An interview to measure vital exhaustion. I. development and comparison with the maastricht questionnaire

Abstract

This article presents an interview designed to measure vital exhaustion (VE), a state characterized by unusual fatigue, increased irritability and feelings of demoralization, which has been found to be a short-term risk indicator of myocardial infarction (MI). This state can be measured by means of the Maastricht Questionnaire (MQ). However, the MQ was found to have some major shortcomings for the selection of subjects for laboratory or clinical investigations. For this reason we designed an interview to assess VE. To test the hypothesis that the interview registers prodromal feelings of MI, the interview was administered to a sample of 81 males who were hospitalized because of a first myocardial infarction (mean age 55.6 years; sd 6.8) and a sample of 168 healthy males (mean age 54.9 years; sd 6.9). Mean scores of cases and controls differed significantly (7.8; sd 6.0 and 3.6; sd 4.0, respectively; t=5.65; p=.000). Mean scores on the questionnaire discriminated significantly too, but the discriminating power was much lower (t=2.31; p=.02). The article gives detailed instructions on the way in which the interview should be administered and scored.     

Gender differences in type a behavior and hostility within an organizational setting

Abstract

Recent investigations suggest that the hostility component of the Type A behavior patter (TABP) is a greater detriment to health than the overall pattern. Some researchers suggest that certain Type A characteristics (e.g., job-involvement) are actually adaptive. This study compared the relative relationship of the TABP and hostility to career-related achievement and psychosocial adjustment among 223 service-delivery employees. Male and female participants completed the Jenkins Activity Survey and the MMPI Hostility Scale as part of a cardiovascular disease risk factor screening. The TABP was positively associated with managerial status for both men and women. However, the TABP was positively related to psychosocial adjustment variables among men only. Hostility was significantly related to undesirable outcomes including lower job status, life dissatisfaction, and unfavorable perceptions of the workplace for both men and women. Discussion addresses organizational factors which might perpetuate hostility and the TABP, as well as gender differences in the experience of these constructs.     

Vital exhaustion measures and their associations with coronary heart disease risk factors in a sample of spanish-speakers

Abstract

The main purpose of this research was to study the reliability and conceptual validity of two Spanish language measures of Vital Exhaustion (VE), a short-term risk factor for coronary artery disease (CAD). The English version of the Maastricht Questionnaire for Vital Exhaustion was used to make a Spanish language questionnaire (VEQ) and a Spanish language interview (VEI) whose scoring systems were equal to the original version. These instruments were administered to a sample of healthy working men (n = 100) and women (n = 130) in Caracas, Venezuela. Participants also completed questionnaires designed to measure anger-expression and social support and were assessed by means of the Structured Interview to measure Type A Behaviour Pattern (TABP). Information about other CAD-risk factors, such as age, smoking behavior, and health habits, were collected.

High reliability coefficients, .85 and .91, were found for the VEI and VEQ, respectively. Principal component analysis provided one-factor solutions for each instrument. The pattern of correlations between VE, assessed by the VEI, and other personality characteristics was rather similar to the pattern observed in other cultures. In general significant, but modest, correlations were observed between VE and TABP, anger expression, a negative self-concept, and low social support. We conclude that VE appears to be a meaningful construct in this particular cultural context.     

Coronary Prone Behavior: Components of the Type A Pattern and Hostility

Traditional and nontraditional risk factors for coronary heart disease (CHD) are discussed with special attention devoted to the Type A behavior pattern (TABP). Positive and negative epidemiological evidence bearing on the risk factors status of global TABP is reviewed. Results of the review suggest that component scoring of the multidimensional global TABP in attempts to uncover "toxic" components, particularly Potential for Hostility, is a profitable research strategy. Similarly, evidence is presented that suggests merit in component scoring of hostility, also a multidimensional construct. To explicate more fully the nature of Potential for Hostility and its categories, correlations between the SI-derived ratings and ratings of established dimensions of individual differences based on the five-factor taxonomic model of personality from subsamples of the MRFIT and WCGS studies are presented. Total Potential for Hostility and especially the Style of interaction category show highly significant relations to Low Agreeableness or Antagonism. High ratings of Potential for Hostility identify individuals who can be described as uncooperative, antagonistic, rude, disagreeable, unsympathetic, callous, and the like. Implications of the evolving concept of coronary-prone behavior, as distinguished from TABP, are briefly considered.     

