Anger in type a women: Implications for coronary heart disease

The present study examines the relationship between Type A behaviour and anger in a sample of managerial women. The Type A behaviour pattern is hard driving, job-devoted lifestyle which is associated with a significantly increased risk of coronary heart disease in men as in women. Anger and hostility have been reported to be critical components of the Type A behaviour pattern which contribute to coronary heart disease. This research also examines the relationship between occupational demands and job anger in managerial women. Occupational demands include demands particularly unique to women in non-traditional occupational roles such as inequity of pay, underutilization of skills, low boss support and perceived sex discrimination. State (job) and Trait Anger were also assessed as were various psychological and behavioural outcomes such as state anxiety, depression, job satisfaction, absenteeism, and “intention to turnover”. Results showed that sex discrimination was a significant occupational stressor in Type As only. Further results of a multiple regression analysis indicated tha for Type As only, sex discrimination was positively associated with job anger when social support from one's boss was low. However, with increasing support, Type As were less likely to report anger when discrimination was high. In conclusion, the results of this study have demonstrated that social support can function as a buffer against anger, thus extending the buffering hypothesis originally put forth to refer to the buffering effects of social support and anxiety.     

Differences between informants about type a,anger, and social support and the relationship with blood pressure

Abstract

In a study on the influence of different natural environments on self-perception and that of significant others, behavioral manifestations of Type A, Anger, and Social Support were assessed. It was hypothesized that due to different environmental demands, participants will be perceived as displaying differences in Type A behavior, anger, and social support at home and at work. Participants were 45 university employees, constituting a convenience sample. Assessment included Type A Structured Interview scores of participants and questionnaire scores for Type A, anger, and social support of participants who were also evaluated by their spouses and work supervisors. Other risk factors for coronary heart disease (i.e., blood pressure, smoking, previous heart condition, being sedentary, and family history) and their relationships with Type A, anger, and social support were also examined.

Participants and spouses agreed significantly on all measures, whereas participants and work supervisors agreed only on Type A behavior. Spouses' and work supervisors' evaluations of the participants' behavior were not or only marginally associated. Multiple regression analysis showed that the level of disagreement between the different informants with respect to Type A and social support were associated with elevated blood pressure. These results suggest that the perception of Vpe A behavior, anger, and social support may be situationally determined.     

Social support,strain, and glycemic control: A path analysis

Social support and strain have been linked with many health outcomes. However, less is known about whether these psychosocial factors are associated with Type 2 diabetes risk. This study uses the Midlife in the United States (MIDUS) dataset to examine the relationship between social support and strain from friends, family members, and spouse/partners and blood hemoglobin A1c levels in married/cohabiting adults who have not been diagnosed with diabetes. In addition, health locus of control is examined as a possible mediator. The study's findings suggest that support from friends is negatively associated with HbA1c levels, indicating a relationship between better glycemic control and social support from friends, and an indirect association for spouse/partner support. A direct effect for internal health locus of control was also found.     

Socioeconomic Differences in Psychosocial Factors Contributing to Coronary Heart Disease: A Review

Psychosocial factors have been shown to play an important role in the aetiology of coronary heart disease (CHD). A strong association between CHD and socioeconomic status (lower-level education, poor financial situation) has also been well established. Socioeconomic differences may thus also have an effect on psychosocial risk factors associated with CHD, and socioeconomic disadvantage may negatively affect the later prognosis and quality of life of cardiac patients. The aim of this study was to review the available evidence on socioeconomic differences in psychosocial factors which specifically contribute to CHD. A computer-aided search of the Medline and PsycINFO databases resulted in 301 articles in English published between 1994 and 2007. A comprehensive screening process identified 12 empirical studies which described the socioeconomic differences in CHD risk factors. A review of these studies showed that socioeconomic status (educational grade, occupation or income) was adversely associated with psychosocial factors linked to CHD. This association was evident in the case of hostility and depression. Available studies also showed a similar trend with respect to social support, perception of health and lack of optimism. Less consistent were the results related to anger and perceived stress levels. Socioeconomic disadvantage seems to be an important element influencing the psychosocial factors related to CHD, thus, a more comprehensive clarification of associations between these factors might be useful. More studies are needed, focused not only on well-known risk factors such as depression and hostility, but also on some lesser known psychosocial factors such as Type D and vital exhaustion and their role in CHD.     

