The relationship between trait hostility and cardiovascular reactivity: a quantitative review and analysis

Examining the moderating effects of anger expression style on the association between facets of trait anger and cardiovascular responses to acute psychological stress

OBJECTIVE

The current study aims to (1) examine the association between measures of trait anger (i.e., anger temperament and anger reaction) and cardiovascular reactivity to acute psychological stress, and (2) to identify if anger expression styles moderate the association between trait anger and cardiovascular reactivity.

METHODS

A sample of 669 participants completed a standardized cardiovascular reactivity protocol consisting of resting baseline and stressor phase (mental arithmetic and Stroop), with systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) monitored throughout. Participants also completed measures of trait anger including anger temperament and anger reaction, as well as measures assessing anger expression styles including anger-in, anger-out and anger control.

RESULTS

Anger temperament was significantly associated with blunted cardiovascular reactivity, as well as increased levels of subjective stress. Moreover, the association between anger temperament and cardiovascular reactivity was significantly moderated by anger-in, with associations observed only amongst those who reported an increased tendency to suppress their anger. The association between anger reaction and cardiovascular reactivity was moderated by both anger-out and anger control.

CONCLUSION

While blunted cardiovascular responses may be a mechanism linking facets of trait anger to adverse health outcomes, the current findings accentuate the importance of considering expression styles when examining the association between anger experience and cardiovascular reactivity.

Infidelity in the Adolescence Stage: The Roles of Negative Affect, Hostility, and Psychological Well-Being

BACKGROUND

Infidelity is a relational process common in all types of romantic relationships and has been established as one of the main causes of relationship breakdown. However, little is known about this type of transgression in adolescent romantic relationships, although it manifests as a fairly frequent behavior involving different motivations. Even less is known about the emotional impact of infidelity on the offending person and its association with hostile behavior and psychological well-being.

METHODS

Through an experimental study (N = 301 Spanish adolescents (190 female and 111 male; M_age = 15.59, SD = 0.69; range from 15 to 17), we sought to analyze the effect of manipulating two types of motivations for infidelity (sexual vs. emotional dissatisfaction) on negative affect, hostility, and psychological well-being.

RESULTS

The main results revealed that committing infidelity motivated by hypothetical sexual (vs. emotional) dissatisfaction was indirectly related to lower psychological well-being through its effects on increased negative affect and hostility.

CONCLUSIONS

Last but not least, we discuss these findings, highlighting the possible implications of infidelity for the psychosocial and psychosexual development of adolescents.

Hostility, Anger, Psycho-emotional Factors and Cardiovascular Disease

The review presents the main aspects of the relationship between psychoemotional factors, hostility, anger and cardiovascular diseases. The first chapter describes the main historical stages in the study of this problem, starting from the Middle Ages and ending with fundamental research of the 19-20 centuries. In the second part, the authors demonstrated that hostility/anger are a risk factor for the CVD development and affect the prognosis and course of CVD (hypertension, ischemic heart disease, various cardiac arrhythmias, etc.). In the third chapter, there were studies that found that high rates of hostility/ anger reduced the effectiveness of cardiovascular therapy. In the fourth part, there are the main correlation mechanisms of negative emotions, hostility/anger and the cardiovascular system, carried out through the relationships with the activation of the hypothalamic-pituitary-adrenal, autonomic nervous system, platelet activation, with the changes in the risk factors characteristics etc. In the final chapter, the authors suggested prospects for further study of the problem, probably associated with the assessment of behavioral interventions, pharmacological or complex effects on the severity of hostility/anger to reduce CVD mortality in individuals with high rates of hostility / anger.

MAOA variants differ in oscillatory EEG & ECG activities in response to aggression-inducing stimuli

Among the genetic variations in the monoamine oxidase A (MAOA) gene, upstream variable number tandem repeats (uVNTRs) of the promoter have been associated with individual differences in human physiology and aggressive behaviour. However, the evidence for a molecular or neural link between MAOA uVNTRs and aggression remains ambiguous. Additionally, the use of inconsistent promoter constructs in previous studies has added to the confusion. Therefore, it is necessary to demonstrate the genetic function of MAOA uVNTR and its effects on multiple aspects of aggression. Here, we identified three MAOA alleles in Koreans: the predominant 3.5R and 4.5R alleles, as well as the rare 2.5R allele. There was a minor difference in transcriptional efficiency between the 3.5R and 4.5R alleles, with the greatest value for the 2.5R allele, in contrast to existing research. Psychological indices of aggression did not differ among MAOA genotypes. However, our electroencephalogram and electrocardiogram results obtained under aggression-related stimulation revealed oscillatory changes as novel phenotypes that vary with the MAOA genotype. In particular, we observed prominent changes in frontal γ power and heart rate in 4.5R carriers of men. Our findings provide genetic insights into MAOA function and offer a neurobiological basis for various socio-emotional mechanisms in healthy individuals.

