Role of Depressive Symptoms in the Expression 
of Self-silencing and Anger in Women

Abstract

Background

In the Indian sociocultural context, women are disproportionately affected by mental health concerns, irrespective of their occupational status. The coping mechanisms employed to manage daily stressors are often maladaptive, contributing to the onset and maintenance of psychological disorders such as anxiety and depression. These conditions may further impair their affect regulation, particularly in the expression of anger.

Purpose

The study aims to see the role of depressive symptoms as a mediator of self-silencing and expression of anger among women living in the National Capital Region of Delhi, northern part of India, considering their possible consequences on women’s psychological well-being.

Methods

This was a cross-sectional design with 201 participants aged 25–50 years, divided into two groups of 100 Working Women (WW) and 101 Non-Working Women (NWW), using the measures of Silencing the Self Scale (STSS), Patient Health Questionnaire-9 (PHQ-9) and the State–Trait Anger Expression Inventory-2. Statistical analysis was conducted using International Business Machines Statistical Package for Social Sciences (IBMSPSS) Statistics software, version 28.0, to perform both descriptive and inferential statistics.

Results

The results indicate robust findings on the mediational analysis of depressive symptoms between self-silencing and expression of anger. The direct effect of self-silencing on expression of rage was β = 1.01 (p < .01); β = 0.56 (p < .01). The total indirect effect (β = 0.456, p < .01) through the mediator, with a point estimate of 0.4617. Significant difference was found between WW and NWW on the domains of self-silencing, depressive symptoms and anger expression.

Conclusion

In the light of this, there is an alarming concern over the mitigation of these factors related to the mental health of women, who negotiate both professional and household roles in Indian context.

Introduction

Women’s psychological experiences are influenced enormously by socialisation techniques that emphasise relational harmony, emotional self-control and conformity to their cultural norms. One of the most common and detrimental consequences of this programming is self-silencing. It describes a pattern of thought and behaviour where individuals, particularly women, suppress the expression of their thoughts, needs, emotions or values in intimate relationships. They often do this to maintain the harmony or to avoid the risk of conflict.^{1, 2} Over time, this self-directed censorship becomes internalised and habitual, compromising the individual’s psychological well-being and leading to a range of affective disturbances. While self-silencing is frequently masked as adaptive or prosocial behaviour, it has been extensively linked with negative mental health outcomes, including low self-esteem, interpersonal dependency, anxiety and notably, depression.^3–5

About one in five women experiences depression, ⁶ making depression a major global health issue. Understanding the psychological causes of depression in women is essential to tackling this widespread health issue. ⁶ Self-silencing, a theory of women’s sadness, suggests that inauthenticity in significant relationships might cause depression, ⁷ which entails ignoring one’s own needs and feelings to meet others, frequently out of fear of losing the relationship or experiencing unpleasant repercussions. ⁶ Self-silencing is ‘loss of voice’, ⁸ which means generating inhibition in the form of self-expression, especially anger and prioritising others’ needs, has been linked to depression and eating disorders. ⁹ In a culture that objectifies women, objectification theory explains how internalising an observer’s perspective on their physical appearance and habitual body monitoring can increase shame and anxiety. ¹⁰ Such experiences may exacerbate self-silencing in women who internalise societal expectations and suppress their desires and emotions to conform to objectified ideals, which can further deteriorate or worsen mental health issues.

