed that CAD patients with expressive hostility behavior experienced higher cardiovascular autonomic activations during the neutral and anger recall tasks, and lower parasympathetic activations during the recovery after an anger episode. On the other hand, CAD patients with suppressive hostility behavior experienced both sympathetic and parasympathetic activations during the baseline and recovery stages, as well as simultaneously activated higher parasympathetic response.

CONCLUSIONS

The results of this study suggested that it is appropriate to extend the cardiac autonomic activation model for expressive and suppressive hostility behaviors in patients with CAD.

KEY WORDS

Cardiac autonomic; Coronary artery disease; Expressive hostility; Suppressive hostility behaviors.

Effects of relationship functioning on the biological experience of stress and physical health

In this paper, we outline how relationship functioning affects the biological experience of stress and its consequences for physical health. Negative relationship perceptions and processes, such as attachment insecurity, hostility, and frequent conflict, tend to heighten stress responses and generate worse health over time, whereas positive relationship perceptions and processes, such as responsiveness, support, and intimacy, are generally associated with reduced or buffered stress responses and improved health (with some caveats). Future research should focus on the mechanisms behind these effects, the extent to which they can be changed or reversed, incorporating developmental perspectives, and effects of individual differences on these processes.

Marital quality, depressive symptoms, and the metabolic syndrome: a couples structural model

The indirect association of marital quality with metabolic syndrome (MetS) through depressive symptoms was examined in 301 middle-aged and older couples. MetS components (i.e., waist circumference, blood pressure, blood draws to assess triglycerides, HDL cholesterol, and fasting glucose) were assessed following a 12-h fast, and were treated as a continuous latent variable for analyses. In structural equation modeling of this indirect effect, overall model fit was good, and husbands' and wives' marital quality was associated with MetS only through depressive symptoms. Joint tests of the parameters indicated that gender did not moderate this association. The best fitting, most parsimonious model, after nested model comparisons, was one in which husbands' and wives' indirect paths were equated. Overall, marital quality was related to MetS through its relationship to depressive symptoms for men and women. Associations of marital quality and depression with MetS may overlap, and couple-based approaches to psychosocial risk factors for cardiovascular disease may be useful in future research.

Trait hostility is associated with systemic inflammation in married couples: an actor-partner analysis

Trait anger and hostility predict the development of coronary heart disease, and systemic inflammation may partly mediate this association. In a sample of 94 middle-aged and older married couples, we replicate research showing a within individuals (i.e., actor effect) association of trait hostility with high sensitivity C-reactive protein (hsCRP). As a novel extension of that research, the present study also examined the association of individuals' trait hostility with their partners' hsCRP (i.e., partner effect). Controlling for potential confounds, trait hostility, measured with the Buss-Perry Aggression Questionnaire, was significantly associated with both participants' own hsCRP, b=.0528 (SE=.0196), p=.008 and their partners' levels b=.0473 (SE=.0194), p=.016. Hence, the inflammatory correlates of trait hostility occur not only within individuals but between them, as well. The effects of unhealthy personality traits may extend to intimate partners and possibly other social network members.

Subjective social status: construct validity and associations with psychosocial vulnerability and self-rated health

BACKGROUND

Subjective social status (SSS) predicts health outcomes independently of traditional, objective indicators of socioeconomic status (SES). However, the potential confounding and mediating effects of negative affect and similar psychosocial risk and resilience factors have not been adequately addressed through formal studies of convergent and discriminant validity of SSS measures.

PURPOSE

The current study provides such a test of construct validity and subsequently examines whether psychosocial factors mediate the relationship between SSS and self-rated health.

METHODS

We examined the convergent and discriminant validity of the MacArthur scales of SSS relative to measures of psychosocial risk and resilience (i.e., neuroticism, depressive symptoms, optimism, and marital quality) as well as SES (i.e., income) in 300 middle-aged and older married US couples. We also tested a factor of psychosocial vulnerability as a mediator of the relationship between SSS and self-rated health.

RESULTS

Findings indicated clear convergent and discriminant validity of the MacArthur scales. Further, controlling age and income, both the US and community measures of SSS predicted psychosocial factors for men, however, only the community measure was independently predictive for women. Psychosocial vulnerability significantly mediated the pathway between SSS and self-rated health for men and women after controlling age and income.