sleep complaints,behavioral characteristics and vital exhaustion in myocardial infarction cases

Abstract

Prodromal symptoms of vital exhaustion and sleep complaints are increasingly being recognized as important risk indicators for myocardial infarction (MI). In this study, the relationships between vital exhaustion, behavioral characteristics, and MI, and between several sleep complaints and MI were investigated. The subjects were 133 male cases with first MI, 192 male hospital controls, and 133 male neighborhood controls. The instruments used were the Maastricht Questionnaire (vital exhaustion), the Life Styles Questionnaire (sleep complaints, coffee consumption, and current smoking), and the Structured Interview (Type A behavior). All sleep complaints, vital exhaustion, Type A behavior, excessive coffee consumption, and current smoking occurred significantly more often in MI-cases. After controlling for these potential confounders, and age, most sleep complaints retained significant associations with MI, in particular often taking naps during the day and waking up in the morning feeling tired and exhausted.     

Hostility predicts metabolic syndrome risk factors in children and adolescents.

The authors tested in 134 African American and European American children whether hostility measured at study entry predicted the metabolic syndrome risk factors an average of 3 years later. Hostility was measured with the Cook-Medley Hostility Scale (W. W. Cook & D. M. Medley, 1954) and with ratings of Potential for Hostility from interview responses. Metabolic syndrome was based on having at least 2 of the following risk factors above the 75th percentile of scores for their age, race, and gender group: body mass index, insulin resistance index, ratio of triglycerides to high-density lipoprotein cholesterol, and mean arterial blood pressure. Children who exhibited high hostility scores at baseline were likely to exhibit the metabolic syndrome at the follow-up. The results highlight the potential importance of early prevention and intervention of behavioral risk factors for cardiovascular disease.     

Heart and Lifestyle: A Type A Treatment Program for Myocardial Infarction Patients

Abstract

Despite almost thiry years of research on the Type A Behavior Pattern (TABP), only a few controlled treatment studies have been performed. Even fewer of them have been designed as long-term programs, the best known and most carefully controlled being the Recurrent Coronary Prevention Project (RCPP) at Mt. Zion Hospital, San Francisco (Friedman et al. 1982, Friedman et al. 1984, Thoresen et al. 1982). In Scandinavia, a study on TABP was published in 1980 (Orth-Gomér et al.), comparing the frequency of TABP among myocardial infarction patients, hypertensive patients, and healty controls. The results indicated more TABP among MI patients, thereby suggesting that TABP may be associated with Coronary Heart Disease (CHD) in Sweden.     

Hostility,oral contraceptive use,and cardiovascular reactivity in women

Abstract

Hostility, task instructions, social desirability and cardiovascular reactivity were investigated in a exploratory study of 70 female college students and employees. Women were administered the Videotaped Clinical Interview (VC1), the Marlowe-Crowne Social Desirability Scale (MC), the Cook-Medley Hostility Scale (CM), the Buss-Durkee Hostility Index (BD) and the Personal Attributes Questionnaire (PAQ) before undergoing a stressful discussion. Oral contraceptive users had significantly higher DBP at baseline. Based on PAQ scores, women were given instructions for the discussion task consistent or inconsistent with their gender-relevant styles. Instruction type predicted heart rate changes, and interacted with hostility to predict DBP reactivity. Interview-based hostility (VCI-H) was associated with increased DBP during the discussion task, as was being high hostile (low MC/high VCI-H). The CM and the BD had less association with heart rate and blood pressure changes. Oral contraceptive (OC) use was associated with higher SBP reactivity under stress, with highest SBP increases in the OC users concerned with social desirability. The complex interaction between trait dimensions like hostility, social desirability, and oral contraceptive use requires further investigation.     

