Anger as a Mechanism of Injustice Appraisals in Pediatric Chronic Pain

Mechanisms explaining the relationship between pain-related injustice appraisals and functional outcomes in youth with chronic pain have yet to be examined. In studies of adults, greater pain-related injustice is associated with worse depressive symptoms and greater pain through greater anger. No study to date has examined anger expression as a mediator in the relationships between pain-related injustice appraisals and physical and psychosocial functioning in youth with chronic pain. The current sample consisted of 385 youth with varied pain conditions (75% female, 88% White, M_age=14.4 years) presenting to a university-affiliated pain clinic. Patients completed self-report measures assessing anger expression (anger-out and anger-in), pain-related injustice, pain intensity, functional disability, and emotional, social, and school functioning. Bootstrapped mediation analyses indicated that only anger-out (indirect effect= -.12, 95% CI: -.21, -.05) mediated the relationship between pain-related injustice and emotional functioning, whereas both anger-out (indirect effect= -.17, 95% CI: -.27, -.09) and anger-in (indirect effect= -.13, 95% CI: -.09, -.001) mediated the relationship between pain-related injustice and social functioning. Neither mode of anger expression mediated the relationship between pain-related injustice and pain intensity, functional disability, or school functioning. Collectively, these findings implicate anger as one mechanism by which pain-related injustice impacts psychosocial outcomes for youth with chronic pain. Perspective: Anger expression plays a mediating role in the relationship between pain-related injustice appraisals and psychosocial outcomes for youth with chronic pain. Anger represents one target for clinical care to decrease the deleterious impact of pain-related injustice on emotional and social functioning.

Neuroticism, resilience, and social support: correlates of severe anxiety among hospital workers during the COVID-19 pandemic in Nigeria and Botswana

Background

The role of healthcare workers (HCWs) during the COVID-19 pandemic may make them more susceptible to anxiety than the general population. This study aimed to determine the prevalence of anxiety and evaluate the potential effects of resilience, neuroticism, social support, and other sociodemographic factors on anxiety among HCWs from two African countries.

Methods

A cross-sectional survey of 373 HCWs was conducted in Botswana and Nigeria, using an anxiety rating scale, neuroticism subscale of Big Five Inventory, Oslo social support scale, and Resilience Scale. Data collection was done between May 1 and September 30, 2020.

Results

The participants’ mean age (SD) was 38.42 (8.10) years, and 65.1% were females. Forty-nine (13.1%) of the HCWs reported clinical anxiety. In the final model of hierarchical multiple regression, neuroticism (B = 0.51, t = 10.59, p = p < 0.01), resilience (B = 0.34, t = − 7.11, p < 0.01), and social support (B = 0.079, t = − 2.11, p = 0.035) were associated with severe anxiety, after controlling for the significant sociodemographic factors.

Conclusions

Severe anxiety exists among HCWs in Africa, although the rate was lower than reported elsewhere. Neuroticism, resilience, and social support may be vital targets for psychological intervention in a pandemic as COVID-19; thus, their roles should be further explored.

Validation of the Anger Expression Scale for Children With Fourth and Fifth Graders: Implications for Identifying Students at Risk for Behavior Problems

An inability to successfully regulate anger has been linked to adverse outcomes for students, including psychological problems and special education placement due to significant emotional and behavioral difficulties. Early identification, therefore, is critical to provide timely intervention for students before anger-related problems escalate. The Anger Expression Scale for Children was developed to address some of the limitations of previous measurement tools designed to assess anger expression with children and adolescents. Yet validation is needed with upper elementary school populations-a key identification and prevention period. Thus, we examined the factor structure of the scale with 2,020 fourth and fifth graders. Results revealed support for a modified two-factor model, with a general Anger Expression factor and Anger Control factor. Criterion-related validity analyses indicated that Anger Expression was positively associated with aggression and externalizing problems, whereas Anger Control was related to emotion control and less internalizing behaviors. We discuss implications of findings for both informed school use and future research.

Emotional Nonacceptance and Anxiety Sensitivity in Relation to Anxious Arousal, Social Anxiety, and Depressive Symptoms Among African American Young Adults

Past work suggests African American college students may be a segment of the college population at heightened risk for anxiety and depressive symptoms; however, there remains an overarching need to broaden our understanding of individual difference variables that may be related to adverse emotional states. The purpose of the present study was to test a theoretically driven interactive model of two individual difference variables (anxiety sensitivity and emotional nonacceptance) in relation to anxiety and depressive symptoms among 133 African American undergraduate students (76.7% female, Mage = 20.9, SD = 5.6; age range = 18-53 years). Results indicated that anxiety sensitivity was positively associated with anxious arousal symptoms at higher levels of emotional nonacceptance (β = 2.1), and more strongly associated with depressive symptoms among individuals endorsing low levels of emotional nonacceptance (β = 3.8). The present data provide novel evidence suggesting there is clinically relevant interplay between anxiety sensitivity and emotional nonacceptance. These findings aid in better understanding the expression of anxiety and depressive symptoms among this population and may represent transdiagnostic constructs of relevance for early intervention.