The complex link between self-silencing, angry expression and depressed symptoms merits further study, particularly the mediation role of depressive symptoms. Self-silencing may increase depressive symptoms, which may affect anger. ⁶ Self-silencing may promote anger suppression, which in turn increases depressive symptoms, producing a feedback loop. Concealing one’s genuine thoughts can lead to a divided self, where the obedient exterior self is incongruent with internal feelings, resulting in wrath and self-condemnation, making certain women more susceptible to depression. ⁶ Self-silencing mediates the relationship between perceived spousal criticism and depressive symptoms, suggesting that women who perceive their partners as critical are more likely to suppress their feelings and present a compliant facade, leading to depression. ⁷ Research also links self-silencing to psychological characteristics such as anger repression and fear of rage expression. ⁶ Gender-specific bans on female anger and aggression restrict their expression. Thus, this study seeks to understand how depressive symptoms may mediate the complex relationship between self-silencing behaviour and anger expression, thereby improving our understanding of depression, particularly in women.^{6, 9}

Assertive and practical expression of negative thoughts and emotions may reduce self-silencing, the difference between inner and outer selves, anger suppression and hopelessness in relationships, promoting problem-solving and reducing depressive symptoms. ⁶ People may self-censor in social conversation, hiding their genuine beliefs from disagreeable listeners. Depression and self-silencing are linked to perfectionism because both involve shame and desperate attempts to follow social norms. Therefore, the present study seeks to address this lacuna by investigating the mediating role of depression in the relationship between self-silencing and anger expression among women. In the context of the theory of self-silencing and cognitive-affective models of emotion regulation, the present study aims to enhance knowledge of how specific gender norms affect emotion regulation strategies and symptoms of depression, which further intersect to shape women’s emotional experiences and their expression of anger. These kinds of studies hold significant implications not only for the theoretical enrichment but also for the clinical interventions that aim to promote empowerment, self-actualised behaviour and psychological well-being among women.

Method

Ethical Committee Approval

Ethical approval from the Institutional Review Board, Centre for Research, Amity University Haryana (Manesar), for the study was received after the ethical aspects were assessed. Informed consent was obtained from all participants for voluntary participation and that the data might be used for publication purposes. Further ensuring their understanding of the study’s purpose, procedures and their right to withdraw at any time. Confidentiality was maintained throughout the study.

Research Design

This study adopted a quantitative, cross-sectional survey design to assess the relationships between self-silencing, depressive symptoms and expressing anger among women. Data were collected using standardised questionnaires to examine these variables and their interconnections.

Sample

The study used a cross-sectional design involving women aged 25–50 years living in the National Capital Region of Delhi, India. The sample size was calculated using G* Power software, which came to be 201, with 100 working women (WW) and 101 non-working women (NWW); however, the analyses presented in this study were restricted to respondents who completed all the items on the administered tools. The participants were selected according to specific inclusion criteria. The inclusion criteria for participants were as follows: (a) 25–50 years of age, (b) 100 working (at least full-time eight hours of work with remuneration) as well as 101 NWW, (c) proficiency in the English language and (d) no chronic psychiatric and neurological illness.

Data Collection

After taking ethical committee clearance. Participants were informed about the purpose and background of the study to provide their informed consent for participation. The personal sheet information was gathered on the age, educational qualification, marital status and family type. These variables were gathered to better understand potential relationships between self-silencing, depressive symptoms and expression of anger.

Tools

A semi-structured sociodemographic proforma was developed and participant information was recorded, including name, sex, age, highest educational qualification, employment and designation.

The Silencing the Self Scale (STSS) was developed by Jack (1991). ¹¹ The scale consists of four dimensions namely Externalised Self-perception (judging the self by external standards), Care as Self-Sacrifice (securing attachments by putting the needs of others before self), Silencing the Self (inhabiting one’s self-expression and actions to avoid conflict and possible loss of relationship), The Divided Self (experience of presenting an outer compliant self to live up to feminine role imperative while the inner self grows angry and hostile). The reliability of the STSS was 0.93. Reliability of STSS in all samples was excellent.

The Patient Health Questionnaire-9 (PHQ-9) ¹² is a nine-item self-report measure used to evaluate the severity of depressive symptomology. The PHQ-9 showed a satisfactory internal consistency (α = 0.87).