Gender differences in the relationship of moderator variables to stress and symptoms

Abstract

This study focused on gender differences in the relationship of four moderator variables (hostility, social support, optimism, and Type A behavior) to perceptions of symptoms and stress based on a sample of 120 female and 79 male undergraduates. Results confirmed significant gender differences in hostility, Type A behavior, and social support but not in optimism. Multiple regression analyses exposed distinct gender differences. For females, social support accounted for 21% and hostility 5% of the total variance in perceived stress. For males, only hostility accounted for any significant variance (10%). Hostility contributed 21% and social support contributed 13% to the total variance in the number of symptoms for females. For males, optimism contributed 14% and hostility 5%. Results indicate that social support is a potent variable for females in their perception of both stress and symptoms but essentially unrelated for males. Hostility, however, relates to perceptions of stress and symptoms for both sexes.     

Two models of adolescent self-mutilation

Currently little research exists examining the theoretical underpinnings of self-mutilation (SM) in community samples of adolescents. Two models, the hostility and anxiety reduction models, were simultaneously tested in order to determine whether SM in adolescence was characterized by greater feelings of anxiety and hostility. Four hundred and forty students were screened for the presence of SM. Sixty-one students who indicated that they hurt themselves as well as a comparison group of non-SM students completed the Hostility and Direction of Hostility Questionnaire (HDHQ), the Beck Anxiety Inventory (BAI), and an interview. Results indicate support for the hostility model of SM. Students who SM reported significantly more anxiety and more intropunitive and extrapunitive hostility. In addition, prior to self-mutilating feelings of both hostility and anxiety were described. Results are discussed with reference to both theoretical models.     

Cognitive-affective assets and vulnerabilities: Two factors influencing adaptation to Fibromyalgia

The present article describes the associations between hostility and serum lipids in Coronary Artery Disease (CAD) patients. A sample of 212 male coronary patients was used of which 127 recently suffered a Myocardial Infarction (MI), and 85 had undergone either a Coronary Artery Bypass Grafting (CABG) or a Percutaneous Transluminal Coronary Angioplasty (PTCA). Total Cholesterol (TC), High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL) and triglyceride concentrations were measured as well as four hostility factors: ‘Negative Affectivity’ (NA), ‘Anger-In’ (AI), ‘Anger-Out’ (AO) and Coping, i.e. behaviors to control feelings of anger and anxiety. The results indicated that the effects of hostility on lipids were mediated by various factors such as body weight in relation to body length (BMI), Socio-Economic Status (SES), Left Ventricle Ejection Fraction (LVEF) and Age. In subgroups of highly exhausted patients or of patients scoring high on the Type A Behavior Pattern (TABP), however, more direct (unilinear) associations between lipids and hostility were found. The findings of the present study confirm the rather weak association between hostility and blood lipids found elsewhere. Furthermore, a low level of triglycerides was consistently associated with low AO, be it again in interaction with BMI (AO × BMI), both in the group of non-MI patients and in the total sample for those patients who score high on vital exhaustion and/or TABP. This finding provides an extra argument against the popular notion of the healthfulness under all circumstances of anger expression. Until now the exact role of triglycerides as a function of anger/hostility has been under-explored. This issue merits further attention in future research.     

Type A behavior and parenting stress in mothers with young children

Type A Behavior Pattern (TABP) is characterized by competitiveness, a sense of time-urgency, impatience, and aggression/hostility and it has been associated with coronary heart disease and occupational stress in men. Recently, research had begun to examine TABP in women. However, the majority of studies focus on women as student or employee and not in the role of mother. Thus, although women spend a significant proportion of their adult lives bearing and raising children, little is known about TABP relationships in these roles. Further, the parenting adjustment literature amply describes the stressful nature of parenting a young child but with little attention paid to the relationship between maternal individual characteristics and parenting stress. This study investigated maternal adjustment and TABP in order to provide a clearer picture of Type A women as mothers as well as to expand information on individual characteristics which contribute to or mediate a woman’s adjustment to motherhood. Because of its presumed relationship to TABP and stress, maternal employment status was a control variable. One hundred twenty-six women with children between the ages of 9–24 months completed questionnaires reporting maternal stress, maternal perceptions of her child and somatic complaints. TABP was assessed by two measures, the Framingham Type A Scale (FTAS) and a recent measure, the Adolescent/Adult Type A Behavior Scale (AATABS), which yields factor scores as well as a global TABP rating. Overall, Type A women reported higher levels of child-related stress and personal stress than Type B women. Certain factors such as Hurry, Control, and Hostility were also associated with stress indices. There was qualified support for a relationship between the TABP factor, Hurry, and self-reported somatic complaints. Directions for future research are discussed.     