Type D personality, physical symptoms and subjective stress: the mediating effects of coping and social support

Coping style and social support may represent mechanisms to explain the relationship between Type D personality and ill-health. This study investigated whether Type D is associated with physical symptoms and perceived stress in a non-cardiac population, and if these relationships are mediated by coping and social support. In a cross-sectional study, 304 participants (110 males, mean age 22.1 years) completed measures of Type D, physical symptoms, coping, perceived stress and social support. Results showed that Type D, the interaction of negative affectivity and social inhibition (NA × SI), was positively correlated with physical symptoms, perceived stress, and avoidant coping, and negatively correlated with social support, problem-focused coping and emotion-focused coping. A series of bootstrapped multiple mediator tests showed that social support and avoidant coping fully mediated the relationship between Type D and physical symptoms. Furthermore, social support and emotion-focused coping partially mediated the relationship between Type D and perceived stress. These findings demonstrate for the first time that Type D personality is associated with physical symptoms in a non-cardiac population. Social support and coping style represent mechanisms that can, in part, explain the relationship between Type D and physical symptoms, and Type D and perceived stress.     

Type D personality,physical symptoms and subjective stress: The mediating effects of coping and social support

Coping style and social support may represent mechanisms to explain the relationship between Type D personality and ill-health. This study investigated whether Type D is associated with physical symptoms and perceived stress in a non-cardiac population, and if these relationships are mediated by coping and social support. In a cross-sectional study, 304 participants (110 males, mean age 22.1 years) completed measures of Type D, physical symptoms, coping, perceived stress and social support. Results showed that Type D, the interaction of negative affectivity and social inhibition (NA?×?SI), was positively correlated with physical symptoms, perceived stress, and avoidant coping, and negatively correlated with social support, problem-focused coping and emotion-focused coping. A series of bootstrapped multiple mediator tests showed that social support and avoidant coping fully mediated the relationship between Type D and physical symptoms. Furthermore, social support and emotion-focused coping partially mediated the relationship between Type D and perceived stress. These findings demonstrate for the first time that Type D personality is associated with physical symptoms in a non-cardiac population. Social support and coping style represent mechanisms that can, in part, explain the relationship between Type D and physical symptoms, and Type D and perceived stress.     

大学生的社会支持、孤独及自尊对主观幸福感的作用机制研究

对389名大学生施测社会支持量表、自尊量表、社会与感情孤独量表及主观幸福感量表,以探讨孤独和自尊在社会支持与主观幸福感的关系中的作用。结果表明：（1）主观幸福感与社会支持、自尊、孤独呈显著相关。（2）路径分析表明,自尊、孤独分别在社会支持与主观幸福感之间起显著的中介作用。社会支持→自尊→孤独→主观幸福感的显著路径表明,这些变量间存在更为复杂的关系。这些结果对于大学生心理健康教育具有重要的意义。     

Construct, concurrent and discriminant validity of Type D personality in the general population: associations with anxiety, depression, stress and cardiac output

The Type D personality, identified by high negative affectivity paired with high social inhibition, has been associated with a number of health-related outcomes in (mainly) cardiac populations. However, despite its prevalence in the health-related literature, how this personality construct fits within existing personality theory has not been directly tested. Using a sample of 134 healthy university students, this study examined the Type D personality in terms of two well-established personality traits; introversion and neuroticism. Construct, concurrent and discriminant validity of this personality type was established through examination of the associations between the Type D personality and psychometrically assessed anxiety, depression and stress, as well as measurement of resting cardiovascular function. Results showed that while the Type D personality was easily represented using alternative measures of both introversion and neuroticism, associations with anxiety, depression and stress were mainly accounted for by neuroticism. Conversely, however, associations with resting cardiac output were attributable to the negative affectivity-social inhibition synergy, explicit within the Type D construct. Consequently, both the construct and concurrent validity of this personality type were confirmed, with discriminant validity evident on examination of physiological indices of well-being.     

Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients

Bergvik, S., Sørlie, T., Wynn, R. & Sexton, H. (2010). Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients. Scandinavian Journal of Psychology. The combination of negative affectivity (NA) and social inhibition (SI) – the Type D Personality – is associated with poor outcomes in coronary artery disease (CAD) patients. A Norwegian translation of the standard instrument measuring Type D (DS14) was tested on 432 CAD patients receiving coronary revascularization treatment. Factor analysis produced two factors with high inter‐item reliability, indicating that the Norwegian DS14 has acceptable psychometric properties. Eighteen percent were classified as Type D, lower than has been reported elsewhere. Type D was associated with anxiety, depression, and passive coping. NA correlated positively with depression, anxiety, and passive coping. SI correlated positively with depression and anxiety, and negatively with active coping. The prevalence of Type D was higher among women, and negatively correlated with time since treatment. The variation in Type D prevalence among studies needs further elucidation as does the predictive power of continuous scoring of the Type D trait.     

Associations among behavior, personality, and traditional risk factors for coronary heart disease: a study at a primary health care center in mid-Norway

The continuing presence of different negative emotions has been suggested as an important factor in the development of coronary heart disease (CHD). The present study was carried out at a medical center to investigate the presence of negative emotions and Type A behavior in a group of 40-yr.-old men and women. The National Institute of Public Health in Norway carried out the data-collection as a part of their CHD risk factor screenings. The correlation between hostility and total cholesterol is negative as is that between systolic blood pressures and the feeling of guilt for women. There was no further support for earlier findings of relationships between either Type A behavior pattern and negative emotions or Type A and elevated cholesterol values. A number of possible explanations are offered. In the study, assessment of hostility was questioned; there was possible support for poor assessment of hostility on the Karolinska Scales of Personality employed in the study.     

Type D personality as a prognostic factor in heart disease: assessment and mediating mechanisms

Type D personality, a synergy between negative affectivity and social inhibition, has established itself as a serious risk factor for morbidity and mortality in patients suffering from cardiovascular disease. In this review, we summarize studies on the validity of the assessment methods of Type D, emphasizing its role as an independent vulnerability factor in the progression of cardiovascular disease. We further present evidence on the physiological characteristics that accompany the 2 psychological traits negative affectivity and social inhibition and may mediate the relation between personality and prognosis in heart disease. Further research needs to determine the mechanisms by which Type D affects the course and outcome of cardiovascular disease as well as how Type D patients may benefit from psychosocial intervention.     

Type D Personality as a Prognostic Factor in Heart Disease: Assessment and Mediating Mechanisms

Type D personality, a synergy between negative affectivity and social inhibition, has established itself as a serious risk factor for morbidity and mortality in patients suffering from cardiovascular disease. In this review, we summarize studies on the validity of the assessment methods of Type D, emphasizing its role as an independent vulnerability factor in the progression of cardiovascular disease. We further present evidence on the physiological characteristics that accompany the 2 psychological traits negative affectivity and social inhibition and may mediate the relation between personality and prognosis in heart disease. Further research needs to determine the mechanisms by which Type D affects the course and outcome of cardiovascular disease as well as how Type D patients may benefit from psychosocial intervention.     

The relation between type A behavior and chronic emotional distress: a meta-analysis

A meta-analysis was conducted of studies examining the relation between Type A behavior and chronic emotional distress as measured by standard psychological scales. Aggregating across all studies, the average effect size was .27, indicating a positive association between Type A and chronic dysphoria; however, there was considerable variability in the size of the relation among studies. Partitioning by Type A measure revealed that Structured Interview-assessed Type A was unrelated to chronic dysphoric emotions; however, most of the self-report measures of Type A behavior were moderately correlated with upset. The Framingham Type A Scale and the Bortner Scale showed the strongest relations. Thus, contrary to the traditional view, Type A measured by self-report does have some emotional concomitants, although they are not in the pathological range. Also discussed are how the results bear on the proposal that the maladjusted personality confers coronary risk, the implications for reported associations between Type A and illness complaints, and for the study of the Type A as a social psychological construct.     