A novel supportive assessment for comprehensive aggression using EEG and ECG

Aggression is a complex, ubiquitous phenomenon that impacts behavioral traits and psychological health. Assessing aggression is challenging because aggression constitutes multiple subtraits, such as anger, reactive aggression, and overt aggression. Conventional methods of assessing aggression are susceptible to bias because they mainly rely upon self-reports. Thus, more objective methods that provide a multifaceted understanding of aggression in individuals are required. Here, we propose a supportive method of assessing specific aggression subtraits in Koreans using electroencephalography (EEG) and electrocardiography (ECG). Our evaluations and statistical analyses revealed that EEG and ECG signals in subjects responding to video cues that induced aggression are associated with aggression subtraits. In particular, we identified spectral differences in EEG signals in response to stimuli with situation-dependent aggression. The α and β signals of the Fp2 site (the right ventromedial prefrontal region) are highly associated with anger, reactive aggression, and overt aggression. Moreover, ECG signals are associated with anger and overt aggression. These results link neurobiological findings to psychological explanations of aggression and multiple aspects of human behavior. Our findings can potentially be applied to supportive assessment methods for psychological counseling or psychiatric diagnoses.

Gender Differences in Aggression-related Responses on EEG and ECG

Gender differences in aggression viewed from an evolutionary and sociocultural perspective have traditionally explained why men engage in more direct and physical aggression, and women engage in more indirect and relational aggression. However, psychological and behavioral studies offer inconsistent support for this theory due to personal or social factors, and little is known about the gender-based neurobiological mechanisms of aggression. This study investigates gender differences in aggression through an analysis of electroencephalography (EEG) and electrocardiography (ECG) based neurobiological responses to commonly encountered stimuli, as well as psychological approaches in healthy Korean youth. Our results from self-reports indicate that overall aggression indices, including physical and reactive/overt aggression, were stronger in men. This agrees with the results of previous studies. Furthermore, our study reveals prominent gender-related patterns in γ signals from the right ventrolateral frontal cortex and changes in heart rate through stimulation by aggressive videos. In particular, gender differences in EEG and ECG responses were observed in response to different scenes, as simple aversion and situation-dependent aggression, respectively. In addition, we discovered decisive gender-distinct EEG signals during stimulation of the situation-dependent aggression regions within the right ventromedial prefrontal and ventrolateral frontal regions. Our findings provide evidence of a psychological propensity for aggression and neurobiological mechanisms of oscillation underlying gender differences in aggression. Further studies of oscillatory responses to aggression and provocation will expand the objective understanding of the different emotional worlds between men and women.

Toxic Affect: Are Anger, Anxiety, and Depression Independent Risk Factors for Cardiovascular Disease?

Three negative affective dispositions—anger, anxiety, and depression—are hypothesized to increase physical disease risk and have been the subject of epidemiological studies. However, the overlap among the major negative affective dispositions, and the superordinate construct of trait negative affectivity (NA) are only beginning to be tested. Presented here is a narrative review of recent prospective studies that simultaneously tested anger, anxiety, depression, and trait NA as risk factors for cardiac outcomes. Anxiety and depression emerged as independent risk factors for premature heart disease in population studies of persons nominally healthy at baseline, and for recurrence/mortality among patients with existing heart disease. General trait NA also was a cardiac risk factor in population samples.

Changes in Heart Rate Variability Recorded in Natural Situation with T-Shirt Integrated Sensors and Level of Observed Behavioral Excitation: A Pilot Study of Patients with Intellectual Disabilities and Psychiatric Disorders

BACKGROUND

The present study investigates the possibilities of using heart rate variability (HRV) parameters as physiological markers that precede increase in observed behavioral excitation of intellectually disabled individuals. The ability to recognize or predict such patterns, especially in patients showing unpredictable reactions and language deficiencies, might be a major step forward in clinical research.

METHOD

Thirteen volunteers with intellectual disabilities, who had suffered of at least one event of overt aggression in the preceding 3 months, participated to the study. The protocol consists in the acquisition of continuous electrocardiogram (ECG) throughout approximately two times of 8 h in natural situation, using a T-shirt integrated with sensors. Simultaneously, an observer evaluates the patient's level of overt excitation from calm (level 1) to extremely tense (level 5) and send online via Bluetooth these triggers into the ECG signals. The HRV indexes were then estimated offline on the basis of the inter-beat intervals recorded by the ECG, independently for the 30 min preceding each behavioral tension marking point, averaged, and compared through non-parametric Wilcoxon matched-pairs test. Of these, the RMSSD and LF/HF calculations were used to observe the fluctuations of inhibitory activity and cardiovagal balance through different tension states.

