ArticlePDF Available

Marital Pair Anger-Coping Types May Act as an Entity to Affect Mortality: Preliminary Findings from a Prospective Study (Tecumseh, Michigan, 1971–1988)

Authors:
Article

Marital Pair Anger-Coping Types May Act as an Entity to Affect Mortality: Preliminary Findings from a Prospective Study (Tecumseh, Michigan, 1971–1988)

Abstract and Figures

The relationship between four anger-coping marital pair types and all-cause mortality was examined with a representative random sample in the community of Tecumseh, Michigan, in a longitudinal analysis (1971–1988) using 192 married pairs. Each spouse (age 35–69) in a married pair was independently classified as an expressive (anger out) or suppressive (anger in) anger-coping type; then four anger-coping pair types were tested for mortality risk, adjusted for major health risk factors. When both spouses were anger suppressors (n = 26 pairs; 13 deaths), death was 2 times more likely than in all Other Types (p < .05); significantly more pairs of “Both Spouses Suppress” occurred where both died than in Other Types. A spouse interaction effect (p = .06) occurred among Both Spouses Suppress Type but not in Other Types.
Content may be subject to copyright.
Journal of Family Communication, 8: 44–61, 2008
Copyright © Taylor & Francis Group, LLC
ISSN 1526-7431 print / 1532-7698 online
DOI: 10.1080/15267430701779485
Marital Pair Anger-Coping Types May
Act as an Entity to Affect Mortality:
Preliminary Findings from a Prospective
Study (Tecumseh, Michigan, 1971–1988)
Ernest Harburg
Emeritus, Department of Epidemiology, School of Public Health and
Department of Psychology, The University of Michigan
Niko Kaciroti
Center for Human Growth and Development,
The University of Michigan
Lillian Gleiberman
Department of Internal Medicine,
The University of Michigan
Mara Julius
Emeritus, Department of Epidemiology, School of Public Health,
The University of Michigan
M. Anthony Schork
Emeritus, Department of Biostatistics, School of Public Health,
The University of Michigan
The relationship between four anger-coping marital pair types and all-cause
mortality was examined with a representative random sample in the community
of Tecumseh, Michigan, in a longitudinal analysis (1971–1988) using 192 married
Correspondence should be addressed to Ernest Harburg, 240 E. 10th St. #9B, New York, NY
10003. E-mail: e@yipharburg.com
MARITAL PAIR ANGER-COPING AND MORTALITY 45
pairs. Each spouse (age 35–69) in a married pair was independently classified as
an expressive (anger out) or suppressive (anger in) anger-coping type; then four
anger-coping pair types were tested for mortality risk, adjusted for major health
risk factors. When both spouses were anger suppressors (n=26 pairs; 13 deaths),
death was 2 times more likely than in all Other Types (p<.05); significantly more
pairs of “Both Spouses Suppress” occurred where both died than in Other Types.
A spouse interaction effect (p=.06) occurred among Both Spouses Suppress Type
but not in Other Types.
The dyad concept was described more than 50 years ago (Becker & Useem, 1942)
and a definition was proposed: “Two persons may be classified as a dyad when
intimate, face-to-face relations have persisted over a period of time sufficient for
the establishment of a discernable pattern of interacting personalities.” To the focus
on “personalities” we would add, “and/or fixed patterns of observable social inter-
action.” The call continues for research designed to treat the dyadic relationship as
a unit of analysis, as a psychosocial entity, with import for health (Ewart, 1993).
Gottman et al. propose a science of “relational analysis” (Gottman, Levenson, &
Woodin, 2001). Such programs of research would, for practical aims, be focused
on the marital dyad or close-lived partnerships. Patently one focus of “emotional”
communication could be on expressions of anger and modes of coping with its
expression and subsequent “health” issues (Kiecolt-Glaser & Newton, 2001).
The concept of suppressed anger has a long history (Dunbar, 1947; Siegman &
Smith, 1994). Our definition of the term “suppressed” comes explicitly from
Newcomb (1950), who conceived that suppression can be observed by what
is omitted in structured communication and interaction; we would add “after
structured provocation.” Suppressed material, which is by definition a semicon-
scious process controlled by an individual desiring to inhibit recall of usually
negative events, can be retrieved in a single survey interview; repressed material,
by definition, cannot. Other studies on cardiovascular outcomes have used the
concept of suppressed anger (all heuristically conceived and measured in different
ways), both in multiyear prospective research (e.g., Everson, Goldberg, Kaplan,
Julkunen, & Salonen, 1998; Kiecolt-Glaser et al., 1993) and in survival after
experimental studies (Denollet, Sys, & Brutsaert, 1995; Thomas, Friedman,
Wimbush, & Schron, 1997). These studies assumed that suppressed anger influ-
ences potential or existent pathologic medical conditions.
