Abstract
Background
Anger problems (anger dysregulation) and depressive symptoms have been linked to risk for all causes of mortality, but less is known about the association between anger dysregulation and depressive symptoms within the context of gender differences and health outcomes.
Objectives
The association between anger dysregulation, depressive symptoms, and self-reports of health in married adults was evaluated using an emotion-regulation model.
Method
Fifty-two married couples completed a series of procedures that included an interview assessing their ability to regulate anger, a questionnaire reporting depressive symptoms (Beck Depression Inventory) and self-reports indicating health.
Results
Results provided support for hypothesized links between the variables, but they varied by gender: (a) greater anger dysregulation in the wives, but not the husbands, was predictive of depressive symptoms; (b) anger dysregulation was predictive of the husbands’ self-reports of health but was not predictive of the wives’ self-reports of health; (c) depressive symptoms were not significantly associated with self-reports of health for either married women or men.
Discussion
These results suggest that anger dysregulation may play different roles in the depressive symptoms and self-reports of health for married women and men.
Keywords: anger, depression, health
Psychosocial factors such as anger and depressive symptoms have been associated with health problems and risk for all causes of mortality (Anda et al., 1993; Miller, Smith, Turner, Guijarro, & Hallet, 1996; Rozanski, Blumenthal, & Kaplan, 1999), but less is known about the association between anger dysregulation and depressive symptoms within the context of gender differences and health outcomes. The purpose of this study was to determine if there was an association between anger dysregulation, depressive symptoms, and self-reports of health in a sample of married women and men.
Hostile personality as a component of anger has been most frequently studied in the context of health risk. A large body of research literature has identified a hostility behavior trait linked to the development of health problems has been identified. These include chronic diseases such as hypertension (Räikkonen, Matthews, & Kuller, 2001), cardiovascular disease (c.f., Rozanski, Blumenthal, & Kaplan, 1999), and risk for all causes of mortality (Siegler et al., 2003). Individuals with this personality trait are easily goaded to hostile behaviors under social situations. They are more likely to characterize a situation as anger-provoking, and are more apt to suppress their anger (Miller, Smith, Turner, Guijarro, & Hallet, 1996). Other researchers (Brosschot & Thayer, 1998; Carrère, et al., 2004) suggest that the hostile behavior pattern of response to anger-provoking situations and interpersonal challenge occur because these hostile individuals are emotionally dysregulated and have difficulty soothing themselves emotionally, physiologically, and behaviorally under stressful situations. This model of emotional regulation/dysregulation is drawn from the child development literature. It has been found with infants and children that the ability to physiologically and emotionally self-regulate is a developmental landmark that has been linked to important childhood outcomes such as physical and mental health (Garber & Dodge, 1991; Thompson, 1994). Physiological self-regulation in children has been studied closely by looking at autonomic dysregulation as indexed by parasympathetic influence on cardiovascular arousal (Porges, Doussard-Roosevelt, Portales, & Greenspan, 1996). Emotional and autonomic dysregulation may play a role in adult health processes as suggested by current research. For example, Carrère et al. (2004) found support for the emotion regulation theory in adults. They reported that anger dysregulation in married women was associated with heightened behavioral displays of anger and diminished parasympathetic influence on the heart (i.e., lower levels of respiratory sinus arrhythmia) during the emotional stress of a marital conflict. Sloan et al. (2001) theorized that autonomic dysregulation and the inability to self-regulate (emotionally, behaviorally, and physiologically) under stressful situations is the mechanism linking the hostile behavioral trait to health problems.
Although the link between episodes of major depression and health risk has been emphasized (e.g., Rozanski, Blumenthal, & Kaplan, 1999; Schulz, Drayer, & Rollman, 2002), the presence of depressive symptoms has been associated with increased risk for all causes of mortality (Wilson, Bienias, Mendes de Leon, Evans, & Bennett, 2003), cardiovascular disease (Anda et al., 1993), and metabolic syndrome (Räikkonen, Matthews, & Kuller, 2001).
Individuals with subclinical levels of depression symptoms have difficulty with the frequency and intensity of emotion. They reported symptoms such as difficulty controlling their crying, an inability to stop feeling sad, irritability, fatigue, and lack of motivation (Beck, 1978). Although there is an ongoing debate about the relationship between major depression and subclinical depressive symptoms, Rozanski, Blumenthal, and Kaplan (1999) concluded that continuum depression affects the relative risk for coronary artery disease (i.e., the greater the magnitude of depressive symptoms the greater the risk for future cardiac events). Little is known about whether there is a similar linear relationship between subclinical levels of depression with other health outcomes.
Subclinical levels of depressive symptoms can be characterized as a form of emotion dysregulation because individuals experiencing depressive symptoms are experiencing an inability to emotionally self-soothe and modulate emotions. Thus, if anger dysregulation and depressive symptoms are linked to difficulties in self-regulation of emotion, there would be an expected association between anger dysregulation and depressive symptoms. This supposition is supported by previous research linking anger dysregulation and depressive symptoms (Biaggio & Goodwin, 1987; Bromberger & Matthews, 1996).