Type D personality,illness perception,social support and quality of life in continuous ambulatory peritoneal dialysis patients

The previous studies reported Type D was associated with poor quality of life (QoL), increased psychological distress, and impaired health status in cardiac patients. The aim of this study is to assess the relationships among Type D personality, illness perception, social support, and investigate the impact of Type D personality on QoL in continuous ambulatory peritoneal dialysis (CAPD) patients. Type D personality was assessed by the Chinese 14-item Type D Personality Scale (DS14). Illness perceptions were assessed using the Chinese version of the Brief Illness Perception Questionnaire (B-IPQ). Social support status was assessed by the well-validated social support rating scale (SSRS). Patients’ QoL was assessed by using Medical Outcomes Short Form 36 (SF-36), respectively. The Type Ds had significantly lower objective support score (8.18 ± 2.56 vs. 9.67 ± 3.28, p = 0.0001), subjective support score (6.71 ± 2.0 vs. 7.62 ± 1.93, p = 0.0001) and utilization of social support score (6.76 ± 2.0 vs. 7.61 ± 1.94, p = 0.0001) than that of the non-type Ds. Type Ds believed their illness had much more serious consequences (7.67 ± 2.64 vs. 6.27 ± 3.45, p < 0.001), and experience much more symptoms that they attributed to their illness (6.65 ± 2.54 vs. 7.31 ± 2.36, p = 0.023). Significant differences were found between Type Ds and non-Type Ds in PCS (40.53 ± 6.42 vs. 48.54 ± 6.21 p < 0.001) and MCS (41.7 1 ± 10.20 vs. 46.35 ± 9.31, p = 0.012). The correlation analysis demonstrated that Type D was negatively associated with physical component score (PCS) (r = –0.29, p < 0.01), mental component score (MCS) (r = –0.31, p < 0.01), and social support (r = –0.24, p < 0.001). Using multiple linear regression analysis, we found that Type D personality was independently associated with PCS (β = –0.32, p < 0.001) and MCS (β = –0.24, p < 0.001). Type D personality was a predictor of poor QoL in CAPD patients. The current study is the first to identify a strong association among Type D, illness perceptions, social support and QoL in CAPD patients. The worse illness perceptions and lower social support level therefore represent possible mechanisms to explain the link between Type D and poor QoL in CAPD patients.     

Personality, type A behavior, and coronary heart disease: the role of emotional expression

The nature of the relation between personality factors and coronary heart disease (CHD, the nation's greatest killer) is one of the most important if controversial issues in the field of psychology and health. Although there is still a great deal of conceptual confusion, progress is being made in refining the key components of a predisposition to heart disease. In this article we examine the construct of a coronary-prone personality in the context of the relations among personality, emotional expression, and disease. Special consideration is given to mode of measurement of the Type A behavior pattern--Structural Interview (SI) versus Jenkins Activity Survey (JAS)--and to components and non-Type A correlates of the general coronary-prone construct. Fifty middle-aged men who had had a myocardial infarction were compared with 50 healthy controls in terms of relevant aspects of their psychological functioning. Results indicate that the SI is better than the JAS as a predictor of coronary heart disease (CHD) because of its attention to emotional expressive style. Traditional emphases on hurry sickness in coronary proneness are deemed wholly inadequate. Furthermore, the results indicate that depression, anxiety, or both may relate to CHD independently of and in addition to Type A behavior. Other aspects of personality and social support are also discussed in the context of improving the construct of coronary proneness.     