Focused observational and experimental studies with smaller purposive
samples began in the 1970s (Gottman & Levenson, 1986), followed by
experimental work. Cronkite and Moos (1984), using longitudinal data, studied
“combinations of coping responses” in 267 married couples and observed that the
stress-illness relationship was strengthened “if both partners relied on avoidance
coping.” Giunta and Compas (1993) studied 153 married couples and reported
that when “escape avoidance coping” was used by both husband and wife, then
46 HARBURG ET AL.
high levels of symptoms in both spouses were observed. Regression analysis
confirmed that “wives’ escape-avoidance coping predicted their own and their
husband’s psychological symptoms.”
The present report adds to this literature by examining the longitudinal
effects of marital pair anger-coping types on all cause mortality. We assumed
that anger-based conflict was inevitable in marital pairs and that suppression
of anger would impede both accuracy in communication (Newcomb, 1950) and
use of reflective problem solving (Harburg, Blakelock, & Roeper, 1979); this
condition would promote medical morbidity and early mortality (Kiecolt-Glaser
& Newton, 2001). We thus hypothesized that the risk of earlier mortality
would be highest in marriages where both spouses were anger suppressors
(as compared to other spouse pair types) because this relationship would
induce more problems in communication and impede problem-solving discourse
(Carlson, 2000). Suppression of “emotions” is simultaneous with suppression
of “cognitive information.”
All respondents were designated as “expressive” or “suppressive” on the
basis of their anger-coping responses to a hypothetical situation in which they
were unfairly attacked (Harburg et al., 1973). An “attack” is defined as an
aggressive/overt behavior with typically destructive or hurtful action (Smith,
1992). Our theory, however, posits that the perception of the “attack” as unfair
and depriving of status is a condition of the anger arousal leading to “resentment”
if chronically attacked within a marital pair (see Discussion). The prediction
that individuals who suppressed their anger to attackers would then have a
significantly increased mortality risk was supported by results on individuals
(regardless of sex) in a 12-year mortality follow-up (Julius, Harburg, Cottington,
& Johnson, 1986) and reconfirmed for individuals for a longer follow-up by
gender and types of mortality (Harburg, Julius, Kaciroti, Gleiberman, & Schork,
2003).
In the present study, 192 marital pairs in a household sample were categorized
with respect to their dyadic anger-coping types. Thus four types follow from a
decision to “dichotomize” the tendency to “suppress” (anger in) or “express”
(anger out); these 0/1 events emerged from prior research (Funkenstein, King, &
Drolette, 1957; Harburg, Blakelock, & Roeper, 1979; Spielberger et al., 1985;
Harburg et al., 2003). Four types are described: both spouses expressed their
anger; husbands suppressed but their wives expressed anger; wives suppressed
but their husbands expressed anger; both spouses suppressed their anger. Between
1971–1988, 54 of the 384 sampled spouses died, 19% husbands, 9% wives. The
a priori hypothesis of this study was that if both husband and wife suppressed
their anger to unfair attacks, then either or both spouse(s) would have earlier
all-cause mortality than spouses in other marital pair anger-coping types.
This hypothesis is focused on Type 4 (Both Suppress); therefore, analyses
tested combined “Other Types” as one group and “Both Suppress anger” as the
MARITAL PAIR ANGER-COPING AND MORTALITY 47
target marital type. The major reason for restricting our inquiry to Type 4 is that
we had no clear, specific, sound theoretical ideas which allowed us to predict to
each of Types 1–3 and mortality; however, results with each of the 3 nonpredicted
types separately are also described and analyzed post hoc. To our knowledge,
there are, as yet, no other longitudinal studies of dyadic anger-coping types and
mortality risk among randomly selected marital pairs in a total community.
METHODS
Sample/Subsample
The Life Change Events Study (LCES), a sociopsychological study of life
change events, anger-coping responses, and psychologic well-being, was
carried out as part of the Fourth Series of examinations (1971–1972) of
the Tecumseh Community Health Study (TCHS). Subjects for this Fourth
Series were selected from a representative sample of the TCHS, a longi-
tudinal epidemiological study of a Michigan community begun in 1959; a
detailed description of the overall TCHS design has been presented elsewhere
(Napier, Johnson, & Epstein, 1970).
The study population for the Fourth Series of examinations consisted of
men and women aged 30–69, who also participated in the Third Series of
examinations (1967–1969). The total response rate in the Fourth Medical Test
Series was 88% (N=6012). From this group, the LCES selected a 20% random
sample of dwelling units, which yielded 1214 persons. Individuals with diagnosed
respiratory or rheumatic disease at the Third Series, who were part of another
study (N=361), were excluded. Also excluded were 20 subjects (2%) over 70
years of age in 1971.
From the remaining 833 individuals selected, 696 (84%) agreed to participate
in the LCES. The demographic characteristics of this sample are similar to the
total community in 1971–1972. Tecumseh, a town of about 10,000 people, had
a predominately White, Anglo-Saxon, middle-class population, of whom 88%
were married. The choice of 192 pairs was based on their availability. Out of 696
subjects, only 192 subjects chose to have their partner participate in the study;
hence, only 192 pairs could be interviewed. We did compare these 384 subjects
with the other 312 subjects whose partners did not participate in the study. There
were no differences between these groups in demography or mortality rates.
Data were collected in the TCHS clinic in 1971–1972. Demographic and
health-related information was obtained by a standard TCHS questionnaire.