The State–Trait Anger Expression Inventory (STAXI-2) ¹³ is designed to provide easily administered and objectively scored measures of the experience, expression and control of anger. Alpha coefficient measures of internal consistency were uniformly high across all scales and subscales (0.84 or higher, median r = 0.88). Therefore, the internal consistency reliabilities of the scales and subscales are satisfactory and were not influenced by either gender or psychopathology. The alpha coefficient for the Anger Expression (AX) Index, ranging from 0.75 to 0.82, indicated satisfactory internal consistency for this measure, which is based on scores of the anger expression and control scales rather than computed directly from item ratings. Evidence for concurrent, convergent and divergent validity is provided in the manual. The revised 57-item STAXI-2 consists of six scales, five subscales and an Anger Expression Index, which provides an overall measure of expression and control of anger.

Results and Interpretations

Table 1. Sociodemographic Table for Women in General (N = 201).

Demographic Character	Category	Mean	n	%
Age		32
Education	Higher Secondary		55	28%
	Graduation		56	28%
	Postgraduation		89	44%
Marital Status	Unmarried		54	27%
	Married		146	73%
Employment status	Working		100	50%
	Non-working		101	50%
Family Structure	Joint family		62	31%
	Nuclear family		138	69%

The above Table 1 shows the mean age of the women is 32 years. Results also showed that 44% are post-graduate, 28% of women have the education level up to graduation and higher secondary respectively. The results reflected that 73% of women were married and 50% of the unmarried but had an intimate partner relationship. We also found that the sample comprised 50% working and 50% NWW. The results indicated that 69% belong to a nuclear family and 31% belong to a joint family.

Table 2. Mean and Standard Deviation (SD) of Self-silencing Dimension Scores and t-value for the Difference Between Scores of the Two Groups (Working and Non-working Women).

Variables	Groups	N	Mean	SD	SED	df	t-value	p Value
Externalised Self-perception	Working	90	16.02	3.90	.43	199	0.08	.827
	Non-working	110	15.27	4.02
Care as Self-sacrifice	Working	90	25.78	4.87	.545	199	3.47	.05*
	Non-working	110	22.25	5.03
Silencing the Self	Working	90	23.88	4.67	.534	199	3.98	.01*
	Non-working	110	20.12	5.48
Divided Self	Working	90	17.43	4.11	.425	199	3.41	.001*
	Non-working	110	13.44	4.23

Note: *p < .01.

Table 2 showing the mean and SD of dimension-wise self-silencing scores of the two groups of women belonging to the working and NWW. The reliability of the dimension-wise difference between the two groups of scores was computed with the help of a t-test. The dimension-wise scores also indicated similar results as the two groups of women differed from each other on all the dimensions of self-silencing example, Externalise Self-perception in WW (M = 16.02) and NWW (M = 15.27) did not show a significant difference (SED = 0.43, t = 0.08, p < .01).

Care as self-sacrifice dimension on the self-silencing among the WW group (M = 25.78) and NWW group (M = 22.25) revealed significant difference (SED = 0.545, t = 3.47, p < .05); Silencing the self-dimension among the WW group (M = 23.88) found relatively higher than the NWW group (M = 20.12) which indicated significant difference (SED = 0.534, t = 3.98, p < .01) and last the divided the self-dimension among the WW group (M =17.43) found relatively higher than the NWW group (M = 13.44) revealed significant difference (SED = 0.425, t = 3.41, p < .01).

Table 3. Mean and Standard Deviation (SD) of Self-silencing Overall Scores and t-value for the Difference Between Scores of the Two Groups (Working and Non-working Women).

Variable	Groups	N	Mean	SD	df	t-value	p Value
Overall Self-silencing	Working	90	81.38	14.75	199	4.12	.001*
	Non-working	110	77.87	18.54

Note: *p < .01.