In the current study, the association between anger dysregulation and depressive symptoms in a sample of married women and men was investigated. The strength of anger dysregulation in predicting depressive symptoms, after first controlling for marital quality, was assessed, to determine if anger dysregulation offered a significant increase in the variance observed in the depressive symptoms scores. Also the power of anger dysregulation and depressive symptoms to predict self-reports of health among the married women and men was examined.
Method
Participants
After the proposal was reviewed and approved by the university Human Subjects Committee, a two-stage sampling procedure was used to draw a sample of couples from the Puget Sound area in Washington. Study participants received payment for participation in the screening telephone interviews and each subsequent laboratory visit on a pro-rated system (i.e., study participants were paid for the number of procedures they participated in). Couples were initially recruited using newspaper advertisements and posted flyers. Those couples interested in participating in the study were asked to phone the laboratory and leave information so that they could be contacted by phone. Oral assent by the spouses to participate in the study was obtained before the telephone interviews were conducted. Both spouses were administered a screening phone interview that included the telephone version of the Marital Adjustment Test (MAT), a scale measuring marital satisfaction (Krokoff, 1984; Locke & Wallace, 1959). The telephone interview also included questions about health and medications. Couples were excluded from participating in the study if either spouse reported taking medication (i.e., beta blockers or tranquilizers) or using medical instrumentation devices that may have affected cardiovascular functioning, or if either spouse had diabetes. The health exclusion steps were taken so that the effects of such drugs and medical devices would not confound physiological measures used in the larger study. Couples were then invited to participate in the first visit to the laboratory. At the beginning of the first laboratory session, study participants met with a study investigator and provided written informed consent. The spouses then separately filled out a series of questionnaires, including the Conflict Tactics Scale (Straus, 1979). Couples were excluded from further participation in the study if their scores on the Conflict Tactics Scale (Straus, 1979) indicated moderate to severe violence on the part of either partner. Those individuals who indicated the use of moderate or severe violence within the marriage were given appropriate referral information and paid for their participation in completing the questionnaire packet.
Couples (N = 129) were recruited to participate in the study and completed (a) the first laboratory visit, during which a series of questionnaires were administered, (b) a marital history interview, and (c) a second laboratory session consisting of a marital problem–solving interaction. The sample was selected so that there was an even distribution of marital satisfaction among the couples’ scores on the telephone version of the MAT (i.e., usual numbers of couples at each point of the marital satisfaction distribution). For example, there were an equal number of couples who were happily married, who had average levels of marital satisfaction, and who were unhappy in their marriages. (This is in contrast to a bell-shaped distribution, which has greater numbers of participants in the middle of the distribution.) This even distribution was chosen so that we might oversample both the very happy and the very distressed couples, but not exclude couples with an average level of marital satisfaction. The sample was selected also to match the racial and ethnic demographics of the Metropolitan Seattle area (City of Seattle Planning Commission Report, 1990). Results of other components of the study (e.g., the behavioral components of marital quality) are being prepared for publication, or have been submitted for publication (e.g., emotional and autonomic dysregulation in women; Carrère et al., 2004).
A third laboratory visit was added to the study so that the Marital Meta-Emotion Interview (MMEI) could be administered (Carrère et al., 1998) individually to the spouses. Of the 129 couples originally recruited for the study, 52 couples completed the MMEI and the questionnaires, owing to a variety of issues, including (a) finding time to come to the laboratory for the third session, (b) moving out of the Puget Sound region, (c) getting deployed with the military elsewhere, (c) missing questionnaire data, and (d) having technical problems that made the quality of the MMEI tapes too poor to code.
The demographic characteristics for the original 129 married couples were: (a) wife mean age (years) = 40.45 (SD = 13.02); (b) husband mean age (years) = 42.59 (SD = 13.81); (c) wife mean marital satisfaction, as indexed by the MAT = 106.71 (SD = 24.47); (d) husband mean marital satisfaction, as indexed by the MAT = 106.58 (SD = 23.13). The sample mean levels for husbands and wives were consistent with the sample of Locke and Wallace (1959) of US married couples (mean level of marital satisfaction = 100; SD = 15). Couples in our study had a combined median income between $60,000 and $80,000. The modal education level for both husbands and wives in the study was a 4-year college degree. The majority of participants were White (70%), whereas 11% identified as Black, 12% as Asian American, 3% as Native American, and 4% as Hispanic.
The data for the 52 married couples used in the following analyses were similar to the spouses recruited for the study. Marital satisfaction for this sample was comparable to levels found in the overall sample (husband mean MAT = 108.3; SD = 23.18; wife mean MAT = 110.3; SD = 21.86). The median income for both groups was between $60,000 and $80,000. The modal level of education for both wives and husbands was a college degree, identical to the larger population. The racial and ethnic composition of the sample used for the analyses in the current article was similar to the original sample. European Americans represented 74% (n = 77) of the sample, Blacks 12.5% (n = 13), Asian Americans 11.5% (n = 12), Native Americans 1% (n = 1), and those of Hispanic origin 1% (n = 1).