Subjects for the LCES also completed the psychosocial questionnaire. Morbidity
was diagnosed in the prior Third Series of examinations (1967–1969) for cardio-
vascular risk, bronchial problems, and Forced Expiratory Volume (FEV1).
48 HARBURG ET AL.
Mortality status was ascertained from death certificates and medical reports
in 1978–1979 for virtually every respondent who had ever participated in the
Tecumseh Project. After 1979, mortality status was updated by screening daily
reports in local newspapers and follow-up contact with relatives. The possible
bias due to mortality status after 1979 was investigated in detail (Harburg et al.,
2003). Two separate survival models were fitted using the mortality status of
1979 and the mortality status of 1988. The point estimates obtained by the two
models were similar. The ascertainment after 1979 was shown not to bias the
estimates. Between 1971 and 1988, 91 (or 13.1%) respondents of the total LCES
(N=696) had died, 17.3% of the men (n=56) and 9.4%, women (n=35).
These death rates were similar to the full TCHS project population. Further,
this present subsample of 192 pairs, or 384 spouses, also had similar death rates:
husbands, 19% (n=37) and wives, 9% (n=17). Finally, all-cause mortality,
as of 1988, was selected as the dependent variable because the sparse number
of deaths for cardiovascular death (n=25) and cancer deaths (n=19) curtailed
meaningful inference from these specific causes.
Anger-coping types were assessed using a format developed by the lead author
(Harburg et al., 1973). A detailed description of the methodology is provided in
Harburg et al. (2003). All spouses independently responded to two hypothetical
anger-provoking situations (with a Spouse and a Policeman) involving injustices
perpetrated by the power figure termed an (unjustified) “attack.” Our assumption
is that a “fair sampling” of suppressed anger behavior requires at least two
different attack situations in different social situations with different alter-role
power “attackers” (e.g., spouse, police, doctor, nurse). The tendency to suppress
would vary across different social situations and specific attacker alter-roles, but
our theory requires multiple situations to measure the general tendency.
The situation was: “Now some questions about your feelings. Imagine that
you were doing something outside and a policeman (or your husband/wife/
sweetheart) yelled in anger or blew up at you for something that wasn’t your
fault, how would you feel?” For each attacker situation the respondent then gave
answers to three items, each with five Likert-type response values, asking about
(a) whether or not they would show their anger, (b) feel guilty or not later if
they had shown their anger, and (c) protest or not to the attacker at the time of
attack.
This method required that each of the five response values be recoded to a
2-point scale after the respondent had chosen from a 5-point scale. We expect
this recoding to increase test-retest reliability and validity, though this might
result in some loss of statistical power and information. The aim is to describe
accurately a two-category measure: express [anger out] or suppress [anger in]
anger-coping modes. The increase in reliability occurs because respondents can
choose to report, e.g., either “anger” or “annoyed,” which then can be collapsed
into a new response. Thus, minor expectable changes in test-retest values will be
MARITAL PAIR ANGER-COPING AND MORTALITY 49
merged in such new responses. If at least two out of three recoded responses for
each attack situation are “suppress” (does not show anger, does feel guilt later
if had shown anger, avoids response to attacker), then that person is categorized
as coping by suppressing anger; otherwise they are categorized as coping by
expressing anger.
Cumulative anger-guilt-protest indices of suppressed anger were then
developed separately for each “attack role” situation, spouse and police, as
was a total index across both situations. Thus, for each role situation, spouse
and police, those persons with a high score (two or more out of three items)
on an anger-guilt-protest index are more likely to not show their anger, or to
feel guilty later, or not protest an unjustified attack. The range was 0–3 for
each of the spouse and police suppressed anger indices. Using the indices,
we have found intercorrelations among items as follows: For Wives, Police
and Spouse anger-coping indices correlate, r=.49 (p<.01); the three Spouse
items correlate with their similar Police items as follows: Show Anger, r=
.24 (p<.001), Guilt Later, r=.56 (p<.001), Protest, r=.34 (p<.001).
For Husbands, Police and Spouse anger-coping indices correlate r=.38
(p<.001); the three Spouse items correlate with similar Police items: Show
Anger, r=.25 (p<.001); Guilt Later, r=.33 (p<.001); Protest, r=.35
(p<.001).
The score of the six items derived from both role situations is labeled the
Suppressed Anger Total Index. This Total Anger Index was categorized into
Express (0–2) and Suppress (3–5) for each husband and wife. The strength of this
scale lies in the convergent and external validity between other suppressed anger
measures and other health outcomes, which have been observed across different
investigators and populations. Each study showed a significant relation of a
suppressed anger index to a medical factor, i.e., blood pressure (Dimsdale, Pierce,
Schoenfeld, Brown, Zusman, & Graham, 1986; Gentry, Chesney, Kennedy,
Hall, Gary, & Harburg, 1983; Harburg et al., 1973; Somova, Diarra, &
Jacobs, 1995), number of chronic diseases (Julius, Lang, Gleiberman, Harburg,
DiFranceisco, & Schork, 1994), high renin (Esler et al., 1977), and mortality
(Harburg et al., 2003).