The Contribution of Ethnic Minority Status to Adaptive Style: A Comparison of Mexican, Mexican American, and European American Children

Ethnic minority status and health minority status (i.e., presence of illness) may facilitate repressive adaptive style (RAS) in an additive fashion, and a “double stigma” hypothesis has been proposed to explain this additive effect. The authors compare RAS in European American, Mexican American, and Mexican children and examine the association of RAS to the traditional values of simpatia and collectivism. Results do not confirm the hypothesis that minority status contributes to RAS; however, collectivism is a significant predictor of defensiveness supporting a cultural hypothesis for RAS.

Anxiety symptomatology and perceived health in African American adults: moderating role of emotion regulation

Although emotional health has been theoretically and empirically linked to physical health, the anxiety-physical health association in particular is not well understood for African American adults. This study examined anxiety as a specific correlate of perceived health in addition to testing the potential moderating role of emotion regulation, an index of how and when individuals modulate emotions, in the association for anxiety to perceived health. Study participants were 151 community-based African American adults who completed measures of anxiety symptomatology and emotion regulation in addition to responding to a self-report question of perceived health. Results showed that higher levels of anxiety symptomatology were associated with poorer health ratings for those who reported more limited access to emotion regulation strategies but not those who reported having more emotion regulation strategies. The findings suggest that anxiety-related distress and health problems may be interrelated when emotion regulation strategies are limited. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Family emotion expressivity, emotion regulation, and the link to psychopathology: examination across race

Research has established links between parental emotion socialization behaviours and youth emotional and psychological outcomes; however, no study has simultaneously compared these relations for White, Black, and Asian individuals. In this study, emerging adults identifying as White (n= 61), Black (n= 51), or Asian (n= 56) retrospectively reported on parents' emotion socialization behaviours during childhood, existing emotion regulation (ER) skills, and current psychopathology symptoms. Asian participants reported fewer positive displays of emotions in their families during childhood than White and Black participants. Despite this difference, low expression of positive emotions in families during childhood did not relate to negative outcomes for Asian participants but was linked for White and Black participants. Overall, Asian participants reported more difficulties with ER than Black or White participants, and relations between ER difficulties and psychopathology varied by racial group. The findings emphasize the need to consider race when conducting research on emotion functioning with families and highlight emotion dysregulation as a potential treatment target for White, Black, and Asian individuals.

Are we worrying about the right men and are the right men feeling worried? Conscious but not unconscious prostate anxiety predicts screening among men from three ethnic groups

Anxieties regarding cancer and screening have been consistently linked in prostate screening behavior with cancer-related anxieties generally thought to be higher among minority men. To date, however, the literature linking cancer anxieties to screening among diverse men remains predicated on self-reported anxiety. Research has yet to consider how "accurate" the reporting of anxiety may be among distinct groups of men or the possibility that anxiety may influence prostate cancer (PC) screening behavior through conscious and nonconscious channels; the current study tested for discrepancies between self-report and Stroop-ascertained general- and prostate-specific anxiety and their links to screening among 180 U.S.-born African American, U.S.-born European American, and immigrant Jamaican men. Men provided self-report information regarding trait and prostate-related anxiety and completed an emotional Stroop task. Mixed model ANOVAs showed that while U.S.-born African Americans had few discrepancies between self-report and Stroop-ascertained anxiety, Jamaicans reported greater PC anxiety than indicated by Stroop performance, while the opposite was true among U.S.-born Europeans. As expected, self-reported (but not Stroop-ascertained) PC anxiety predicted screening in multivariate analysis. Although men from different age and ethnic groups varied in the discrepancy between self-reported and Stroop-ascertained PC anxiety, the influence of avoidance-producing emotions appears to operate predominantly through conscious channels.

Self-Reported Daily Stress, Squelching of Anger and the Management of Daily Stress and the Prevalence of Uterine Leiomyomata: The Ultrasound Screening Study

Self-reported daily stress, ways of managing stress and squelching anger were examined in association with uterine leiomyomata (aka fibroids). These stress factors were obtained from 560 Black and 375 White women enrolled in the National Institute of Environmental Health Sciences Uterine Fibroid Study. Race-specific prevalence differences (PD) and 95% confidence intervals (95% CI) were calculated. Black women with severe stress had a prevalence of fibroids that was 11% higher (95% CI: 0%, 21%) than those in the no or mild stress group (referent). White women with severe stress, compared to the referent, had a non-significantly (NS) higher prevalence of fibroids [PD = 7%; 95% CI: (-103, 213)]. For both groups, moderate daily stress was associated with a weak elevation (NS) in fibroid prevalence. Black women who reported squelching their anger had an elevated prevalence of fibroids (8%) compared to non-squelchers [95% CI: (-03, 153)] while there was no association for White women. Women with symptomatic fibroids had higher stress than those without, but exclusion of symptomatic women only slightly attenuated the associations. Consistent with a previous report, symptomatic fibroids may cause stress. However, further research is warranted to prospectively investigate a possible aetiologic role for stress in the development of fibroids.