Type A behavior and stress in college males

Substantial inconsistency can be noted among studies that have considered the relationship between Type A status and subsequent cardiac pathology. This erratic prediction pattern could be partially explained by the failure to consider level of stress in Type As, because only Type As that experience excessive and sustained stress should be at special risk. A stress-vulnerability model for young Type A college students was proposed involving selected Type A characteristics and other personality moderator variables serving to elicit, augment, and sustain stress. We considered self-preoccupation as a stress moderator in Type A college males and found evidence that it serves this function. Self-preoccupied Type As reported excessive stress over the previous year, whereas less self-centered Type As did not. Self-preoccupation was of no importance in moderating stress in Type Bs.     

Bortner type A scores and basic emotions: aggression, distrustful, depression, and gregarious

We examined the correlations between scores on Bortner's scale and measures of aggression, distrustful, gregarious, and depression in 1,084 employees. Prospectively over 2 yr. we investigated the relationship of Type A behavior with cardiac mortality. Subjects classified as Type A had higher mean ratings on measures of aggression and distrustful than did persons classified as Type B. Mortality was lower in patients classified as reporting Type A behavior (12%) than in the patients classified as reporting Type B behavior (22%).     

Type A Behavior and Stress in College Males

Substantial inconsistency can be noted among studies that have considered the relationship between Type A status and subsequent cardiac pathology. This erratic prediction pattern could be partially explained by the failure to consider level of stress in Type As, because only Type As that experience excessive and sustained stress should be at special risk. A stress-vulnerability model for young Type A college students was proposed involving selected Type A characteristics and other personality moderator variables serving to elicit, augment, and sustain stress. We considered self-preoccupation as a stress moderator in Type A college males and found evidence that k serves this function. Self-preoccupied Type As reported excessive stress over the previous year, whereas less self-centered Type As did not. Self-preoccupation was of no importance in moderating stress in Type Bs.     

Components of type A behavior and two-year prognosis of patients with acute coronary syndrome

We investigated prospectively the relationship of Type A behavior and its subcomponents with cardiac mortality and recurrent nonfatal cardiac events in a 2-yr. follow-up of 90 patients [69 men and 21 women, M age=56.4 yr., SD=8.4] after acute coronary syndrome. Type A behavior was assessed via the general Bortner Type A Index. Each patient completed the Bortner's scale before hospital discharge. During the first 2-yr. follow-up, there were 14 cardiac deaths among patients with myocardial infarction. 8 patients had recurrent cardiac events and were hospitalized, and 19 patients had an effort-induced angina pectoris. Patients with acute myocardial infarction who died during follow-up had a significantly lower Bortner score than patients with a secondary cardiac event. Bortner scores of patients with acute myocardial infarction who died indicated Type B behavioral patterns. Mortality was significantly higher in the patients classified as showing Type B (21.8%) behavior than in the patients classified as showing Type A (12.0%) behavior. Patients with a secondary cardiac event had more common Type A behavior patterns and higher Bortner scores than patients without a secondary cardiac event. The items on Bortner's scale "very competitive, ever rushed, tries to do too many things at once, fast in daily activities and expresses feelings" were inversely associated with cardiac deaths. These findings suggest that patients with acute coronary syndrome classified by scores on the Bortner scale as Type B behavior have a greater probability of death, and patients classified on the Bortner scale as Type A behavior have a greater probability of secondary cardiac events during follow-up. This finding may have implications for the treatment of patients with acute coronary syndrome. The inferior survival of patients with Type B personalities argues against attempts to modify Type A behavior in postinfarction patients.     

Interpreting coronary-prone behaviour: Relationships among type a behaviour,hopelessness, anger management and social contact

Abstract

Two approaches to interpreting relationships among psychosocial risk factors for coronary heart disease are contrasted: the profile approach which focuses on predictive validity and confounding; and the theoretical approach which emphasises internal validity. These approaches are explored by applying them to a set of correlations found among Type A behaviour, hopelessness, anger management and social contact in a female sample. Type A behaviour was positively correlated with hopelessness and with anger expression, whilst anger management was related to the availability of social contact. The relationships between Type A, anger expression and hopelessness also appeared to be moderated by degree of social contact. These results are interpreted from the profile perspective and from that of Price's cognitive social learning theory. The relative merits of the two approaches are considered and a case is made for encouraging more theoretically based research on coronary-prone behaviour.