The anger-coping pair index was then constructed as follows: Type 1 =
Husband (H) Express/Wives (W) Suppress; Type 2 =H Express/W Express;
Type 3 =H Suppress/W Express; and Type 4 =H Suppress/W Suppress. Since
the focus of this research was on Type 4, the Types 1-3 pairs were collapsed
into a new category termed “Other Types.”
Health risk factors were ascertained during the Medical Tests Series
interviews and medical tests in 1971–1972 which included age in years,
cigarette smoking, relative weight, elevated blood pressure, education in years.
Cardiovascular risk, FEV1and bronchial problems were measured in the
1967–1969 TCHS Third Medical Series. For each of the final four health risk
50 HARBURG ET AL.
factors constructed for this analysis, the majority of the deaths were clustered
at the upper end of the distributions. This resulted in a nonlinear relationship of
these variables with the logarithmic function of the hazard.
Therefore, those few health risk factors that were continuous were
dichotomized into two categories of “low risk” and “high risk.” As the data were
robust, the results were clearly similar, whether or not continuous or dichotomous
variables were used in the analysis. The anger types Express and Suppress were
dichotomized a priori for theoretical reasons, and mortality patently is 0/1. First,
the age variable was dichotomized as “0” =below 50 years old and “1” =
above 50 years (few deaths occurred below 50 years old). Blood pressure was
measured with a mercury sphygmomanometer. All readings were taken with the
subject seated and using his/her right arm. Both systolic pressure and diastolic
(fifth phase) pressure were recorded.
The variable Elevated BP was constructed as follows: those persons below
140 SBP and below 90 DBP were coded “0,” and those with SBP 140 and/or
DBP >90 were coded “1.” Next, cardiovascular risk was a diagnosis of suspect
or probable CHD, defined as a probable history of myocardial infarction or
angina or electrocardiographic evidence of myocardial infarction (Minnesota
codes 1-1 or 1-2) and was coded “0” =no risk or coded “1” =high risk (one or
more risk factors). The respiratory risk variable (0,1) was constructed as being
“1” if any one of three respiratory risk factors were coded “1”: smoking was
coded 0/1; bronchial problems, 0,1; and FEV1, 0,1. Bronchial problems (suspect
or possible), were defined as chronic bronchitis or persistent cough or phlegm
and coded “0” =no risk, “1” =high risk. The FEV1score was first adjusted
for sex, age, and height using the FEV1values of the nonsmoking respondents
without respiratory disease or symptoms as the baseline for comparison, and
reversed such that higher scores indicate lower FEV1: Code “0” =no risk, code
“1” =high risk (above the median).
Statistical Methods
The Cox proportional hazard analytic method was used to model survival curves
from 1971 until 1988. The Cox Frailty Model, using the marital pair unit as a
random effect, was implemented as a first model to control for interdependence
of the survival times between spouses due to unobserved heterogeneity. If this
term was not significant, the general Cox Model was used without this random
effect term. The survival time for each individual was calculated as the difference
between the date of death and starting date of this study in 1971 for the cases
who died; and the difference between the date of last contact and starting date
for those who were still alive in 1988, i.e., these individuals were censored at
the end of the study.
MARITAL PAIR ANGER-COPING AND MORTALITY 51
RESULTS
Data in Table 1 show the distribution of the four anger-coping marital pair types
for the 192 pairs, rank ordered by percentage of spouse deaths for each type. The
percent of each type is as follows: Husband (H) Express/Wife (W) suppress (29%,
N=57 pairs), H Express/W Express, (32%, N=62), H Suppress/W Express
(25% N=47), and H/Suppress/W Suppress (14%, N=26). It was assumed that
Type 4 (Both Suppress) would be the lowest in proportion of types as it was
conceived to be a “morbidly interactive pattern.” The four anger-coping type
marriages appear to occur as a result of random mating. Chi-square tests revealed
there were no significant differences between the observed and expected pairings
across the four marital types: the observed and expected percentages of spouse
pairs for Type 1 to Type 4, respectively, are 30/26, 32/35, 24/22 and 14/17. The
expected percentages were derived from the marginal percentages of husbands
and wives, separately, who expressed or suppressed. These computations are
based on the hypothesis that mating patterns are generated independently of each
individual’s anger type. Further, although our theory did not predict the rank
order of deaths in Types 1, 2, or 3, it did predict that the Type 4 pairs would
result in the earliest and relatively highest mortality, assumed to be generated
by mutual anger suppression, poor communication (of feelings and issues), and
poor problem-solving with medical consequences.