Analyses were conducted to compare the demographic data for the couples used for these analyses with the full sample of the larger study. There was no significant difference in marital satisfaction for the men (t(125) = −0.14; ns, M = 108.33, SD = 23.18 for husbands with complete data; M = 106.76, SD = 23.38 for husbands with incomplete data), nor was there a significant difference in the marital satisfaction for wives t(127) = 0.29, ns; M = 1110.33, SD = 21.86 for wives with complete data; M = 107.44; SD = 25.08 for the wives with incomplete data). There was no significant age difference between the groups of husbands (t(127) = 1.11, ns, M = 44.23, SD = 13.83 for the complete-data group of husbands; M = 41.42, SD = 13.50 for the incomplete-data group of husbands), or the groups of wives (t(126) = 1.31, ns, M = 42.27, SD = 13.01 for the complete-data group of wives; and M = 39.19, SD = 12.75 for the incomplete-data group of wives). The differences in the degrees of freedom for these analyses are due to missing demographic data from the original sample of 129 couples.
Procedures
Marital Interaction Laboratory Procedures
The marital study had several components, including a semistructured interview with each couple about the history of their relationship and the completion of questionnaires (first laboratory visit), a laboratory-based marital interaction session utilizing physiological and behavioral measures (second laboratory visit), and the MMEI (Carrère et al., 1998) conducted individually with each spouse (third laboratory visit). This article focuses on the study participants who took part in the MMEI and who completed the questionnaires used in the study.
Marital Meta-Emotion Interview
The research participants were interviewed using the MMEI, a semistructured interview that takes about 90 minutes to complete. The husband and wife were interviewed separately about their emotions. The goal was to get an understanding of a particular emotion in each person. The original version of the interview was used with parents of preschool-aged children (Hooven, Gottman, & Katz, 1995) and examined two emotions, sadness and anger. The current study expanded the interview to include pride and love/affection (Carrère et al., 1998).
The MMEI is organized around each emotion, so that the questions about one emotion were covered before the interviewer moved onto the next emotion. For each emotion, individuals were asked to remember back to when they were growing up in their family of origin and how that emotion was expressed in their family. They were then “moved” to the present time and asked how they currently experienced that emotion, especially in their relationship with their spouse. The participants were questioned about their spouse’s experience of the emotion; this interview was videotaped. Videotapes and all data from the study were recorded and stored using no information about the identity of the study participants. All data for the study are kept in locked facilities accessible only to study investigators. Permission from the human subjects committee was taken to store the data from the study indefinitely so that future behavioral analyses of the data could be conducted. The consenting procedures during the first laboratory visit included comprehensive information on protocols for data management and storage for the study.
Measures and Materials
Marital Satisfaction
The 15-item MAT (Locke & Wallace, 1959; Krokoff, 1984) was administered to the wives and husbands during the initial telephone interview. The MAT is used to assess marital satisfaction and is frequently used in marital research because of its strength in distinguishing between happily and unhappily married couples. (e.g., Locke & Wallace, 1959). The items on the questionnaire ask spouses to indicate the frequency with which they disagree about topics such as finances, sex, communication, and other common sources of marital discord. The questionnaire also explores whether spouses confide in their partner, whether they would marry the same person again, whether they have similar interests in activities, and their overall rating of the quality of their relationship. The scores for the different items are weighted on the basis of their criterion validity in predicting maladjustment and divorce (Locke & Wallace, 1959). The range of scores possible on the MAT is 2–158, with higher scores indicating greater marital satisfaction. As noted earlier, the mean marital satisfaction score using the MAT for the United States’ samples is 100 (SE = 15; Locke & Wallace, 1959). In the original study by Locke and Wallace, the Spearman-Brown split-half reliability technique was utilized to compute a reliability coefficient of .90. In the present study the internal consistency of the questionnaire was moderate (α = .74). The telephone version of the MAT was used to interview spouses about their marital satisfaction during the original sample selection phase of the study. The telephone version of the MAT includes the same items used in the paper-and-pencil version of the MAT (Krokoff, 1984).
Depression Symptoms
The Beck Depression Inventory (BDI; Beck, 1978) is a well-validated scale that measured symptoms of sadness, perceptions of self-worth, irritability, difficulties with controlling expressing emotions, and behavioral changes. Examples of some of the items on the scale include the following: “I am sad all of the time and I can’t snap out of it,” “I cry all of the time now,” “I am disappointed in myself,” and “I don’t sleep as well as I used to.” Scores range from 0 to 36. Greater scores on the BDI indicate increases in intensity of depressive symptoms. Internal consistency for the current sample was moderately strong (α = .79).
Self-Reports of Health
A single item was used to gauge the study participants’ physical health. Study participants were asked to rate their health on a scale of 0 to 100, with 100 representing perfect health and 0 representing extremely poor health. Self-reports of health such as this have demonstrated good test-retest reliability and strong agreement with physicians’ rating of study participants’ health (Kiecolt-Glaser, Dura, Speicher, Trask & Glaser, 1991). Single-item ratings of health are also strong predictors of mortality (Hays, Schoenfeld, Blazer, & Gold, 1996; Idle, Kasl, & Lemke, 1990).