RESULTS

Seven individuals have sufficient reliable data for analysis. They have reached at least a level 3 of behavioral excitation (moderately tense) or more (very to extremely tense, level 4 and 5) and have been retained for further analysis. In sum, a total of 197 periods of tension were kept, made up of 46 periods of slight excitation (level 2), 18 of moderate excitation (level 3), 10 of high excitation (level 4), and 5 of extreme agitation (level 5). Variations in the HRV as a function of degree of excitation are observed for RMSSD index only (inhibitory parasympathetic activity). The changes from calm to increasing levels of excitation are characterized by a significant downfall in RMSSD index when patients were evaluated to be in a very high level of tension (level 4).

CONCLUSION

The presence of precursors to agitation, reflected in the falling-off of parasympathetic activity, offers potentially interesting prospects for therapeutic development.

Person-Environment Fit and its Limits: Agreeableness, Neuroticism, and Emotional Reactivity to Interpersonal Conflict

A naturalistic diary study was conducted to investigate the degree to which agreeableness and neuroticism moderate emotional reactions to conflict and nonconflict problems. Healthy community-residing males made diary recordings at the end of each of 8 successive days concerning problem occurrence and daily mood. Consistent with predictions based on person-environment fit, participants who scored higher in agreeableness experienced more subjective distress when they encountered more interpersonal conflicts than did their less agreeable counterparts. Neuroticism was related to a small but consistent reactivity to both conflict and nonconflict problems, contrary to person-environment fit. Reasons for the differences in the affective dynamics of agreeableness and neuroticism are discussed.

Emotional Reactivity to Everyday Problems, Affective Inertia, and Neuroticism

A naturalistic diary recording study was conducted to assess affective responses to everyday stress. Community-residing male participants made diary recordings regarding problem occurrence and mood several times a day for 8 days. In addition to reporting more frequent daily problems, persons scoring high in neuroticism were more reactive to stressors and were more distressed by recurrent problems than were persons scoring low in neuroticism. New problems affected everyone comparably. There was also evidence of affective inertia, such that bad mood was more likely to carry over to the next assessment. This lag effect tended to be stronger among more neurotic individuals.

The Contribution of Individual Differences in Hostility to the Associations between Daily Interpersonal Conflict, Affect, and Sleep

Adults of both sexes completed phone interviews assessing interpersonal conflict, state negative and positive affect (NA and PA), and sleep from the previous night on 7 consecutive evenings. Greater interpersonal conflict was associated with increased NA and decreased PA that day and increased sleep disturbance that night (measured on the next day). Mediational analyses were consistent with NA on the conflict day (but not PA) being a partial mediator of the prospective relation between greater conflict and greater sleep disturbance. Greater NA was associated with retrospective reports of obtaining less sleep and experiencing greater sleep disturbance the previous night but conflict was not associated with NA or PA on the following day. The associations between conflict and greater NA and sleep disturbance were exacerbated among individuals higher in cynical hostility. This exacerbation was not due to individuals higher in hostility reporting a greater number conflicts or more severe conflicts.

Anger Traits Associated With Cardiovascular Risk Biomarkers in the Metabolic Syndrome

BACKGROUND

Recent studies have shown that different personality traits contribute to mortality in different subtypes of cardiovascular disease (CVD). Anger traits have been shown to promote the constellation of the metabolic syndrome (MetS), which in turn increases CVD risks.

OBJECTIVE

To determine covariation of anger traits with CVD biomarkers, we examined patients (N = 101; 34 men and 67 women; age, 45.6 ± 13.96 years) in a nationally sampled treatment cohort for MetS in the Ukrainian governmental healthcare system.

METHODS

Data collection was conducted in 2007. Laboratory data of single components of the MetS according to International Diabetes Federation Consensus were dependent measures in regression models with self-reported overt aggressivity and covert hostility in the Buss-Durkee Hostility Inventory and sociodemographic data. Structural equation models (SEMs) were tested.

RESULTS

The SEM results are in favor of a sex-adjusted 2-factor solution R = 0.723), as indicated by equation-level Bentler-Raykov goodness-of-fit coefficients of 0.81 to 0.97 for paths to biological variables. Two latent components, 1 relating to aggressivity and the other to hostility, combine lipid/obesity-related measures and cholesterol-related measures, respectively.

CONCLUSIONS

The SEM results suggest that CVD-risk biomarker variables in this MetS sample (a) associate into 2 distinct profiles and (b) that 1 profile associates with overt anger, whereas the other associates with covert hostility. These results could contribute to more personalized prevention and care in CVD patients.