When marital pairs were analyzed from the data in Table 1, it is noted that
Type 4 pairs yielded 50% deaths (13 out of 26 pairs) whereas Types 1, 2, 3
combined show 25% deaths (41 out of 166 pairs). The crude RR for Type 4 was
3.05 times Other Types combined, unadjusted chi-square =7.12, p<.01. When
pairs with double deaths as a proportion of all pairs (Type 4: 6 of 26 pairs and
TABLE 1
Number of Marital Pairs, Percentages and Number of Spouse Deaths by
Anger-Coping Types
Total Spouse Deaths
Marital Pair
Anger-Coping
Types
Husband/Wives
All Pairs
(N = 192)
Spouses’ Deaths
in Pairs with:
One Death % (N)
Two Deaths
% (N)
% of Type
pairs (N)
Type 1 Express/Suppress 57 12% (7) 4% (2) 16% (9)
Type 2 Express/Express 62 19% (12) 6% (4) 25% (16)
Type 3 Suppress/Express 47 26% (12) 9% (4) 35% (16)
Type 1–3 Other Types 166 19% (31) 6%(10) 25% (41)
Type 4 Suppress/Suppress 26 27% (7) 23% (6) 50% (13)
Total Spouse
Deaths
38 16 54
52 HARBURG ET AL.
for Types 1-3 combined: 10 of 166 pairs) were analyzed the crude RR for Type
4 was 4.68 times Other Types combined, unadjusted chi-square =8.56, p<. 01.
When time to death with adjustment for other health risk factors is considered,
the analyses were completed via the Cox Model for comparing Type 4, where
both H/W suppress, against the other types separately, and combined for
husbands and wives separately (n=192); results are shown in Table 2. Frailty
Cox regression model adjusting for other health risk factors with a pair unit
as a random effect was used for comparing time to death of Type 4 against
the other types combined for spouse death (either husband or wife; n=384).
The test for independence showed that the survival times between spouses were
independent of each other. The parameter estimate of the random effect for the
marital pair was not significant, p=0.26. Hence, the Cox regression model
stratifying by spouse (husbands or wives) and adjusted for other individual risk
factors was used as the final model for comparing the survival time of Type 4
against Other Types.
The results (see Tables 2 and 3) show significant differences in time to
death by anger-coping pair types. It should be noted that for the final parsimo-
nious models as presented in Tables 2 and 3, the education and relative weight
variables were not included as covariates because they were highly insignificant
in contributing to the log likelihood function. We first tested H and W mortality
separately (Table 2). Although age (over 50) and Elevated BP (SBP 140
and/or DBP 90) were each significantly related to H and W mortality (not
shown), only the wives’ mortality was significantly affected by being in a Type
4 marital pair, RR =3.13, CI (1.04, 9.43), p<.05.
However, it must be noted that in the Type 1 vs. Type 4 comparison for wives,
there are only two deaths in Type 1, thus rendering this significant nonpredicted
difference rather dubious. When death per marital anger-coping type was tested
(see Table 3), the mortality in a Type 4 pair where both H and W suppress
their anger, compared with Other Types was significantly higher: RR =1.95, CI
(1.02, 3.75), p<.05. Also, mortality in Type 4 was significantly higher than in
Type 1 (50% vs. 16%, see Table 1): RR =2.93, CI (1.22, 6.99), p<.05, but did
TABLE 2
Risk Ratios and 95% CI of All-Cause Mortality of Husbands and Wives by
Anger-Coping Pair Types Adjusted for Health Risk Factors
Anger-Coping Marital
Pair Types
Husbands (n = 192)
Risk Ratio (37 Deaths) 95% CI
Wives (n = 192)
(37 Deaths) 95% CI
Both Suppress vs. Type 1 218 (0.75,6.29) 776(1.36,44.4)
vs. Type 2 165 (0.63,4.32) 236 (0.66,8.44)
vs. Type 3 123 (0.49,3.30) 217 (0.64,8.82)
vs. Other Types 162 (0.70,3.74) 313(1.04,9.43)
*p-value < .05. Adjusted for age, elevated BP, respiratory risk and cardiovascular risk.
MARITAL PAIR ANGER-COPING AND MORTALITY 53
TABLE 3
Risk Ratios and 95% CI of All-Cause Mortality for
Marital Pairs by Anger-Coping Pair Types Adjusted for
Health Risk Factors
Anger-Coping
Marital Pairs
Marital Pair Types (N = 192)
Risk Ratio (46 Deaths)95% CI
Both Suppress vs. Type 1 293(1.22, 6.99)
vs. Type 2 185 (0.87, 3.95)
vs. Type 3 149 (0.70, 3.18)
vs. Other Types 195(1.02, 3.75)
46 deaths correspond to the number of pairs with at least one dead spouse;
eight pairs had double deaths (see Table 1). *p-value < .05. Adjusted for age,
elevated BP, respiratory risk, and cardiovascular risk.
not differ from Type 2 or Type 3. These findings are post hoc but are reported
here even though they are outside of our theoretical and a priori focus that tests
Type 4 mortality vs. Other Types.
To visualize the temporal occurrence of these earlier deaths among spouses
in pairs where both suppress their anger, Figure 1 presents adjusted survival
curves computed with Cox regression models for H and W separately and for
the pairs. It is clear in this figure that in the 17 years of follow-up for the Type 4
pairs (Both Suppress), the rate of deaths is higher compared to the Other Types.
We also observed that for husbands in all Other Types 17% died compared to
35% for husbands in Type 4; for wives in all Other Types, 7% died, while
15% died in Type 4. Thus the trends were similar for each gender though only
significant for wives (see Table 2). Of import, indices of suppressed anger were
not found to be significantly directly related to blood pressure level in this
sample.