The Conflict Tactics Scale
The Conflict Tactics Scale (Straus, 1979) assesses the level of violence in a relationship. This scale was used to screen out violent couples from the study. The Conflict Tactics Scale contains three scales including reasoning, verbal/symbolic aggression, and physical violence. Only the physical violence scale was measured in the present study. There are seven items that evaluate behaviors such as hitting, kicking, beating up a spouse, and threatening a partner with a knife or gun. The Conflict Tactics Scale is a widely used scale with good internal consistency (α = .88 in the original study; Straus, 1979).
Marital Meta-Emotion Interview
The videotapes of the MMEI were coded using a specific checklist rating system that codes for individuals’ awareness of each of their own emotions, their regulation of these emotions, and their acceptance of these emotions (Yoshimoto, et al., 2000). The Anger Dysregulation scale is the primary focus of the current study. The Anger Dysregulation score is a sum of five items: (a) individual has difficulty regulating the intensity of anger; (b) individual has difficulty regulating the frequency of anger; (c) anger is a problem/concern in their social or occupational life; (d) anger is a problem/concern in home life; (e) individual does not have adaptive remediation techniques (activities to help soothe them and get them through the emotional experience). Coders rate each of these with a 5-point response set (strongly agree, somewhat agree, neutral, somewhat disagree, strongly disagree). Intraclass correlations for independent observers (Armstrong, 1981) were used to assess interrater reliability. The intraclass correlation for the Anger Dysregulation scale was moderate (.72).
Results
Data Analyses
Preliminary analyses consisted of calculating the means and standard deviations for the wives and husbands (Table 1), and separate sets of correlations for the spouses (Table 2). A series of sequential regression models was estimated to evaluate the relation between anger dysregulation and depressive symptoms and health variables (Tabachnick & Fidell, 1996). Separate regression equations were created for the wives and the husbands. The decision to analyze the wives and husbands’ data separately was made for several reasons. First, the outcomes of interest were the depressive symptoms and health outcomes and not marital outcomes. Thus, the unit of analysis was the individual rather than the couple. Second, wives’ and husbands’ data are not independent. In any marriage, the behavior of spouse influences the spouse’s behavior. Thus, if a husband has difficulty managing his anger, his behavior will influence his wife’s perception of the marriage, her behavior, and mental and physical health. The dynamics of the marriage can overwhelm and mask the individual measures of interest, in this case the influence of anger dysregulation on individual outcomes. For these reasons regression analyses were conducted separately for the wives and husbands. To control for the quality of the marriage, MAT scores were entered into the equation in the first block. For those analyses on the links between anger dysregulation and BDI scores of depressive symptoms, MAT scores were entered into the equation in the first block and anger dysregulation scores were entered into the equation in the second block. For those analyses of the association between anger dysregulation and depressive symptoms with self-ratings of health, MAT scores were entered into the equation in the first block, depression scores on the BDI were entered in the second block, and anger dysregulation scores were entered in the third block. For the analyses of health predictors, anger dysregulation was entered in the last block to determine if its scores were predictive of self-ratings of health, above and beyond marital satisfaction and depressive symptoms.
TABLE 1.
Means and Standard Deviations of Variables for Husbands and Wives (N = 104)
| Variable | Mean | SD |
|---|---|---|
| Wife (n = 52) | ||
| Anger dysregulation scores | 11.5 | 2.61 |
| Beck Depression Scale scores | 6.77 | 5.94 |
| Marital satisfaction score (MAT) | 110.33 | 21.86 |
| Quality of health | 80.15 | 17.65 |
| Husband (n = 52) | ||
| Anger dysregulation score | 12.19 | 3.67 |
| Beck Depression Scale scores | 5.52 | 3.72 |
| Marital satisfaction score (MAT) | 108.33 | 23.18 |
| Quality of health | 85.58 | 10.61 |
Note. MAT = Marital Adjustment Test.
TABLE 2.
Correlations Between the Measures
| Variable | 1 | 2 | 3 | 4 |
|---|---|---|---|---|
| Correlations for wives (n = 52) | ||||
| 1 Anger dysregulation | ||||
| 2 Depression symptoms (BDI) | 0.41** | |||
| 3 Self-report of health | −0.16 | −0.24 | ||
| 4 Marital satisfaction (MAT) | −0.30* | −0.38** | 0.19 | |
| Correlations for husbands (n = 52) | ||||
| 1 Anger dysregulation | ||||
| 2 Depression symptoms (BDI) | −0.26 | |||
| 3 Self-report of health | −0.33* | −0.17 | ||
| 4 Marital satisfaction (MAT) | −0.29* | −0.35* | 0.07 | |
Note. BDI = Beck Depression Inventory; MAT = Marital Adjustment Test.
p < .05, 2-tailed significance.
p < .01, 2-tailed significance.