CONCLUSIONS

These results provide strong support for the construct validity of the MacArthur scales and provide additional evidence of the role of psychosocial risk and resilience factors as mediators of the effects of SSS on health.

Spousal relationship quality and cardiovascular risk: dyadic perceptions of relationship ambivalence are associated with coronary-artery calcification

The quality of spousal relationships has been related to physical-health outcomes. However, most studies have focused on relationship positivity or negativity in isolation, despite the fact that many close relationships are characterized by both positive and negative aspects (i.e., ambivalence). In addition, most work has not accounted for the reciprocal nature of close-relationship processes that can have an impact on health. Using a sample of 136 older married couples, we tested whether actor-partner models of relationships that were either primarily positive or ambivalent (i.e., perceived as having both helpful and upsetting aspects) predicted measures of coronary-artery calcification. Results revealed an Actor × Partner interaction whereby coronary-artery calcification scores were highest for individuals who both viewed and were viewed by their spouse as ambivalent. These data are discussed in light of the importance of considering both positive and negative aspects of relationship quality and modeling the interdependence of close relationships.

Marital quality and health: a meta-analytic review

This meta-analysis reviewed 126 published empirical articles over the past 50 years describing associations between marital relationship quality and physical health in more than 72,000 individuals. Health outcomes included clinical endpoints (objective assessments of function, disease severity, and mortality; subjective health assessments) and surrogate endpoints (biological markers that substitute for clinical endpoints, such as blood pressure). Biological mediators included cardiovascular reactivity and hypothalamic-pituitary-adrenal axis activity. Greater marital quality was related to better health, with mean effect sizes from r = .07 to .21, including lower risk of mortality (r = .11) and lower cardiovascular reactivity during marital conflict (r = -.13), but not daily cortisol slopes or cortisol reactivity during conflict. The small effect sizes were similar in magnitude to previously found associations between health behaviors (e.g., diet) and health outcomes. Effect sizes for a small subset of clinical outcomes were susceptible to publication bias. In some studies, effect sizes remained significant after accounting for confounds such as age and socioeconomic status. Studies with a higher proportion of women in the sample demonstrated larger effect sizes, but we found little evidence for gender differences in studies that explicitly tested gender moderation, with the exception of surrogate endpoint studies. Our conclusions are limited by small numbers of studies for specific health outcomes, unexplained heterogeneity, and designs that limit causal inferences. These findings highlight the need to explicitly test affective, health behavior, and biological mechanisms in future research, and focus on moderating factors that may alter the relationship between marital quality and health.

The quality of spouses' social networks contributes to each other's cardiovascular risk

OBJECTIVES

Although the quality of one's own social relationships has been related to cardiovascular morbidity and mortality, whether a partner's social network quality can similarly influence one's cardiovascular risk is unknown. In this study we tested whether the quality of a partner's social networks influenced one's own ambulatory blood pressure (ABP).

METHODS

The quality of 94 couples' social networks was determined using a comprehensive model of relationships that separates out social ties that are sources of positivity(supportive), negativity (aversive), and both positivity and negativity (ambivalent). We then utilized statistical models (actor-partner analyses) that allowed us to separate out the links between one's own social network quality on ABP (actor influences), a partner's social network quality on ABP (partner influences), and a couple's network quality combined on ABP (actor X partner interactions).

RESULTS

Independent of one's own relationship quality, results showed that an individual's ABP was lower if their spouse had more supportive ties, and higher if a spouse had more aversive and ambivalent ties. In addition, couples' networks in combination were associated with higher ABP but only if both had a low number of supportive ties, or a high number of aversive or ambivalent ties.

CONCLUSIONS

These data suggest that the social ties of those we have close relationships with may influence our cardiovascular risk and opens new opportunities to capitalize on untapped social resources or to mitigate hidden sources of social strain.