Finally, we can test the general hypothesis that the effect of spouse anger
suppression on his/her own mortality is increased when combined with the
other spouse’s anger suppression. Previously it has been shown (Harburg et al.,
2003) that an individual’s suppressed anger type is related to earlier mortality,
especially for women. In the present article, therefore, it is hypothesized that
for married women there is an additional effect of her anger type interacting
with the husband’s anger type. The same hypothesis is tested for husbands. We
tested these hypotheses by adding an interaction term (H, W, HxW) for each of
four spouse anger types in a Cox regression adjusting for health risk factors as
in Table 2. We found no interaction effects in predicting husband’s mortality;
however, there was evidence (p=.06) of an interaction effect for Type 4 only
(both spouses suppress anger) in predicting wives’ mortality.
54 HARBURG ET AL.
0.50
0.60
0.70
0.80
0.90
1.00
Other Types
Both Suppress
% Survival Rate
% Survival Rate
% Survival Rate
1.a All Cause Mortality for Wives by Anger-Coping Pair Types.
0.50
0.60
0.70
0.80
0.90
1.00
Other Types
Both Suppress
Years
1.b All Cause Mortality for Husbands by Anger-Coping Pair Types.
0.50
0.60
0.70
0.80
0.90
1.00
Years
1971 1976 1981 1986
1971 1976 1981 1986
1971 1976 1981 1986
Other Types
Both Suppress
Years
1.c All Cause Mortality for all Pairs by Anger-Coping Types.
FIGURE 1 Survival curves for all cause mortality by anger-coping pair types, adjusted for
age, elevated BP, respiratory risk and cardiovascular risk (see Table 2 and 3).
MARITAL PAIR ANGER-COPING AND MORTALITY 55
DISCUSSION
This study used the dyad concept to define four types of spouse pair anger-coping.
Results showed no significant differences among the observed and expected
pairings; thus, it appears that the types are a postmarital result of random mating.
We found as hypothesized, the risk of all cause mortality over the 17-year
follow-up period was significantly higher when both spouses suppressed their
anger compared to the mortality risk for the three Other Types combined: 50% of
husbands and/or wives in the suppress/suppress type died, which was higher than
the mortality risk for the 3 Other Types combined, 25% (p<.01). Furthermore,
in the suppress/suppress dyad, 23% of the couples had double deaths; whereas
in the three Other Types combined, only 6% had double deaths, p<.01. Last, a
statistical interaction (p=.06) was found between Type 4 husbands and wives
(who both suppressed anger) adding additional prediction to early mortality for
the wives but not for husbands.
Are wives more vulnerable to a morbid interaction as in Type 4 than
husbands? It appears that most women, unlike most men, want to express their
negative (and positive) feelings and want them responded to (more than men)
and find it “punishing” when they are ignored (Levenson & Gottman, 1985).
Musante, Treiber, Strong, and Levy (1990) reported that “anger- in” wives
viewed their families as having high conflict, low emotional expressiveness, and
low cohesiveness. Husbands who were anger-in merely saw the family as less
expressive.
We would hypothesize that in couples where both suppress anger, in severe
conflict, his withdrawal/ avoidance/“stonewalling”/disengagement/anger-in or
anger-suppressive behavior becomes more punishing to his wife than if he
responded with low-level anger. Suppressed anger and subsequent “rumination”
among women in dyads may be more intense, more frequent, and last longer than
among men, thereby creating more severe psychophysiological consequences
(Nolen-Hoeksema, Larson, & Grayson, 1999). Her needs for emotional commu-
nication, even of negative issues, if not reciprocated, can generate a perception
of unjust treatment. Wives perhaps feel that a lack of “emotional reciprocity”
may mean a loss of long-term involvement that “should” prevail.
Several studies of college students using self-reported observations—not
responses to imagined or actual unfair attacks—indicate generally no differ-
ences in gender for types of reported anger (Kopper, 1993; Kopper & Epperson,
1991; Thomas & Williams, 1991); however, Zuckerman (1999) suggests “self-
concepts” such as anxiety, depression, and self-esteem do show coping response
differences by gender. Further, a small experimental study by Nunn (1999)
presents evidence that low self-esteem relates to higher Anger-Out response
for men but conversely higher Anger-In responses for females. For subjects
with high self-esteem, however, no gender differences in anger expression were
56 HARBURG ET AL.
found. We can speculate that such findings may well apply to marital pairs.
It is intriguing that only 9% of mortality in our study occurs among Type
1 couples (see Table 1). Do healthy self-concepts interact with anger-coping
modes in exchanging information and emotions during the process of conflict
resolution? Do long-term partners in “communal” relations live longer than
those in “stable neurotic” relations? The conceptual model of the anger-coping
measure used in the present study is based on the thesis that psychophysiologic
responses of anger/hostility are automatically induced in those social situations
when the person appraises (1) a loss or threat of loss of (2) something felt to
be possessed (rights, self-esteem, physical objects, etc.) through (3) perceived
arbitrary (unfair) acts by others (person, group, or society). An imagined attack
as in our 2 situations can induce bio-anger responses (Schwartz, Weinberger, &
Singer, 1981). When the loss is felt to be sudden, and is perceived to be highly
arbitrary involving a matter strongly valued, then anger responses will be more
intense. The combination of covert anger and overt absence of anger expression
to an attacker are elements of suppressed anger (Harburg, 1962).