The Affective Paradox

Despite generally more challenging developmental, environmental, economic, health, and social contexts, minority populations in the United States often report a lower frequency of many negative affects. In some views, such findings reflect a reporting or response bias among minority groups. However, an alternate view suggests that reports of negative emotion differ because minorities do not consciously experience certain discrete emotions as frequently. A study of 1,364 women from six ethnic subpopulations tested this thesis using trait anger as an exemplar. As expected, linear regressions demonstrated that while social desirability explained some ethnic variance in anger reports, a measure of repressive coping explained additional variance in trait anger and eliminated ethnic effects; social desirability no longer predicted trait anger once repressive coping was controlled. Results are discussed in terms how of how developmentally oriented, emotion regulation theories may supplement reporting bias conceptualizations of affective differences across ethnic groups. Implications and directions for future research are given.

The importance of the repressive coping style: findings from 30 years of research

During the last three decades there has been substantial research exploring the repressive coping style as defined by Weinberger, Schwartz, and Davidson. As "repressors," who score low on trait anxiety and high on defensiveness, account for up to 50% of certain populations, they are an essential group for psychologists to study. However, there are methodological issues in identifying repressors as well as considerable evidence that repressors avoid negative self-relevant information. Possible methods of addressing these difficulties are discussed in this review. Importantly, there is a body of evidence linking repressive coping and poor physical health, including heart disease and cancer. However, some preliminary findings suggest that repressors compared to non-repressors may be better at health behaviors that they perceive as under their personal control. This needs more extensive investigation as such behaviors are only one aspect of health and other factors may contribute to repressors' poor physical health. Possible future directions of research are discussed including: the need for systematic empirical research of a new theory of repressive coping--the Vigilance-Avoidance Theory--more longitudinal health studies, and an in-depth exploration of the physiological mechanisms which may underlie repressive coping.

Repressive adaptive style and self-reported psychological functioning in adolescent cancer survivors

Low levels of posttraumatic stress disorder (PTSD), posttraumatic stress symptoms (PTSS), and psychosocial distress have been reported in pediatric cancer survivors. One explanation is the relatively high prevalence of the repressive adaptive style (low distress, high restraint) in this population. We investigated the relationship between this adaptive style and PTSD, PTSS, and psychosocial functioning in 29 adolescent cancer survivors (12 through 18 years). Adolescents categorized as repressors (n = 14) reported moderate/large effect size differences in PTSD, PTSS, and psychosocial distress (lower) as well as QOL (better) compared to non-repressors. Furthermore, repressors reported less PTSD and QOL variability. Thus, the repressive adaptive style, pronounced in this population, may obscure systematic and clinically meaningful adaptive style group differences across psychological measures.

Associations between the repressive adaptive style and self-reported hope in Mexican American and Euro-American children

A large literature has examined the associations between Weinberger, Schwartz, and Davidson's (1979) repressive adaptive style (RAS) construct and various self-report measures of distress or unpleasant emotional states in adults and children. Fewer investigations have examined the role of RAS in self-reported positive psychology constructs. In this investigation, we used Weinberger et al.'s (1979) categorical typology to examine the associations between adaptive style and hope in Euro-American (n = 60) and Mexican American (n = 49) children (M age = 11.4 years) who were students at 1 of 3 parochial schools in a large Midwestern city. Partially supporting the hypotheses, a univariate 2 (ethnic group) x 2 (repressor group) analysis of variance indicated a significant main effect for adaptive style group but no significant main effect for ethnic group and no significant interaction effect. Results extend the literature on the associations between adaptive style and self-report instruments and indicate that (similar to self-reported measures of distress) self-reported hope may be subject to social desirability bias.

Modalities of anger expression and the psychosocial adjustment of early adolescents in eastern Cuba

Culture influences the acceptability of the overt expression of anger. In many cultures, overt expression of anger is considered legitimate for males but not for females. We explored the implications of anger expression among early adolescents in Cuba, expecting that overt, explosive expression of anger would be particularly maladaptive in a society that is collectivistic by virtue of both its cultural heritage and ideology. Given the sharp gender-role distinctions in traditional Latin American society, we expected to find more overt expression of anger by males. However, the analyses revealed no significant gender differences in anger expression. Overt expression of anger was significantly associated with multiple measures of maladjustment. Evidence that the inhibition of anger is associated with maladjustment was not as consistent, but holding anger in was linked with internalizing difficulties. Sociometric data indicated that early adolescents who demonstrate control of their anger are highly accepted and considered as leaders.