Integrating emotion regulation and emotional intelligence traditions: a meta-analysis

Two relatively independent research traditions have developed that address emotion management. The first is the emotion regulation (ER) tradition, which focuses on the processes which permit individuals to influence which emotions they have, when they have them, and how they experience and express these emotions. The second is the emotional intelligence (EI) tradition, which focuses—among other things—on individual differences in ER. To integrate these two traditions, we employed the process model of ER (Gross, 1998b) to review the literature on EI. Two key findings emerged. First, high EI individuals shape their emotions from the earliest possible point in the emotion trajectory and have many strategies at their disposal. Second, high EI individuals regulate their emotions successfully when necessary but they do so flexibly, thereby leaving room for emotions to emerge. We argue that ER and EI traditions stand to benefit substantially from greater integration.

When the Love Hormone Leads to Violence

Does oxytocin influence intimate partner violence (IPV)? Clues from prior research suggest that oxytocin increases prosocial behavior, but this effect is reversed among people with aggressive tendencies or in situations involving defensive aggression. Animal research also indicates that oxytocin plays a central role in defensive maternal aggression (i.e., protecting pups from intruders). Among highly aggressive people, a boost of oxytocin may cause them to use aggression toward close others as a means of maintaining their relationship. Adopting an interactionist approach, we predicted that oxytocin would increase IPV inclinations, but this effect would be limited to people high in trait physical aggression. In a double-blind, placebo-controlled, between-subject experiment, participants varying in trait physical aggression received either 24 international unit of oxytocin or a placebo. Following two provocation tasks, participants rated the probability that they would engage in various aggressive behaviors (e.g., slapping, throwing an object that could hurt) toward a romantic partner. Oxytocin increased IPV inclinations, but this effect was limited to participants prone to physical aggression. These data offer the first evidence that IPV inclinations have a biological basis in a combination of oxytocin and trait physical aggressiveness.

Physiological correlates of psychopathy, antisocial personality disorder, habitual aggression, and violence

This chapter reviews the existing literature on physiological correlates of psychopathy, antisocial personality disorder, and persistent violence/aggression. Coverage is provided of findings from studies utilizing peripheral, electrocortical, and neuroimaging measures. The review begins with a discussion of how psychopathy and antisocial personality are defined, and how these conditions relate to one another and to violent behavior. A case is made that the relationships psychopathy and ASPD show with violent and aggressive behavior, and similarities and differences in associations of each with physiological measures of various types can be understood in terms of symptomatic features these conditions have in common versus features that distinguish them. Following this, an overview is provided of major lines of evidence emerging from psychophysiological and neuroimaging studies conducted to date on these conditions. The final section of the chapter summarizes what has been learned from these existing studies and discusses implications and directions for future research.

A test of Spielberger's state-trait theory of anger with adolescents: five hypotheses

Spielberger's state-trait theory of anger was investigated in adolescents (n = 201, ages 10-18, 53% African American, 47% European American, 48% female) using Deffenbacher's five hypotheses formulated to test the theory in adults. Self-reported experience, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) responses to anger provoking imagery scripts found strong support for the application of this theory to adolescents. Compared with the low trait anger (LTA) group, adolescents with high trait anger (HTA) produced increased HR, SBP, and DBP, and greater self-report of anger to anger imagery (intensity hypothesis) but not greater self-report or cardiovascular reactivity to fear or joy imagery (discrimination hypothesis). The HTA group also reported greater frequency and duration of anger episodes and had longer recovery of SBP response to anger (elicitation hypothesis). The HTA group was more likely to report negative health, social, and academic outcomes (consequence hypothesis). Adolescents with high hostility reported more maladaptive coping with anger, with higher anger-in and anger-out than adolescents with low hostility (negative expression hypothesis). The data on all five hypotheses supported the notion that trait anger is firmly entrenched by the period of adolescence, with few developmental differences noted from the adult literature.

Stress-induced inflammatory responses in women: effects of race and pregnancy

OBJECTIVE

African Americans experience preterm birth at nearly twice the rate of whites. Chronic stress associated with minority status is implicated in this disparity. Inflammation is a key biological pathway by which stress may affect birth outcomes. This study examined the effects of race and pregnancy on stress-induced inflammatory responses.

METHODS

Thirty-nine women in the second trimester of pregnancy (19 African American, 20 white) and 39 demographically similar nonpregnant women completed an acute stressor (Trier Social Stress Test). Psychosocial characteristics, health behaviors, and affective responses were assessed. Serum interleukin (IL)-6 was measured at baseline, 45 minutes, and 120 minutes poststressor.