Wives
Depressive Symptoms
The estimated sequential regression models for the wives’ scores on the BDI are shown in Table 3. When the wives’ marital satisfaction scores were entered into the equation for the wives, there was a significant effect (R2 = .14; F(1, 51) = 8.41, p < .01), and there was a significant, additional increase in the variance explained when the wives anger dysregulation scores were added to the model that included marital satisfaction (R2 change of .10; F(2, 50) = 6.46, p < .05). These results suggest that anger dysregulation scores for wives predict their depressive symptoms.
TABLE 3.
Summary of Sequential Regression Analyses for Wives’ Depression Symptoms (n = 52)
| Variable | B | SE | β |
|---|---|---|---|
| First block | |||
| Marital satisfaction score (MAT) | −0.10** | 0.04 | −.38 |
| Second block | |||
| Marital satisfaction score (MAT) | −0.07* | 0.04 | −.28 |
| Anger dysregulationa | 2.37* | 0.93 | .33 |
| Final Model: Intercept = 15.45 | R2 = 0.24 | Adjusted R2 = 0.21 | R = .49 |
Note. DV = dependent variable; MAT = Marital Adjustment Test.
z scores used for anger dysregulation.
p < .05, 2-tailed significance.
p < .01, 2-tailed significance.
Health
The wives’ marital satisfaction, depressive symptoms, and anger dysregulation were used to estimate sequential regression models for self-rating of their health (Table 4). The marital satisfaction scores did not significantly predict health (R2 = .04; F(1, 51) = 1.9, ns), nor was there a significant increase in the variance explained when wives’ depressive symptom scores were added to the model (R2 change = .03; F(2, 50) = 1.67, ns), or when the wives’ anger dysregulation scores were added to the model (R2 change = .002; F(3, 49) = .12, ns). These results indicate that wives’ self-rating of health is not associated with marital quality, depressive symptoms, or level of anger dysregulation.
TABLE 4.
Summary of Sequential Regression Analyses for Wives’ Self-Report of Health (n = 52)
| Variable | B | SE | β |
|---|---|---|---|
| First block | |||
| Marital satisfaction score (MAT) | 0.15 | 0.11 | .19 |
| Second block | |||
| Marital satisfaction score (MAT) | 0.10 | 0.12 | .12 |
| Depression symptoms (BDI) | −0.57 | 0.44 | −.19 |
| Third block | |||
| Marital satisfaction score (MAT) | 0.09 | 0.12 | .11 |
| Depression symptoms (BDI) | −0.52 | 0.48 | −.17 |
| Anger dysregulationa | −1.15 | 3.3 | −.05 |
| Final Model: Intercept = 73.79 | R2 = .07 | Adjusted R2 = .01 | R = .27 |
Note. DV = dependent variable; MAT = Marital Adjustment Test; and BDI = Beck Depression Inventory.
z scores used for anger dysregulation.
p < .05, 2-tailed significance.
Husbands
Depressive Symptoms
The estimated sequential regression models for the husbands’ scores on the BDI are shown in Table 5. When the husbands’ marital satisfaction scores were entered into the equation for the husbands, there was a significant effect (R2 = .12; F(1, 51) = 6.74, p < .05). However, there was no significant increase in the variance explained when the husbands’ anger dysregulation scores were added to the model that included marital satisfaction (R2 change = .03; F(2, 50) = 1.55, ns). These results indicate that there is an association between marital quality and depression for husbands, but not between anger dysregulation and depression symptoms.
TABLE 5.
Summary of Sequential Regression Analyses for Husbands’ Depression Symptoms (n = 52)
| Variable | B | SE | β |
|---|---|---|---|
| First block | |||
| Marital satisfaction score (MAT) | −0.06* | −0.02 | −.36 |
| Second block | |||
| Marital satisfaction score (MAT) | −0.05* | 0.02 | −.30 |
| Anger dysregulationa | 0.55 | 0.44 | .17 |
| Final Model: Intercept = 10.59 | R2 = .15 | Adjusted R2 = .11 | R = .38 |
Note. DV = dependent variable; MAT = Marital Adjustment Test.
z scores used for anger dysregulation.
p < .05, 2-tailed significance.
Health
The husbands’ marital satisfaction, depression symptoms, and anger dysregulation were used to estimate sequential regression models for self-rating of their health (Table 6). The marital satisfaction scores did not significantly predict health (R2 = .005; F(1, 51) = .25, ns), nor was there a significant increase in the variance explained when husbands’ depression scores were added to the model (R2 change = .02; F(2, 50) = 1.16, ns). However, when anger dysregulation was added to the model, there was a significant increase in the variance for the sequential regression model for the husbands’ self-rating of health (R2 change = .09; F(3, 49) = 4.93, p < .05). An interpretation of these results is that for husbands, perceptions of their health are predicted by their level of anger dysregulation, but not by the quality of their marriage or their depression symptoms.
TABLE 6.