One of the major health-relevant psychosocial precipitators of anger in
marital pairs we posit to be a perception of social injustice, which arbitrarily
deprives the spouse of his/her “rights” (e.g., spouses’ long-term commitment
or status or self-esteem in a social context) and may subsume many of the
substantive issues promoting conflict inventoried by Buss (1991). Similarly,
attitudes and bio-anger responses, even with infrequent or single intense contacts
within dyadic social role pairs, e.g., landlord-tenant (Harburg et al., 1973),
child-parent, citizen-police (Brondolo et al., 1998), or marital or close-living
partners are a fertile field for longitudinal direct observations of a syndrome of
resentment.
Several studies using the anger-coping index generated the concept of
“resentful” coping behavior (Harburg et al., 1979), and the idea that “chronic
resentment” might result from either chronic anger-in or anger-out responses at
the time of interpersonal attack depending on an absence of problem-solving or
reflective responses at the time of attack (Davidson, MacGregor, Stuhr, Dixon, &
MacLean, 2000) and later (Harburg, Gleiberman, Russell, & Cooper, 1991).
Engebretson, Matthews, and Scheier (1989) found “unexpectedly elevated
SBP” still prevailed in 78 young males a “full 25 minutes” after anger-provoking
harassment regardless of anger-out or anger-in coping style.
We now conceive that chronic resentment is an internal, autonomous response
composed of both psychic hostility and biologic anger acting simultaneously
in self-experience of either inhibiting anger expression to the unfair attacker
or exhibiting chronically intense attacking responses, both of which usually
prevent problem solving. Thus either chronic extreme anger-out or anger-in (both
related to incident hypertension, Everson et al., 1998), if followed by chronic
“brooding” about experiences, may build to “hatred,” which is usually unable
MARITAL PAIR ANGER-COPING AND MORTALITY 57
to be easily reported by most Americans; however, the intensity, duration, and
frequency of unjust attacks with no effective expression of anger, i.e., with no
problem-solving intent, and later “brooding” about the attacker’s injustice can
be reported in surveys (Cottington, Matthews, Talbot, & Kuller, 1986; Kahn,
Medalie, Neufeld, Riss, & Gouldbourt, 1972; Medalie & Gouldbourt, 1976;
Medalie, Stange, Zyzanski, & Gouldbourt, 1992; Siegel, 1985).
In experiments, the concept of “rumination” or “later mental re-creation of
the original response” has been studied in its relation to delayed cardiovascular
recovery for “emotion-producing situations”; later rumination induced sustained
and recurrent blood pressure elevations, even with nonsocial stimuli and tasks
to which young males responded with CV reactivity even more than young
women (Glynn, Christenfeld, & Gerin, 2002). Thus reiteration of both psychic
hostility and biological anger responses through recall occur sporadically, but
chronic resentment remains in the structured, specific set of hostile attitudes
(Harburg, 1962) or “enduring negative cognitions” (Engebretson, Matthews, &
Scheier, 1989) and in the memory of suppressed or extremely expressed anger
response toward the specified attacking element long after situational anger
dissipation (Harburg, Kasl, Tabor, & Cobb, 1969). When the recall becomes
distorted into obsessive and paranoid modes, the anger/hostility also becomes
more frequent and stronger, and thus chronic resentment becomes pathological
(Scheler, 1961).
In the present study, the data further suggest that chronic resentment might
be jointly held, each spouse resenting the other’s chronic silence or moodiness
or one spouse’s chronic resentment disturbs the marital relationship (Carlson,
2000). These joint behaviors can be observed in dyadic pairs in long-term
marriages where both spouses exhibit chronic “escape-avoidance” (Giunta &
Compas, 1993) or “withdrawal” (Gottman & Krokoff, 1989) or as in the present
study “suppressed anger” from problems of perceived spousal injustice; then
suppressing anger and impeding problem solving, in turn, can lead to continuous
marital dysfunction, biological disequilibrium (Cassel, 1976; Kiecolt-Glaser
et al., 1993), morbidity, and earlier mortality (Kiecolt-Glaser & Newton, 2001).
It should be noted that the kinds of outcomes and retention of experimental
arousal will vary depending on the level of conflict imposed by the level of
attack (Engbretson et al., 1989; Hoffman, Harburg, & Maier, 1962; Levenson &
Gottman, 1985). As yet there are no adequate measures of a chronic resentment
syndrome.