RESULTS

IL-6 responses at 120 minutes poststressor were 46% higher in African Americans versus whites (95% confidence interval = 8%-81%, t(72) = 3.51, p = .001). This effect was present in pregnancy and nonpregnancy. IL-6 responses at 120 minutes poststressor tended to be lower (15%) in pregnant versus nonpregnant women (95% confidence interval = -5%-32%, p = .14). Racial differences in inflammatory responses were not accounted for by demographics, psychological characteristics, health behaviors, or differences in salivary cortisol. Pregnant whites showed lower negative affective responses than did nonpregnant women of either race (p values ≤ .007).

CONCLUSIONS

This study provides novel evidence that stress-induced inflammatory responses are more robust among African American women versus whites during pregnancy and nonpregnancy. The ultimate impact of stress on health is a function of stressor exposure and physiological responses. Individual differences in stress-induced inflammatory responses represent a clear target for continued research efforts in racial disparities in health during pregnancy and nonpregnancy.

Anger and the heart: perspectives on cardiac risk, mechanisms and interventions

In the popular imagination, anger has long been linked to cardiovascular diseases (CVD), but empirical validation from case-control and prospective studies emerged only in the 1970's. After describing the multidimensional nature of anger and its assessment (via self-report or observed in structured interviews), this paper selectively reviews evidence in (a) behavioral epidemiology, (b) stress and biological processes with implications for cardiopathogenesis, and (c) behavioral/pharmacological interventions for anger/hostility reduction. Although evidence is inconsistent, chronic feelings of anger, cynical distrust and antagonistic behavior are at least modestly associated with risk of both initiation and progression of CVD. Anger/hostility also is linked to stress exposure and reactivity, exaggerated autonomic function, reduced heart rate variability, platelet aggregation and inflammation. Clinical and pharmacologic treatment of anger/hostility has the potential to reduce anger and its health-damaging effects. Limitations, including third-variable explanations and overlap among the negative emotions, and implications for cardiology and behavioral medicine research and practice are discussed.

Winning isn't everything: mood and testosterone regulate the cortisol response in competition

Dominance contests are recurrent and widespread causes of stress among mammals. Studies of activation of the stress axis in social defeat – as reflected in levels of adrenal glucocorticoid, cortisol – have generated scattered and sometimes contradictory results, suggesting that biopsychological individual differences might play an important mediating role, at least in humans. In the context of a larger study of the regulation of endocrine responses to competition, we evaluated the notion that mood states, such as self-assurance and hostility, may influence cortisol reactivity to dominance cues via an interplay with baseline testosterone, considered as a potential marker of individual differences in dominance. Seventy healthy male university students (mean age 20.02, range 18–26) provided saliva samples before and after competing for fifteen minutes on a rigged computer task. After a winner was determined, all participants were assessed on their mood states through a standardized psychometric instrument (PANAS-X). Among winners of a rigged videogame competition, we found a significant interaction between testosterone and self-assurance in relation to post-competition cortisol. Specifically, self-assurance was associated with lower post-competition cortisol in subjects with high baseline testosterone levels, but no such relationship was observed in subjects with lower baseline testosterone levels. In losers of the competition no interaction effect between basal testosterone and hostility was observed. However, in this subgroup a significant negative relationship between basal testosterone and post-competition cortisol was evident. Overall, these findings provide initial support for the novel hypothesis that biological motivational predispositions (i.e. basal testosterone) and state (i.e. mood changes) may interact in regulating the hypothalamic-pituitary-adrenal axis activation after a social contest.

Combining personality traits with traditional risk factors for coronary stenosis: an artificial neural networks solution in patients with computed tomography detected coronary artery disease

Background. Coronary artery disease (CAD) is a complex, multifactorial disease in which personality seems to play a role but with no definition in combination with other risk factors. Objective. To explore the nonlinear and simultaneous pathways between traditional and personality traits risk factors and coronary stenosis by Artificial Neural Networks (ANN) data mining analysis. Method. Seventy-five subjects were examined for traditional cardiac risk factors and personality traits. Analyses were based on a new data mining method using a particular artificial adaptive system, the autocontractive map (AutoCM). Results. Several traditional Cardiovascular Risk Factors (CRF) present significant relations with coronary artery plaque (CAP) presence or severity. Moreover, anger turns out to be the main factor of personality for CAP in connection with numbers of traditional risk factors. Hidden connection map showed that anger, hostility, and the Type D personality subscale social inhibition are the core factors related to the traditional cardiovascular risk factors (CRF) specifically by hypertension. Discussion. This study shows a nonlinear and simultaneous pathway between traditional risk factors and personality traits associated with coronary stenosis in CAD patients without history of cardiovascular disease. In particular, anger seems to be the main personality factor for CAP in addition to traditional risk factors.

Culture moderates the cardiovascular consequences of anger regulation strategy

PURPOSE

This research examined cultural differences in experiential and cardiovascular outcomes of three anger regulation strategies (expression, suppression and reappraisal).