How neighborhood disorder increases blood pressure in youth: agonistic striving and subordination

Growing evidence links perceptions of neighborhood disorder to adverse health outcomes but little is known about psychological processes that may mediate this association. We tested the hypothesis that two psychological mechanisms-agonistic striving and subordination-mediate the link between perceived neighborhood disorder and hypertension risk in youth. Perceived neighborhood disorder, agonistic striving, subordination experiences, negative affect, obesity, and ambulatory blood pressure during daily activities (48 h) were assessed in a multiethnic sample of 167 low- to middle-income urban adolescents. Path analyses revealed that agonistic striving, subordination, and obesity each independently mediated the association between neighborhood disorder and blood pressure; these variables accounted for 73 % of the shared variance, 42 % of which was explained by agonistic striving. The direct relationship between perceived neighborhood disorder and blood pressure was no longer significant in the presence of these mediators. Negative affect was associated with neighborhood disorder and subordination, but not blood pressure. Agonistic striving proved to be a significant and substantial mediator of the association between perceived neighborhood disorder, blood pressure, and future hypertension risk. New research should seek to clarify the processes by which stressful neighborhoods induce persistent agonistic motives and perceptions of subordination in adolescents.

Marital discord and coronary artery disease: a comparison of behaviorally defined discrete groups

OBJECTIVE

Marital difficulties can confer risk of coronary heart disease, as in a study of outwardly healthy couples (T. W. Smith et al., 2011) where behavioral ratings of low affiliation and high control during marital disagreements were associated with asymptomatic coronary artery disease (CAD). However, taxometric studies suggest that marital discord is more accurately represented by discrete groups, rather than continuous dimensions. To determine if a categorical representation of marital discord was also related to CAD, discordant and nondiscordant groups were identified via cluster analysis in further analyses of the T. W. Smith et al. (2011) study.

METHOD

One hundred fifty healthy couples (M age = 63.5) completed a marital disagreement discussion, self-reports of anxiety and anger during the disagreement, and self-report measures of marital adjustment. CAD was measured as coronary artery calcification (CAC) via computed tomography scans.

RESULTS

In a 2-group cluster solution, 31% of couples were characterized as discordant, with higher levels of hostility and dominance and lower levels of warmth compared with the nondiscordant group. Discordant couples reported lower marital adjustment and greater negative affect during the discussion. Controlling biomedical and behavioral risk factors, discordant couples had greater CAC (p = .029, η² = .035). Discordant and nondiscordant groups defined via self-reported marital adjustment did not differ in CAC (p = .17, η² = .014).

CONCLUSIONS

Marital discord defined categorically and with behavioral observations was associated with greater levels of asymptomatic CAD. Marital discord is associated with higher risk at early stages of coronary heart disease, but commonly used self-reports may underestimate this risk.

Do agonistic motives matter more than anger? Three studies of cardiovascular risk in adolescents

OBJECTIVES

Three motivational profiles have been associated with recurring psychological stress in low-income youth and young adults: Striving to control others (agonistic striving), striving to control the self (transcendence striving), and not asserting control (dissipated striving). Agonistic striving has been associated with elevated ambulatory blood pressure during daily activities. Three studies tested the hypotheses that: (1) agonistic striving is associated with poor anger regulation, and (2) agonistic striving and poor anger regulation interactively elevate blood pressure.

DESIGN

Motivational profiles, anger regulation, and ambulatory blood pressure were assessed in a multiethnic sample of 264 urban youth.

MAIN OUTCOME MEASURES

(1) anger regulation/recovery during laboratory challenge; (2) anger/blood pressure during daily activities (48 hours).

RESULTS AND CONCLUSION

Replication of the profiles in distant cities showed they occur with similar frequency across differences of region, race, and gender. Analyses controlling for body size, race, and gender revealed that individuals with the agonistic striving profile had higher ambulatory pressure, especially during social encounters. They became more openly angry and aggressive when challenged but did not exhibit difficulty regulating anger in the laboratory, nor did they feel angrier during monitoring. However, individuals with the agonistic striving profile who did display poor anger regulation in the lab had the highest blood pressure; deficient self-regulatory capability amplified the positive association between agonistic striving and cardiovascular risk in both genders and all ethnic groups. Although anger is thought to increase cardiovascular risk, present findings suggest that anger and elevated blood pressure are coeffects of agonistic struggles to control others.