Table 3 shows the overall score of self-silencing of women belonging to two different groups, namely, working and NWW. From the result, it appeared that self-silencing was much higher among the WW than their NWW counterpart, as the mean scores on self-silencing for the two groups were 81.38 and 77.87, respectively. The difference in the mean scores of the two groups was found statistically significant as the t-value was found to be 4.12 (df = 199) beyond the level of 0.001.

Table 4. Mean and Standard Deviation (SD) of Depressive Symptoms Scores and t-value for the Difference Between Scores of the Two Groups (Working and Non-working Women).

Variable	Groups	N	Mean	SD	df	t-value	p Value
Depressive Symptoms	Working	100	11.104	9.07	399	2.63	.008
	Non-working	101	8.885	7.75

Note: *p < .01.

Table 4 indicating the overall score of depressive symptoms of women belonging to two different groups, namely, working and NWW. From the result, it appeared that depressive symptoms were higher among the WW than their NWW counterpart, as the mean scores on self-silencing for the two groups were 11.10 and 8.88, respectively. The difference in the mean scores of the two groups was found statistically significant as the t-value was found to be 2.63 (df = 199) beyond the level of 0.01.

Table 5. Mean and Standard Deviation (SD) of Anger Expression Overall Scores and t-value for the Difference Between Scores of the Two Groups (Working and Non-working Women).

Variable	Groups	N	Mean	SD	df	t-value	p Value
Anger Expression	Working	90	40.12	6.47	199	3.89	.001*
	Non- working	101	36.89	6.01

Note: *p < .01.

Table 5 indicating the overall score of anger expression of women belonging to two different groups namely working and NWW. From the result it appeared that anger expression, was much higher among the WW than their NWW counterpart as the mean scores on self-silencing for the two groups were 40.12 and 36.89, respectively. The difference in the mean scores of the two groups were found statistically significant as the t-value was found 3.89 (df = 199) beyond the level of 0.01.

Table 6. Coefficient of Correlation Between the Scores of Self-silencing, Depressive Symptoms and Anger Expression Among Women in General (N = 201).

Variables	External Self-perception (1)	Care as Self-sacrifice (2)	Silencing the Self (3)	Divided Self (4)	Overall Self-silencing (5)	Depressive Symptoms (6)	Inward Anger Expression (7)	Outward Anger Expression (8)	Anger Expression (9)
(1)	1	.47**	.49**	.51**	.68**	.49**	.55**	.38*	.41**
(2)		1	.64**	.40*	.74**	.68**	.39*	.28*	.44**
(3)			1	.59**	.72**	.67**	.36*	.26*	.49**
(4)				1	.67**	.71**	.26**	.11	.45**
(5)					1	.80**	.61**	.12	.56**
(6)						1	.62**	.28*	.57**
(7)							1	.29*	.79**
(8)								1	.72**

Note: *p < .01; **p < .05.

The above Table 6 results clearly indicate that overall self-silencing was positively related to depressive symptoms of the women in general. The relationship was found to be strong (r = 0.80) and statistically significant, indicating that higher levels of overall self-silencing are associated with greater depressive symptoms among women. The dimension-wise analyses also showed similar results, as all the dimensions of both the variables were directly related to each other and all the correlation coefficients were found statistically significant. Overall, self-silencing was positively correlated with anger expression, as the results of the above table make abundantly evident. The association was judged to be statistically significant due to its considerable intensity (r = 0.61). In other words, women who score higher on general self-silencing will also show their anger more frequently. The results of the dimension-wise analyses were likewise comparable, with all the dimensions of the two variables having a direct relationship with one another and all correlation coefficients being determined to be statistically significant. The table shows that depressive symptoms were positively related to anger expression of the women in general. The relationship was strong (r = 0.62) and statistically significant, indicating that greater levels of depressive symptoms are associated with greater levels of anger expression among women; the dimension-wise analyses likewise produced comparable results.