Summary of Sequential Regression Analyses for Husbands’ Self-Report of Health
| Variable | B | SE | β |
|---|---|---|---|
| First block | |||
| Marital satisfaction score (MAT) | 0.03 | 0.07 | .07 |
| Second block | |||
| Marital satisfaction score (MAT) | 0.007 | 0.07 | .02 |
| Depression symptoms (BDI) | −0.46 | 0.43 | −.16 |
| Third block | |||
| Marital satisfaction score (MAT) | −0.03 | 0.07 | −.06 |
| Depression symptoms (BDI) | −0.30 | 0.42 | −.10 |
| Anger dysregulationa | −2.89* | 1.30 | −.32 |
| Final Model: Intercept = 90.38 | R2 = .12 | Adjusted R2 = .06 | R = .34 |
Note. DV = dependent variable; MAT = Marital Adjustment Test; and BDI = Beck Depression Inventory.
z scores used for anger dysregulation.
p < .05, 2-tailed significance.
Discussion
These results provide partial support for the hypothesis that higher scores of anger dysregulation predict increases of depressive symptoms and poorer self-reports of health. After controlling for the influence of marital quality, greater scores of anger dysregulation for women, but not for men, accounted for a significant level of variance in depressive symptoms. Anger dysregulation, but not depressive symptoms, was predictive of self-reports of health for the men. This association between anger dysregulation and health for men was significant even after controlling for marital quality. Neither anger dysregulation nor depressive symptoms were predictive of the women’s self-reports of health.
Emotional Dysregulation
The developmental emotion regulation/dysregulation model was used to describe the emotion regulation mechanisms that prevent emotionally dysregulated individuals from being able to behaviorally soothe themselves during emotionally provocative and stressful situations. It was theorized that both problematic anger behavioral patterns and depressive symptoms represent emotion dysregulation. It was predicted that individuals who had difficulty regulating anger would have difficulties regulating behaviors associated with depressive symptoms (e.g., experiences of sadness, crying). The hypothesis was supported only for the women in the study. There was no association between anger dysregulation and depressive symptoms for the married men.
One explanation for this outcome can be found in the literature on gender roles and depression. According to this literature, women were more likely to use ruminative styles of coping in response to negative events, and such ruminative coping behaviors and holding anger in were associated with increases in depressive symptoms (Bromberger & Matthews, 1996; Nolen-Hoeksema, Larson, & Grayson, 1999). Rustings and Nolen-Hoeksema (1998) found that rumination in response to an angry mood tended to increase anger. In a related study of coping strategies, the association between passive coping and depressive symptoms was mediated by hostility, suggesting that passive coping styles such as rumination and holding anger in may exacerbate feelings of hostility and anger, resulting in increases in depressive symptomatology (Mao, Bardwell, Major, & Dimsdale, 2003). Bromberger and Matthews (1996) proposed that the link between such patterns of anger management and depressive symptomatology is associated with female social gender roles.
Health
Although both depressive symptoms and anger behavioral patterns have been associated with all risks for mortality (Anda et al., 1993; Haynes, Feinleib, & Kannel, 1980; Miller, Smith, Turner, Guijarro, & Hallet, 1996; Rozanski, Blumenthal, & Kaplan, 1999), only anger dysregulation in the men predicted self-ratings of health in this sample. Although previous research on the anger/hostility behavioral pattern and health has been more consistent in finding this link for men than for women (c.f., Chaput et al., 2002), it is unclear why such a gender difference appears for the association between anger dysregulation and self-ratings of health in the current study. It may be that the health symptoms associated with anger problems do not become apparent in middle adulthood for women. This could be true especially for symptoms of cardiovascular disease that tend to be delayed by up to 15 years in women because of the protective influence of ovarian hormones (Eaker, Packard, Wenger, Clarkson, & Tyroler, 1987).
There was no association between depressive symptoms and health for either the women or the men in the study. This finding is not consistent with previous research that linked subclinical depressive scores and health (Anda et al., 1993). There has been little research supporting an association between subclinical levels of depression and health; however, there has been more research supporting clinical levels of depression (Rozanski, Blumenthal, & Kaplan, 1999).
The number of participants in this study was relatively small. Studies having small sample sizes are an ongoing concern in hostility/anger dysregulation research (Fichera & Andreassi, 1998). Couples were excluded from the study if either spouse had a cardiovascular health problem and was being treated by a health care professional through the use of medication or a medical device. These exclusion criteria reduced the chance that the health problem caused a greater level of depressive symptoms or anger dysregulation. However, these exclusion criteria may have resulted in a more conservative estimate of the association between health problems and the affect-related variables in the study (i.e., anger dysregulation and subclinical depressive symptoms).
The use of a one-item self-rating of health is a limitation of this study, although such health ratings indicate mortality (Hays, Schoenfeld, Blazer, & Gold, 1996; Idle, Kasl, & Lemke, 1990).
Anger dysregulation is associated with subclinical levels of depressive symptoms for married women, even with marital satisfaction levels controlled. No such association between anger dysregulation and subclinical levels of depressive symptoms were found for the husbands in this study. Yet, anger dysregulation was predictive of the men’s, but not the women’s, self-reports of health. The results underscore the significance of gender differences in the stress and health processes.
Acknowledgments
The preparation of this article was supported by a grant from the National Institute of Mental Health RO1 MH042484 (Carrère). The authors thank Cathryn Booth-LaForce for her helpful feedback on earlier drafts of this aticle. The authors also thank the women and men who participated in this study for allowing us into to their lives and marriages.