Is social isolation/alienation confounded with, and non-independent of, emotional distress in its association with early onset of coronary artery disease?

Both emotional distress (ED) and social isolation/alienation (SI/A) have been found to prospectively predict adverse cardiac events, but few studies have tested the confounding/redundancy of these measures as correlates/predictors of outcomes. In this study, 163 patients with documented coronary artery disease (CAD) were interviewed for multiple indices of SI/A and administered the Symptom Checklist 90 - Revised (SCL90R). A spouse or friend provided an independent rating of ED using the spouse/friend version of the Ketterer Stress Symptom Frequency Checklist (KSSFC). The measures of ED and SI/A covaried. All three scales from the KSSFC (depression, anxiety, and "AIAI" - aggravation, irritation, anger, and impatience), and three scales from the SCL90R (anxiety, depression, and psychoticism), were associated with early Age at Initial Diagnosis (AAID) of CAD. Neither three scales derived from the SCL90R (shyness, feeling abused, and feeling lonely) nor the interview indices of SI/A (married, living alone, having a confidant, self description as a lone wolf, and self-description as lonely) were associated with early AAID. Thus, it is concluded that the present results indicate that ED and SI/A are confounded and that, even when tested head-to-head in a multivariate analysis, only ED is associated with AAID.

Affiliation and control during marital disagreement, history of divorce, and asymptomatic coronary artery calcification in older couples

OBJECTIVE

To examine behavioral observations of affiliation (ie, warmth versus hostility) and control (ie, dominance versus submissiveness) and prior divorce as predictors of coronary artery calcification (CAC) in older couples. In some but not all studies, marital disruption and low marital quality have been shown to confer risk of coronary artery disease (CAD). Inconsistencies might reflect limitations of self-reports of marital quality compared with behavioral observations. Also, aspects of marital quality related to CAD might differ for men and women.

METHODS

Couples underwent computed tomography scans for CAC and marital assessments, including observations of laboratory-based disagreement. Participants were 154 couples (mean age, 63.5 years; mean length of marriage, 36.4 years) free of prior diagnosis of CAD.

RESULTS

Controlling traditional risk factors, we found behavioral measures of affiliation (low warmth) accounted for 6.2% of variance in CAC for women, p < .01, but not for men. Controlling behavior (dominance) accounted for 6.0% of variance in CAC for men, p < .02, but not for women. Behavioral measures were related to self-reports of marital quality, but the latter were unrelated to CAC. History of divorce predicted CAC for men and women.

CONCLUSIONS

History of divorce and behavioral--but not self-report--measures of marital quality were related to CAD, such that low warmth and high dominance conferred risk for women and men, respectively. Prior research might underestimate the role of marital quality in CAD by relying on global self-reports of this risk factor.

The inextricable nature of mental and physical health: implications for integrative care

There is growing evidence that physical health problems are caused and exacerbated by psychological factors. Research indicates that psychological distress leads to physical disease through impairment of the neuroendocrine system and its interface with the body's immune response. However, the current health care delivery system splinters care into "psychiatric" and "physical" health silos. New approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric-mental health nurses in primary care settings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.

Conflict and collaboration in middle-aged and older couples: I. Age differences in agency and communion during marital interaction

Prior theory and research regarding age differences in marital interaction suggest that older couples display and experience more positivity and less negativity than middle-aged couples. However, studies of overt behavior in older couples are relatively rare and have emphasized disagreement, neglecting other important contexts for older couples such as collaboration during everyday problem solving. Further, the affiliation or communion dimension of social interaction (i.e., warmth vs. hostility) is commonly assessed but not the control or agency dimension (e.g., dominance vs. submissiveness). The present study examined affect, cognitive appraisals, and overt behavior during disagreement (i.e., discussing a current conflict) and collaboration (i.e., planning errands) in 300 middle-aged and older married couples. Older couples reported less negative affect during disagreement and rated spouses as warmer than did middle-aged couples. However, these effects were eliminated when older couples' greater marital satisfaction was controlled. For observed behavior, older couples displayed little evidence of greater positivity and reduced negativity-especially women. During collaboration, older couples displayed a unique blend of warmth and control, suggesting a greater focus on emotional and social concerns during problem solving.