Table 7 indicates that the relationship between self-silencing and expression of anger was mediated by depressive symptoms. The estimates of 95% confidence intervals and summary of mediation analyses are presented in Table 7 and Figure 1. The direct effect of self-silencing on expression of anger was β = 1.01 p < .01; β = 0.56, p < .01. The difference between the total and direct effects was the total indirect effect (β = 0.456, p < .01) through the proposed mediator, with a point estimate of 0.4617 and a 95% confidence interval of 0.449746 to 0.473654. Hence, it can be concluded that depressive symptoms mediate the relationship between self-silencing and expression of anger.

Table 7. Indirect Effect of Self-silencing on Expression of Anger Through Depressive Symptoms (N = 200).

	Point of Estimate	Z Value	Std. Error	Sig. (Two Tailed)	95% Confidence Interval
					Lower	Upper
Sobel	0.4617	7.5	0.0119	0.0001*	0.449746	0.473654

Note: *p < .01.

Figure 1. Simple Mediator Model in the Prediction of Expression of Anger. β = Standardised Beta Coefficients. The Value Outside of the Parentheses Represents the Total Effect of Self-silencing on Expression of Anger Before the Inclusion of the Mediating Variable. Value in the Parentheses Represents the Direct Effect of Self-silencing on Expression of Anger After the Mediator is Included. ∗p < .01.

Discussion

The mental health of both men and women must be prioritised, particularly in light of the rising prevalence of depression over the past two decades. It is imperative to examine the contributing and maintaining factors underlying such psychological conditions. Research indicates that women are disproportionately affected by depression compared to men. This disparity may be attributed, in part, to the dual burden many women face in balancing occupational responsibilities with domestic roles, which can disrupt emotional regulation. One notable behavioural pattern associated with this is self-silencing, characterised by the suppression of personal needs, emotions and desires to maintain harmony or avoid conflict. Empirical studies have consistently demonstrated a strong association between self-silencing and depression, with each potentially reinforcing the other. Moreover, self-silencing is often linked to maladaptive emotional expression, particularly with respect to the suppression or dysregulation of anger. Therefore, it is clinically relevant to investigate the interplay between depression, self-silencing behaviours and anger expression to better understand the mechanisms underlying these difficulties and inform appropriate interventions.

Psychosocial issues include the mean age of 32, education, marriage and intimate relationship rates, working and NWW distribution and family structure composition complicate women’s lives. ¹⁴ The sample includes reproductive and professional women in their prime, when career, family and personal growth matter, with an average age of 32. With 44% post-graduate and 28% graduation and upper secondary education, this generation may have more employment, decision-making and social prestige. ¹⁵ Even though 73% of married women accept cultural norms, 50% of unmarried women in intimate relationships have modified their views on marriage and cohabitation. Since there are equal numbers of working and NWW, we can investigate their economic and domestic management. Nuclear households are replacing mixed families. The sample’s 50% working and 50% NWW have many effects. Education, support and marriage affect female careers. ¹⁶ Despite different lifestyles, 73% of the sample women are married, demonstrating marriage’s social significance. Family support and childcare may affect women’s work engagement. Family structure (69% nuclear, 31% joint) impacts many. Nuclear households may lack extended family support, but give women more independence and choice. ¹⁷ Joint homes reduce childcare and eldercare and reinforce gender norms. Urbanisation, migration and individualism may impact nuclear families. ¹⁸ The opportunities, problems and well-being of women depend on these forces. Professionally, working and NWW self-silencing differ. ⁶ Relational theory and feminist psychology define self-silencing as the act of disguising thoughts, feelings and needs to maintain relationships or meet social expectations. ¹⁹ Women experience this more due to social conditioning and relationship self-construal, which can cause psychological and physiological concerns. ⁹ Researching domain-specific self-silencing, including Externalised Self-perception, care as self-sacrifice, silencing the self and divided self, helps women understand how their identities and interpersonal dynamics affect their employment. Self-silencing differences between working and NWW show how work, identity and mental health are interconnected. Workplace pressures may silence women. ²⁰