METHODS

Forty-five Chinese and 45 Caucasian females participated in a laboratory experiment in which role play was used to induce anger. During this role play participants were instructed to either express or suppress their feelings or engage in cognitive reappraisal. Emotional experience was measured before and after the role play. Cardiovascular indices were measured continuously during the experiment.

RESULTS

Significant interactions were obtained such that Caucasians showed stronger cardiovascular responses to suppression than expression of anger whereas the opposite was true for Chinese.

CONCLUSIONS

These results demonstrate that physiological consequences of emotion regulation strategies vary by cultural background. Possible reasons as well as implications of these findings are discussed.

Hostile behavior links negative childhood family relationships to heart rate reactivity and recovery in young adulthood

Prior research has demonstrated that vulnerability to stress is influenced by early life experiences. This study evaluates the impact of negative childhood family relationships on cardiovascular stress reactivity in young adulthood. Participants (age 18-22) from families characterized by negative (n=39) or positive relationships (n=36) engaged in a role-play conflict task. Hostile/aggressive verbal behaviors during the task were observed, and blood pressure (BP) and heart rate (HR) responses were measured before, during, and after the task. Participants from negative families engaged in more hostile/aggressive verbal behavior during the task and showed attenuated HR reactivity. Hostile/aggressive verbal behavior predicted attenuated HR reactivity and recovery. Path analyses linked negative family relationships to more hostile verbal behavior during the task, and attenuated HR reactivity and recovery. These results support the development of hostile/aggressive behavior in social situations as a pathway linking childhood adversity to stress vulnerability across the lifespan.

Mediation and moderation of the association between cynical hostility and systolic blood pressure in low-income women

Hostility may be related to risk factors for cardiovascular disease (CVD), such as blood pressure. However, the process by which hostility affects blood pressure is not fully understood. The current study sought to evaluate abdominal obesity (waist-to-hip ratio [WHR]) as a potential mediator and modifier of the relationship between cynical hostility and systolic blood pressure (SBP) in a group of disadvantaged women. Path analysis and multiple regression models were used to identify mediating and moderating pathways in the relationship between cynical hostility and SBP. Results indicate a significant interaction between WHR and cynical hostility. WHR was a partial mediator and significant moderator of the association between hostility and blood pressure. These findings highlight the potential importance of examining abdominal obesity and psychosocial factors as conjunctive determinants of CVD and risk factors for related metabolic conditions.

Attributing illness to 'old age:' consequences of a self-directed stereotype for health and mortality

Stereotypic beliefs about older adults and the aging process have led to endorsement of the myth that 'to be old is to be ill.' This study examined community-dwelling older adults' (N = 105, age 80+) beliefs about the causes of their chronic illness (ie, heart disease, cancer, diabetes, etc.), and tested the hypothesis that attributing the onset of illness to 'old age' is associated with negative health outcomes. A series of multiple regressions (controlling for chronological age, gender, income, severity of chronic conditions, functional status and health locus of control) demonstrated that 'old age' attributions were associated with more frequent perceived health symptoms, poorer health maintenance behaviours and a greater likelihood of mortality at 2-year follow-up. The probability of death was more than double among participants who strongly endorsed the 'old age' attribution as compared to those who did not (36% vs. 14%). Findings are framed in the context of self-directed stereotypes and implications for potential interventions are considered.

Cynical hostility, anger expression style, and acute myocardial infarction in middle-aged Japanese men

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

Post-weaning social isolation induces abnormal forms of aggression in conjunction with increased glucocorticoid and autonomic stress responses

We showed earlier that social isolation from weaning (a paradigm frequently used to model social neglect in children) induces abnormal forms of attack in rats, and assumed that these are associated with hyperarousal. To investigate this hypothesis, we deprived rats of social contacts from weaning and studied their behavior, glucocorticoid and autonomic stress responses in the resident-intruder paradigm at the age of 82 days. Social isolation resulted in abnormal attack patterns characterized by attacks on vulnerable targets, deficient social communication and increased defensive behaviors (defensive upright, flight, freezing). During aggressive encounters, socially deprived rats rapidly switched from one behavior to another, i.e. showed an increased number of behavioral transitions as compared to controls. We tentatively term this behavioral feature "behavioral fragmentation" and considered it a form of behavioral arousal. Basal levels of plasma corticosterone regularly assessed by radioimmunoassay between 27 and 78 days of age were not affected. In contrast, aggression-induced glucocorticoid responses were approximately doubled by socially isolation. Diurnal oscillations in heart rate assessed by in vivo biotelemetry were not affected by social isolation. In contrast, the aggression-induced increase in heart rate was higher in socially isolated than in socially housed rats. Thus, post-weaning social isolation induced abnormal forms of aggression that developed on the background of increased behavioral, endocrine and autonomic arousal. We suggest that this paradigm may be used to model aggression-related psychopathologies associated with hyperarousal, particularly those that are triggered by adverse rearing conditions.