Contributor Information
Sybil Carrère, PhD, Research Assistant Professor, Department of Family and Child Nursing, University of Washington School of Nursing, Seattle..
Angela Mittmann, BS, Doctoral Student, Department of Psychology, University of California, Los Angeles..
Erica Woodin, BS, Doctoral Student, Department of Psychology, State University of New York, Stony Brook..
Amber Tabares, PhC, Doctoral Student, Department of Psychology, University of Washington, Seattle..
Dan Yoshimoto, MS, Doctoral Student, Department of Psychology, University of Washington, Seattle..
References
- Anda R, Williamson D, Jones D, Macera C, Eaker E, Glassman A, et al. Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults. Epidemiology. 1993;4:285–294. doi: 10.1097/00001648-199307000-00003. [DOI] [PubMed] [Google Scholar]
- Armstrong G. D. (1981). The intraclass correlation as a measure of interrater reliability of subjective judgements. Nursing Research, 30(5), 314–315, 320A. [PubMed]
- Beck, A. T. (1978). Depression inventory. Philadelphia: Center for Cognitive Therapy.
- Biaggio MK, Godwin WH. Relation of depression to anger and hostility constructs. Psychological Reports. 1987;61:87–90. doi: 10.2466/pr0.1987.61.1.87. [DOI] [PubMed] [Google Scholar]
- Bromberger JT, Matthews KA. A “feminine” model of vulnerability to depressive symptoms: A longitudinal investigation of middle-aged women. Journal of Personality and Social Psychology. 1996;70(3):591–598. doi: 10.1037//0022-3514.70.3.591. [DOI] [PubMed] [Google Scholar]
- Brosschot JF, Thayer JF. Anger inhibition, cardiovascular recovery, and vagal function; A model of the link between hostility and cardiovascular disease. Annals of Behavioral Medicine. 1998;20:326–332. doi: 10.1007/BF02886382. [DOI] [PubMed] [Google Scholar]
- Carrère S, Buehlman KT, Gottman JM, Coan JA, Ruckstuhl L. Predicting marital stability and divorce in newlywed couples. Journal of Family Psychology. 2000;14:42–58. doi: 10.1037//0893-3200.14.1.42. [DOI] [PubMed] [Google Scholar]
- Carrère, S., Gottman, J. M., McGonigle, M., Prince, S., Yoshimoto, D., Hawkins, M. W., et al. (1998). Marital meta-emotion interview Unpublished manuscript. University of Washington at Seattle.
- Carrère, S., Yoshimoto, D., Mittmann, A., Woodin, E., Tabares, A., Ullman, J., et al. (2004). Anger dysregulation and gender differences in biobehavioral responses to marital stress Manuscript submitted for publication.
- Chaput LA, Adams SH, Simon JA, Blumenthal RS, Vittinghoff FL, Loh E, et al. Hostility predicts recurrent events among postmenopausal women with coronary heart disease. American Journal of Epidemiology. 2002;156(12):1092–1099. doi: 10.1093/aje/kwf158. [DOI] [PubMed] [Google Scholar]
- City of Seattle Planning Commission Report (1990).
- Cook WW, Medley DM. Proposed hostility and pharisaic-virtue scales for the MMPI. Journal of Applied Psychology. 1954;38:414–418. [Google Scholar]
- Eaker, E. D., Packard, B., Wenger, N. K., Clarkson, T. B., & Tyroler, H. A., eds. (1987). Coronary Heart Disease in Women New York: Haymarket Doyma.
- Fichera LV, Andreassi JL. Stress and personality as factors in women’s cardiovascular reactivity. International Journal of Psychophysiology. 1998;28:143–155. doi: 10.1016/s0167-8760(97)00092-5. [DOI] [PubMed] [Google Scholar]
- Garber, J., & Dodge, K. (1991). The development of emotional regulation and dysregulation New York: Cambridge University Press.
- Hays JC, Schoenfeld D, Blazer DG, Gold DT. Global self-ratings of health and mortality: Hazard in the North Carolina Piedmont. Journal of Clinical Epidemiology. 1996;49 (9):969–979. doi: 10.1016/0895-4356(96)00138-2. [DOI] [PubMed] [Google Scholar]
- Hooven C, Gottman JM, Katz LF. Parental meta-emotion structure predicts family and child outcomes. Cognitions and Emotion. 1995;9:229–264. [Google Scholar]
- Idler EL, Kasl SV, Lemke JH. Self-evaluated health and mortality among the elderly in New Haven, Connecticut, and Iowa and Washington counties, Iowa, 1982–1986. American Journal of Epidemiology. 1990;131(1):91–103. doi: 10.1093/oxfordjournals.aje.a115489. [DOI] [PubMed] [Google Scholar]
- Kiecolt-Glaser JK, Dura JR, Speicher CE, Trask OJ, Glaser R. Spousal caregivers of dementia victims: Longitudinal changes in immunity and health. Psychosomatic Medicine. 1991;53(4):345–362. doi: 10.1097/00006842-199107000-00001. [DOI] [PubMed] [Google Scholar]
- Krokoff, L. J. (1984). A telephone version of the Locke-Wallace test of marital adjustment Unpublished manuscript, University of Illinois, Champaign IL.