WW had a greater Externalised Self-perception (M = 16.02) than NWW (M = 15.27), showing that employment status may alter how women regard themselves in reference to external standards and expectations, as it measures external self-image influence. ²⁰ Minor workplace evaluations may make WW more sensitive to external appraisals. WW show distinct self-silencing traits than NWW, worsening mental health. ⁴ Workplace culture, job requirements and coping techniques differ. Women worked selflessly. Relationship sacrifice is assessed. The need for selflessness and empathy may challenge working mothers. WW masked more than NWW owing to pressure. This metric examines how often people hide their thoughts, feelings and attitudes to avoid conflict. Self-silencing can lead to inauthenticity, alienation and low self-esteem. ⁸ Female workers’ personal and professional selves clashed. Different selves in different settings make this dimension uneven. Internal division can cause conflict and self-doubt. ¹⁹ Higher scores for WW may worsen self-silencing. A composite score measures concealment. Work-life balance therapies and support networks may minimise self-silencing depression in women. ⁶

Statistical differences between working and NWW across self-silencing factors confirm these findings. The t-values exceeded statistical significance; therefore, inconsistencies are not random. Gender and job should be included while studying self-silencing, despair and rage. ²⁰ Silence damages relationships. ⁹ High self-silencing can induce inner discontent because their public image does not match their feelings. ⁶ A ‘divided self’, where external submission covers inner wrath, generates melancholy; therefore, mental health demands authenticity and self-expression. ⁶ Self-silencing and depression or eating disorders in women. Psychological injury can result from emotional alienation.^{1, 22} It is crucial to examine why WW had greater depression symptom scores than NWW (t = 2.63, p < .01). WW had a higher mean self-silencing score of 11.10 than NWW (8.88) and a significant t-value of 2.63 (df = 199) over 0.01 shows that salient demands or events uniquely affect their psychological well-being. Workplace stress, work-life balance, cultural expectations and coping methods can cause depression in WW. Many studies imply that women have a ‘double work day’ due to pressure to excel in employment, parenting, homemaking and family care. ⁶ Role-tension or role-strain may affect employed women balancing diverse role expectations, but their relationship to mental health is complex and depends on employment type, perception of control or choice over job and life decisions, education level, satisfaction with homemaking and marital roles and work and home social. Research shows that WW are happier. ²³

Despite job benefits, the effort-recovery paradigm demonstrates that work and family restrictions, especially time restraints, may mentally harm the WW. ²⁴ Managing work and home can drain cognitive and emotional resources, creating stress and despair. The mental health of WW must be examined. Carer stereotypes and employment gender bias may impair women’s mental health. ²⁵ WW typically feel overworked. ²⁵ Without time, skills or social support, WW must work harder and longer to keep pace with urban development and may need to balance work and family. ²⁶ Women can feel depressed by work-family balance. ²⁷ Poor work-life balance and inconsistent schedules affect mental health. ²⁸ Women can be depressed by work. Assess discrimination, autonomy, support and job satisfaction. ¹⁷ Employment boosts women’s self-esteem, status and mental wellness. ²³ Careers, marriage and children can enhance women’s mental and physical health. ²³

Job stress can impair mental health through coping, personality and social support. Culture and society may affect women’s depression and work-life balance.

WW had greater mean anger expression ratings (40.12) than NWW (36.89), needing socio-psychological inquiry. ²⁹ Women may struggle to manage work and family due to long hours, performance pressure and career goals. ³⁰ Workplace ‘double burden’ or multitasking can frustrate and resentful women. ²⁴ Women may be stressed by gender discrimination, unequal promotion and complex coworker-superior relationships. ³¹ Culture and gender norms may enrage them.