Repressive adaptation in a nonclinical sample: consistent and inconsistent reports of child psychosocial functioning across informants

Using multiple indicators (self-report, parent report, school grades, and disciplinary referrals), we compared the psychosocial functioning of children across Weinberger's (1990) and Weinberger, Schwartz, and Davidson's (1979) repressive adaptive style (RAS) groups. Participants included 134 children ages 10 to 13 years that were recruited from public schools and 117 of their caregivers. Relative to nonrepressors, we hypothesized repressors to evidence lower levels of self-reported distress but higher parent-reported distress on the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992). Summary scores from the BASC self-report differed significantly between repressors and nonrepressors in the expected directions. No significant group differences in parent-reported distress or school functioning emerged. Consistent with Phipps (2005), results question the predominant assumption that the RAS is associated with risk of psychosocial difficulties in children.

Anger expression in children and adolescents: A review of the empirical literature

Understanding the links between anger expression by children and adolescents, their health, and their interpersonal interactions is important given the evidence that anger is associated with maladjustment and illness among adults. This review covers: 1) possible origins of the awareness and expression of anger; 2) assessment of anger in children and adolescents, including both self-report and observational approaches; 3) implications of anger expression for interpersonal relationships; and 4) outcomes of anger expression. Dimensions of anger expression found in adults have been corroborated to some extent in child and adolescent data. Reliable and valid measures of these dimensions have been developed. There has been much less research on the correlates of maladaptive anger expression in children or adolescents than in adults. Nevertheless, the current data base provides some confirmation that youth who cope inappropriately with their anger are at risk for problematic interpersonal relationships and negative outcomes in terms of both mental and general health.

Children's self-reported coping strategies: the role of defensiveness and repressive adaptation

This study examined differences in self-reported coping strategies across children classified according to Weinberger et al.'s (1979) adaptive style paradigm. Consistent with the larger literature, it was hypothesized that repressors (i.e. characterized by high self-reported defensiveness and low self-reported distress) would endorse fewer behaviorally and cognitively avoidant coping strategies than other adaptive style groups. Participants included 134 children, ranging in age from 10 to 13 (M=11.26, sd=.59), who completed measures of defensiveness, trait anxiety, and coping. Consistent with the hypotheses, results indicated significantly lower endorsement of avoidant coping strategies, and significantly higher endorsement of approach-oriented strategies among repressors, but no significant differences across adaptive style groups for other forms of coping. Results indicate that, consistent with other indicators of psychological functioning, the measurement of coping strategies is subject to the effects of socially desirable responding. Further, results provide evidence that measures of coping may be contaminated by items reflecting adjustment problems.

The social antecedents of anger proneness in young adulthood

Anger has been shown to be an important factor in occupational maladjustment, family conflict, physical and sexual assault, criminal behavior and substance abuse. It has also been linked with such adverse health outcomes as hypertension, heart disease, and cancer. Focusing on anger proneness, conceptualized as a relatively enduring propensity to experience and express anger; this article examines both early and recent antecedent factors that predict and may condition levels of anger proneness. The roles of both prospectively and retrospectively assessed factors are considered. Data from an ethnically diverse and representative sample of young adults reveals clear gender differences and, at least for short-tempered anger; decreasing levels of anger with increasing socioeconomic status. Prior exposure to violent events, prior exposure to other forms of social stress, and certain personal attributes were found to be significant antecedents of both hostility and short-tempered forms of anger proneness.

Repressing distress in childhood: a defense against health-related stress

This paper is a review of empirical investigations of the repressive adaptive style in youth. Studies were selected on the basis of their adherence to Weinberger et al.'s (J Abnorm Psychol 88: 369-380, 1979) paradigm, consisting of the interaction between a measure of distress and a measure of defensiveness to categorize repressors. The presence of a repressive style of adaptation was identified in adolescence, especially among pediatric populations. Adolescent repressors were found to exhibit characteristics similar to those identified among adult samples (i.e., self-deception, biased self-reports, and inhibition of signals of distress). Only one study focused on young repressors' autonomic reactivity, which is another main characteristic of a repressive adaptive style in adulthood. Methodological inconsistencies between child studies are highlighted and weaknesses in the psychometric properties of defensiveness measures in childhood are discussed. Future investigations should examine the impact of a repressive adaptive style on health outcomes and behaviors to see if adult health data associated with a repressive style of adaptation are replicable in childhood.