Hostility, relationship quality, and health among African American couples

OBJECTIVE

This study investigated the association between hostility and health and whether it is moderated by the quality of an individual's primary romantic relationship.

METHOD

Longitudinal data were provided by 184 African Americans, including 166 women. Participants averaged 38 years old and were married or in long-term marriagelike relationships. Hostility and relationship quality were measured at the first assessment. Hostility was based on participants' responses to items tapping cynical attitudes about relationships. Relationship quality was based on trained observer ratings of videotaped couple interactions on behavioral scales reflecting warmth, support, and communication skills. At 2 assessments approximately 5 and 7 years later, participants provided health data. Health index scores were formed from responses to five scales of the SF-12 (Ware, Kosinski, & Keller, 1998) as well as to responses to questions about the number of chronic health conditions and the number of prescribed medications.

RESULTS

Stepwise regression analyses controlling for demographic variables and the earlier health score tested the main and interactive effects of hostility and relationship quality on longitudinal changes in health. Whereas no main effects were supported, the interaction of hostility and relationship quality was significant (p < .05). The form of the interaction was such that high-hostile individuals had better health outcomes if they were in a high-quality relationship.

CONCLUSION

Hostile persons in high-quality relationships may be at less risk for negative health outcomes because they do not regularly experience the physiologic reactivity and adverse psychosocial outcomes that they would otherwise experience as a result of recurring interpersonal conflict.

Anger, coping, and frontal cortical activity: The effect of coping potential on anger-induced left frontal activity

The present research tested whether relative left midfrontal cortical activity would be greater when individuals believed they could engage in behaviour to ameliorate an anger-inducing situation as compared to when they believed they could do nothing. The research also examined whether relative left midfrontal cortical activity would relate to behaviors aimed at ameliorating the anger-inducing situation, when individuals believed they could do something. To test these primary hypotheses, university students who were opposed to a tuition increase at their university were exposed to a pilot radio editorial that argued for increased tuition, and their electroencephalographic (EEG) activity, self-reported emotions, and behavioural responses were then collected. Prior to hearing the editorial, participants were led to believe that the tuition increase would definitely occur or that the tuition increase may occur and that petitions were being circulated to attempt to prevent it. Results supported the primary hypotheses and also revealed that relative left midfrontal activity was associated with anger in response to the editorial and that the effects were specific to the midfrontal cortical regions.

Depressive symptoms, trait aggression, and cardiovascular reactivity to a laboratory stressor

BACKGROUND

Depression and anger/aggression-related traits are thought to promote coronary disease, at least in part, through their associations with stress-related cardiovascular processes. It is unclear whether the effects of these factors on cardiovascular reactivity (CVR) are redundant, additive, or synergistic.

PURPOSE

The main goal of this study was to examine the independent and interactive effects of depressive symptoms and anger/aggression-related traits in promoting CVR.

METHODS

Participants were 63 healthy females who completed the Beck Depression Inventory and Buss-Perry Aggression Questionnaire and performed a stressful speaking task. Systolic and diastolic blood pressure (SBP and DBP) and heart rate were recorded.

RESULTS

Significant interaction effects indicated that depressive symptoms were positively associated with SBP and DBP reactivity among women high in verbal aggression but not among those low in verbal aggression.

CONCLUSIONS

Depressive symptoms and verbal aggression may interact to promote exaggerated blood pressure responses to stressors, a possible marker for mechanisms that contribute to heart disease.

Cynical hostility and stimulated Th1 and Th2 cytokine production

Hostility has been associated with heightened proinflammatory activity. However, it is not known whether greater hostility contributes to greater inflammation by promoting higher Th1 activity, lower Th2 activity, or both. The present study examines the relation of hostility to mitogen-stimulated Th1 and Th2 cytokine production in vitro. Participants were 193 healthy men and women (mean age 37.3; 44% non-white). Hostility was assessed with a 20-item version of the Cook-Medley Hostility Scale (CMHS). PHA-stimulated interleukin (IL)-2, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma were used to measure Th1 activity; PHA-stimulated IL-4, IL-5, and IL-10 were used to measure Th2 activity. Greater hostility was related to greater production of two of the three Th1 cytokines, TNF-alpha and IFN-gamma. Hostility was not associated with any measure of Th2 cytokine production. Associations with Th1 cytokines were independent of age, sex, race, socioeconomic status, body mass index, depressive symptoms, and health-related behaviors, and were consistent across men and women. Associations were not explained by social network characteristics, social support, or personality traits closely associated with social behavior. Exploratory analyses substituting the CMHS cognitive, affective, and behavioral subscales for total hostility revealed that associations between hostility and Th1 cytokine production were primarily driven by the cognitive component of hostility (i.e., cynicism). Results suggest that a unique dimension of hostility, particularly the cynicism subcomponent, that is unrelated to social factors, may influence inflammation by promoting greater Th1 cytokine production. This effect on stimulated cytokine activity may have implications for a role of hostility in exacerbating immune-related disease.