WW who manage their emotions must understand wrath. Women can get exhausted, angry and violent from emotional labour in many jobs. ³² Suppressing or manipulating emotions to fulfil job norms may cause rage or other maladaptive behaviour. ³³ WW encounter family and financial issues. ²⁶ Working two jobs is hard, ³⁴ as the substantial t-value (t = 3.89, df = 199, p < .01) indicates that anger expression disparities between groups are not random, hence family and education determine women’s rage. ³⁴ Gender difference depends on employment; hence, gender and occupational stress must be researched. ³⁵ Women can be mentally and physically exhausted by work. ³⁶ Office gender prejudices bother WW. ³⁴

Women who hide their sentiments to avoid conflict or sustain relationships can get angry. Depression, anxiety and fury can result from silence. Women may hide rage due to social pressure. ³⁷ Feminists educate women to hide anger. ³⁸ Knowing that gender socialisation affects women’s emotional expressions, particularly anger, WW may struggle to match these expectations with their need to release anger about work issues. Gender and anger stereotypes may cause people to hide their rage. ³⁸

Childcare, household management and financial dependence may not reduce emotional demands on NWW. Home life is less stressful than work, yet it might cause social isolation, unpaid work and family issues. Flexibility and less effort may relax non-WW. ³⁹ We must study stress, emotional labour, self-silencing and gender role expectations to understand how working and NWW exhibit anger. Female depression increases with self-silencing. ⁶ Limiting connection desires may cause depression. ¹⁹ In a study ⁶ found high links between all self-silencing traits and depression in women. Self-silencing increases anger, showing that drive suppression may increase wrath. Each dimension-wise correlation coefficient between self-silencing and wrath expression is significant. ⁶ Research shows that depressed women are angrier. ⁶ A large correlation coefficient indicates that sad women are also likely to be angry. Depression greatly affects fury. ⁶ Self-silencing to avoid intimate conflict or loss may produce depression and disordered eating in women.^{21, 22} Self-silencing may affect depressive gender gaps. ⁹

Self-silencing indirectly affects fury expression through depression, says a mediational study. Self-silencing affects wrath without depression, statistics show. Depression from self-silencing indirectly influences the expression. These findings confirm the self-silencing theory, which holds that women may hide their feelings in relationships to maintain connection, causing despair and rage.^{6, 7} For fear of spousal judgement, women may limit their wishes and sentiments. ⁷ Depression can trigger latent violence in women. ⁶ Depression rises with female wrath suppression and self-silencing. ⁶ Depression was predicted by feminine gender-related anger suppression. ⁶ Self-silencing causes depression and eating disorder gender gaps. ⁹ Women’s mental health must address despair, self-silencing and rage. ⁶

Conclusion

The relationship between self-silencing and anger expression is often indirect, with depression serving as a key mediator. Depression influences whether anger is suppressed, internalised or expressed destructively. Addressing self-silencing behaviours and emotional repression in therapy (such as through cognitive behavior therapy (CBT) or expressive interventions) can help break this cycle and promote healthier emotional regulation.

Authors’ Contribution

P. Sharma: Contributed to conception design, acquisition, analysis, or interpretation, drafted manuscript, critically revised the manuscript.

M. N. Kirmani: Contributed to conception design, acquisition, analysis, or interpretation, drafted manuscript, critically revised the manuscript and gave final approval.

D. K. Salvi: Contributed to acquisition, analysis, or interpretation, critically revised the manuscript and gave final approval.

All authors agree to be accountable for all aspects of work ensuring integrity and accuracy.

ICMJ Statement

We hereby declare that this original article has been prepared in accordance with the ICMJE guidelines.

Informed Consent

Informed consent was obtained from all participants and the study was conducted in accordance with ethical guidelines. The confidentiality and privacy of participants were maintained throughout the study.

Statement of Ethics

I confirm that this work is original and has not been previously published, nor is it currently under consideration elsewhere. I further confirm that the data presented are accurate and that no data have been fabricated, falsified or manipulated. All sources used are properly cited and plagiarism has been avoided.