Type A behavior and parenting stress in mothers with young children

Type A Behavior Pattern (TABP) is characterized by competitiveness, a sense of time-urgency, impatience, and aggression/hostility and it has been associated with coronary heart disease and occupational stress in men. Recently, research had begun to examine TABP in women. However, the majority of studies focus on women as student or employee and not in the role of mother. Thus, although women spend a significant proportion of their adult lives bearing and raising children, little is known about TABP relationships in these roles. Further, the parenting adjustment literature amply describes the stressful nature of parenting a young child but with little attention paid to the relationship between maternal individual characteristics and parenting stress. This study investigated maternal adjustment and TABP in order to provide a clearer picture of Type A women as mothers as well as to expand information on individual characteristics which contribute to or mediate a woman’s adjustment to motherhood. Because of its presumed relationship to TABP and stress, maternal employment status was a control variable. One hundred twenty-six women with children between the ages of 9–24 months completed questionnaires reporting maternal stress, maternal perceptions of her child and somatic complaints. TABP was assessed by two measures, the Framingham Type A Scale (FTAS) and a recent measure, the Adolescent/Adult Type A Behavior Scale (AATABS), which yields factor scores as well as a global TABP rating. Overall, Type A women reported higher levels of child-related stress and personal stress than Type B women. Certain factors such as Hurry, Control, and Hostility were also associated with stress indices. There was qualified support for a relationship between the TABP factor, Hurry, and self-reported somatic complaints. Directions for future research are discussed.     

Response of the pituitary-adrenal axis in terms of type a behaviour,hostility and vital exhaustion in healthy middle-aged men

Abstract

Pituitary-adrenal axis was studied in terms of Type A behaviour, hostility and vital exhaustion among 69 healthy middle-aged men. The results showed that psychological factors could explain a significant proportion of the biologically manipulated responses of HPA axis, but they worked in different ways. Type A behaviour was related to a high level of mean basal ACTH and a low level of cortisol response to ACTH stimulation after dexamethasone suppression; hostility was related to a high level of mean basal cortisol and a high cortisol in cortisol/ACTH ratio, while vital exhaustion was characterized by a low level of mean basal ACTH and a decreased ACTH in relation to cortisol. The adrenocortical patterns, i.e. a high ACTH-low cortisol; a high cortisol; and a low ACTH-low mean basal cortisol, as related to Type A behaviour, hostility and exhaustion, respectively, are in line with the traditional physiological stress model and suggest that different adrenocortical responses might be able to identify different mental stress processes. Sense of control has been suggested to be a key concept for psychological understanding of this finding.     

The role of vital exhaustion in predicting the recurrence of vascular events: A longitudinal study

Background/objective

The aim of this study was to examine the role of vital exhaustion in predicting the recurrence of vascular events.

Influence of age, sex, and family on Type A and hostile attitudes and behaviors.

We describe the influence of age, sex, and family on Type A and hostility indices that have been related to rates of coronary heart disease (CHD). The sample consisted of 120 girls and 95 boys (ages 6 to 18 years) and 141 women and 120 men (ages 31 to 62 years) from 142 families residing in an upper middle class community. Results showed little familial aggregation of Type A and hostility. Adults had higher Structured Interview (SI) Potential for Hostility ratings than did children, whereas children had higher Minnesota Multiphasic Personality Inventory (MMPI)-derived Hostility scores and SI Anger-In ratings than did adults. Male adults and male children had higher SI Potential for Hostility ratings and MMPI-derived Hostility scores than did their female counterparts. The heightened hostility of males may account, in part, for their heightened risk of CHD relative to females'.     

A Multitrait Multimethod Measurement Approach to the Traits (or States) of Anxiety,Depression and Hostility

This study tested the convergent and discriminant validities of various psychological techniques used for the measurement of the affects of anxiety, depression and hostility. The subjects were 29 psychiatric patients and 25 normal controls, all males. Subjects were interviewed and rated for the three affects and given an extensive battery of tests. Anxiety and depression measures from ratings, checklists, and questionnaires demonstrated good convergent validity but poor discriminant validity. The projective methods did not demonstrate much convergent validity. Hostility was separable from anxiety and depression but the tests showed poor convergent validity for hostility. In the normals, fantasy hostility (TAT) and admitted hostility (Multiple Affect Adjective Check List) showed some convergence, but in the patients there was no congruence between these two levels.     