Association of salivary cortisol circadian pattern with cynical hostility: multi-ethnic study of atherosclerosis

OBJECTIVE

To determine if cynical hostility is associated with alterations in diurnal profiles of cortisol. Hostility has been linked to cardiovascular disease but the biological mechanisms mediating this association remain unknown.

METHODS

Up to 18 measures of salivary cortisol taken over 3 days were obtained from each of 936 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Cynical hostility was measured using an eight-item subscale of the Cook-Medley Hostility Scale. Cortisol profiles were modeled using regression spline models that incorporated random parameters for subject-specific effects. Models were adjusted for race, sex, age, socioeconomic position, and lifestyle factors. The association of cynical hostility with key features of the cortisol diurnal profile, both in the full sample and important subsamples, was examined.

RESULTS

Waking cortisol levels as well as the extent of the morning surge in cortisol levels did not differ significantly across tertiles of cynical hostility. Respondents in the lowest tertile of cynical hostility experienced a 22% sharper decline in salivary cortisol (age- and sex-adjusted slope of -0.49 microg/dL per hour) than respondents in the highest tertile (-0.40 microg/dL per hour, p for difference = .0004). Intertertile differences in these parameters remained unaltered after further adjustment for potential confounders. This pattern of differences in cortisol diurnal profile tended to be related in a dose-response way to level of cynical hostility, and persisted in stratified analyses.

CONCLUSIONS

Cynical hostility is associated with the declining phase of the awakening cortisol response. The implications of this for cardiovascular and other health outcomes remain to be determined.

Hostility and anger in: cardiovascular reactivity and recovery to mental arithmetic stress

BACKGROUND

Hostility and anger have been attributed as psychosocial risk factors for coronary heart disease. Heightened cardiovascular reactivity (CVR), and poor recovery, to provocative stressors are thought to hasten this risk.

PURPOSE

To examine the relationship between hostility and anger inhibition (AI), and the moderating situational influences of harassment and evaluation, in predicting CVR and recovery to mental arithmetic (MA) stress using a multiple regression approach.

METHODS

48 male undergraduate students engaged in the following 3 minute tasks during recording of the electrocardiogram, impedance cardiography, and blood pressure: baseline, MA, and evaluation. Hostility and AI were assessed with the Cook-Medley Hostility Scale and the Speilberger Anger In subscale, respectively.

RESULTS

An interaction between hostility and AI showed high diastolic blood pressure reactivity to the MA task among hostile anger inhibitors. Harassment did not modify this effect. However, harasser evaluation predicted prolonged systolic blood pressure (SBP) responding among men scoring high in AI, and facilitated SBP recovery among those scoring low on AI.

CONCLUSIONS

The findings highlight the interactive influences of AI and hostility in predicting CVR to stress and underscore the importance of recovery assessments in understanding the potentially pathogenic associations of these constructs.

A influência de fatores emocionais sobre a hipertensão arterial

OBJETIVO: Realizar revisão bibliográfica de artigos que abordam a relação entre hipertensão arterial e fatores emocionais, levando em consideração a relevância do tema. MÉTODOS: Fez-se busca ativa na Biblioteca Virtual em Saúde, na base de dados MedLine (1997-2008), utilizando palavras da língua portuguesa. Os descritores de assunto escolhidos foram "hipertensão" e "doença cardíaca coronária". Em seguida, refinou-se a busca com os termos "hostilidade", "raiva", "ansiedade", "comportamento impulsivo" e "personalidade impulsiva". Não foram selecionados artigos que tratavam exclusivamente de doenças cardiovasculares e fatores psicológicos ou que associavam hipertensão e doenças cardiovasculares com depressão e doença de Alzheimer. RESULTADOS E DISCUSSÃO: Há inconsistência nos achados que relacionam os fatores emocionais com a hipertensão arterial e cardiopatias. Foram encontrados tanto estudos que demonstram relação positiva da raiva, hostilidade, ansiedade, impulsividade e estresse com hipertensão e doenças cardiovasculares quanto estudos que retratam relações negativas. CONCLUSÃO: O que se pode inferir das relações pesquisadas é que o risco de desenvolvimento da hipertensão arterial e a reatividade cardiovascular parecem ser influenciados por fatores emocionais como impulsividade, hostilidade, estressores, ansiedade e raiva. No entanto, mais estudos são necessários para melhor elucidar essas relações.