- Locke HJ, Wallace KM. Short marital adjustment and prediction tests: Their reliability and validity. Marriage and Family Living. 1959;21:251–255. [Google Scholar]
- Mao WC, Bardwell WA, Major JM, Dimsdale JE. Coping strategies, hostility, and depressive symptoms: A path model. International Journal of Behavioral Medicine. 2003;10(4):331–342. doi: 10.1207/s15327558ijbm1004_4. [DOI] [PubMed] [Google Scholar]
- Miller TQ, Smith TW, Turner CW, Guijarro ML, Hallet AJ. A meta-analytic review of research on hostility and physical health. Psychological Bulletin. 1996;119(2):322–348. doi: 10.1037/0033-2909.119.2.322. [DOI] [PubMed] [Google Scholar]
- Nolen-Hoeksema S, Larson J, Grayson C. Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology. 1999;77(5):1061–1072. doi: 10.1037//0022-3514.77.5.1061. [DOI] [PubMed] [Google Scholar]
- Porges SW, Doussard-Roosevelt JA, Portales AL, Greenspan SI. Infant regulation of the vagal “brake” predicts child behavior problems: A psychobiological model of social behavior. Developmental Psychobiology. 1996;29:697–712. doi: 10.1002/(SICI)1098-2302(199612)29:8<697::AID-DEV5>3.0.CO;2-O. [DOI] [PubMed] [Google Scholar]
- Räikkonen K, Matthews KA, Kuller LH. Trajectory of psychological risk and incident and hypertension in middle-aged women. Hypertension. 2001;38:798–802. [PubMed] [Google Scholar]
- Räikkonen K, Matthews KA, Kuller LH. The relationship between psychological risk attributes and the metabolic syndrome in healthy women: Antecedent or consequence. Metabolism. 2002;51(12):1573–1577. doi: 10.1053/meta.2002.36301. [DOI] [PubMed] [Google Scholar]
- Rosenman, R. H. (1978). The interview method of assessment of the coronary-prone behavior pattern. In T. M. Dembroski, S. W. J. Shields, S. G. Haynes, & M. Feinleib (Eds.), Coronary-prone behavior (pp. 55–69). New York: Springer-Verlag.
- Sherwood, A., & Turner, J. R. (1992). A conceptual and methodological overview of cardiovascular reactivity research. In J. R. Turner, A. Sherwood, & K. C., Light (Eds.), Individual differences in cardiovascular response to stress (pp. 3–32). New York, NY: Plenum Press.
- Rozanski A, Blumenthal JA, Kaplan J. Impact of psychosocial factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99:2192–2217. doi: 10.1161/01.cir.99.16.2192. [DOI] [PubMed] [Google Scholar]
- Rustings CL, Nolen-Hoeksema S. Regulating responses to anger: Effects of rumination and distraction on angry mood. Journal of Personality and Social Psychology. 1998;74(3):790–803. doi: 10.1037//0022-3514.74.3.790. [DOI] [PubMed] [Google Scholar]
- Schulz R, Drayer RA, Rollman BL. Depression as a risk factor for non-suicide mortality in the elderly. Biological Psychiatry. 2002;52:205–225. doi: 10.1016/s0006-3223(02)01423-3. [DOI] [PubMed] [Google Scholar]
- Siegler IC, et al. Patterns of change in hostility from college to midlife in the UNC alumni heart study predict high-risk status. Psychosomatic Medicine. 2003;65:738–745. doi: 10.1097/01.psy.0000088583.25140.9c. [DOI] [PubMed] [Google Scholar]
- Sloan RP, Bagiella E, Shapiro PA, Kuhl JP, Chernikhova D, Berg J, et al. Hostility, gender and cardiac autonomic control. Psychosomatic Medicine. 2001;63:434–440. doi: 10.1097/00006842-200105000-00012. [DOI] [PubMed] [Google Scholar]
- Straus MA. Measuring intrafamily conflict and violence: The Conflict Tactics (CT) Scales. Journal of Marriage & the Family. 1979;41:75–88. [Google Scholar]
- Tabachnick, B. G., & Fidell, L. S. (1996). Using multivariate statistics (3rd ed.). New York: HarperCollins College Publishers.
- Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. In N. A. Fox, (Ed.), The development of emotion regulation: Biological and behavioral considerations. Monographs of the Society for Research in Child Development, 59 (2–3, Serial. 240). Chicago, IL: The University of Chicago Press. [PubMed]
- Wilson RS, Bienias JL, Mendes de Leon CF, Evans DA, Bennett DA. Negative affect and mortality in older persons. American Journal of Epidemiology. 2003;158(9):827–35. doi: 10.1093/aje/kwg224. [DOI] [PubMed] [Google Scholar]
- Yoshimoto, D., Mittman, A., Woodin, E., Tabares, A., Carrère, S., Schwab, J., et al. (2000). Marital meta-emotion coding system Unpublished manuscript, University of Washington, Seattle.