The Aggression Questionnaire: a validation study in student samples

The goal of this study was to examine the psychometric properties of the Aggression Questionnaire (AQ) in Spain. The AQ is a 29-item instrument designed to measure the different dimensions of the hostility/anger/aggression construct. It consists of 4 subscales that assess: (a) anger, (b) hostility, (c) verbal aggression, and (d) physical aggression. In Study 1, reliability, construct validity, and convergent validity were evaluated in a group of 384 male and female university students. Test-retest reliability was evaluated using a group of 154 male and female university students. The results of the factor analysis were similar to the scale structure claimed for this instrument. The subscales also showed internal consistency and stability over time. The AQ and its subscales were also compared with the scales and subscales of the Spielberger State-Trait Anger Expression Inventory (STAXI), the Cook-Medley Hostility Scale (Ho), the Buss-Durkee Hostility Inventory (BDHI), and the Jenkins Activity Survey-Form H (JASE-H). The results show that the AQ evaluates some aspects of anger, such as Anger-Trait and Anger-Out, rather than other elements, such as Anger-In or Anger-State. In Study 2, two new male groups were used to evaluate the criterion validity of the AQ: 57 prison inmates and 93 university students, finding that this instrument discriminated between the scores obtained by common offenders and university students.     

Potential for hostility and dimensions of anger

Recent reviews have linked Potential for Hostility derived from the Structured Interview (SI) to coronary artery disease, independent of the global Type A pattern. The present study examined the construct validity of Potential for Hostility ratings by correlating Potential for Hostility with 21 scales from four widely used anger/hostility measures: 7 scales from the Anger Self-Report, 8 scales from the Buss-Durkee Hostility Inventory, the total score from the Novaco Anger Inventory, and 5 scales from the Multidimensional Anger Inventory. The pattern of correlations revealed that Potential for Hostility was significantly related to scales reflecting awareness and arousal of anger, particularly the verbal expression of anger. To identify underlying anger dimensions, the 21 scales were factor-analyzed. Examination of two and three rotated principal components confirmed previous solutions. The first component, representing anger-arousing and -eliciting situations and anger awareness, was labeled Experience of Anger. The second component, consisting of scales dealing with either physical assault or verbal expression of anger, was labeled Expression of Anger. When a third factor was retained, it contained scales of suspicion, mistrust-suspicion, and guilt: It was therefore labeled Suspicion-Guilt. Potential for Hostility was correlated only with the Expression of Anger factor in the two-factor solution; in the three-factor solution, Potential for Hostility was correlated equally with the Experience of Anger and Expression of Anger factors but was not correlated with the Suspicion-Guilt factor. The implications of these results for the assessment of hostility are discussed.     

Comparative study of hostility in depressive patients with and without a suicide attempt history

Hostility in association with depression seems to be connected to suicidal behavior. This study aimed to evaluate hostility and its dimensions in relation to depression in patients who suffered from diagnosed depression with and without a suicide attempt history. The study included 168 participants; 58 patients with depression and suicide attempt history, 55 patients with depression without a suicide attempt history and 55 healthy controls. Hostility was assessed with the Hostility and Direction of Hostility Questionnaire, while depression with the Beck Depression Inventory (BDI). Patients with depression and a suicide attempt history compared with the patients without attempt history presented statistically significantly higher total hostility (28.71 ± 6.43 vs 24.20 ± 7.66), extroverted hostility (17.16 ± 4.37 vs 14.15 ± 4.63), acting out hostility (6.03 ± 2.09 vs 4.73 ± 1.93), and self criticism (6.95 ± 2.12 vs 5.89 ± 2.32). No statistically significant differences were found between the two clinical groups in depression according to the BDI. Moreover depressive patients with suicide attempt history scored higher in all the hostility dimensions than the controls. Therefore, it could be suggested that hostility and especially its extrapunitive dimensions are associated with suicidal behavior, since no differences in depression were recorded between the two clinical groups.