The findings in this study are subject to a number of limitations that urge
caution in assessment. The research was carried out in a small, semirural,
ethnically homogeneous (Anglo-Saxon) community with little socioeconomic
diversity or conflict and a sample born and raised prior to the 1960–1970 “sexual
revolution,” e.g., most of the married women in Tecumseh, 1971, were “house-
wives”; generalizing to larger, ethnically diverse, socioeconomically disparate
58 HARBURG ET AL.
populations would be problematic. Further, while the study had complete
ascertainment of death certificates up until 1979, after this date to 1988 the
deaths were obtained through newspaper obituaries; although death confirmation
evidence from relatives was rigorously gathered within this small community,
selection effects could not be avoided. The measure of anger-coping used in
this study is not part of a standard psychological inventory; it has a different
measurement strategy and is derived from a specific theoretical framework.
Unexpectedly, we found that pair Type 1 (husband express/wife suppress)
had the lowest mortality rate and significantly lower from Type 4. Only further
theory and research can pursue this finding. We chose not to speculate post hoc
for each type, especially if specific causes are analyzed, because clearly, our
mortality data are sparse. Plans for a 30-year follow-up on this sample (data not
now available) should yield more certified deaths of all sample members and
strengthen further tests of hypotheses concerning all-cause mortality rates and
specific types of mortality rates among the dyadic anger-coping types by gender.
The implications of this line of research involve therapeutic intervention among
troubled marital pairs, who both suppress their anger and have minimal capacity
for healthy communication. Effective behavioral therapy can relieve risk factors
such as elevated blood pressure (Ewart, Taylor, Kraemer, & Agras, 1984), which,
in turn, is a risk factor for early mortality (Kubzansky & Kawachi, 2000).
REFERENCES
Becker, H., & Useem, R. (1942). Sociological analysis of the dyad. American Sociological Review,
7, 15–26.
Brondolo, E., Masheb, R., Stores, J., Stockhammer, T., Tunick, W., Melhado, E., Karlin, W. A.,
Schwartz, J., Harburg, E., & Contrada, R. J. (1998). Anger-related traits and response to inter-
personal conflict among New York City traffic agents. Journal of Applied Social Psychology,28,
2089–2118.
Buss, D. M. (1991). Conflict in married couples: Personality predictors of anger and upset. Journal
of Personality,59, 663–688.
Carlson, D. L. (2000). Overcoming hurts and anger: Finding freedom from negative emotions.
(p. 67). Eugene, OR: Harvest House Publishers.
Cassel, J. (1976). The contribution of the social environment to host resistance. American Journal
of Epidemiology,104, 798–814.
Cottington, E. M., Mathews, K. A., Talbott, E., & Kuller, L. H. (1986). Occupational stress,
suppressed anger, and hypertension. Psychosomatic Medicine,48, 249–260.
Cronkite, R. C., & Moos, R. H. (1984). The role of predisposing and moderating factors in the
stress-illness relationship. Journal of Health and Social Behavior,25, 372–393.
Davidson, K., MacGregor, W. M., Stuhr, J., Dixon, K., & MacLean, D. (2000). Constructive anger
verbal behavior predicts blood pressure in a population-based sample. Health Psychology,19(1),
55–64.
Denollet, J., Sys, S. U., & Brutsaert, D. L. (1995). Personality and mortality after myocardial
infarction. Psychosomatic Medicine,57, 582–591.
MARITAL PAIR ANGER-COPING AND MORTALITY 59
Dimsdale, J. E., Pierce, C., Schoenfeld, D., Brown, A., Zusman, R., & Graham, R. (1986). Suppressed
anger and blood pressure: The effects of race, sex, social class, obesity and age. Psychosomatic
Medicine 48, 430–436.
Dunbar, E. (1947). Emotions and bodily changes: A survey of literature on psychosomatic interre-
lationships, 1910–1945. New York: Columbia University Press.
Engebretson, T. O., Matthews, K. A., & Scheier, M. F. (1989). Relations between anger expression
and cardiovascular reactivity: Reconciling inconsistent findings through a matching hypothesis.
Journal of Personality and Social Psychology,57(3), 513–521.
Esler, R., Julius, S., Zweifler, A., Randall, O., Harburg, E., Gardiner, H., & DeQuattro, V. (1977).
Mild high-renin essential hypertension. New England Journal of Medicine,296, 405–411.
Everson, S. A., Goldberg, D. E., Kaplan, G. A., Julkunen, J., & Salonen, J. (1998). Anger expression
and incident hypertension. Psychosomatic Medicine,60, 730–735.
Ewart, C. K. (1993). Marital interaction–the context for psychosomatic research. Psychosomatic
Medicine,55, 410–412.
Ewart, C. K., Taylor, C. B., Kraemer, H. C., & Agras, W. S. (1984). Reducing blood pressure
reactivity during interpersonal conflict: Effects of marital communication training. Behavioral
Research and Therapy,15, 473–484.
Funkenstein, D., King, S., & Drolette, M. (1957). Mastery of stress. Cambridge, MA: Harvard
University Press.
Gentry, W. D., Chesney, A. P., Kennedy, C. D., Hall, R. P., Gary, H. E., & Harburg, E. (1983). The
relation of demographic attributes and habitual anger-coping styles. Journal of Social Psychology,
121, 45–50.
Glynn, L. M., Christenfeld, N., & Gerin, W. (2002). The role of rumination in recovery
from reactivity: Cardiovascular consequences of emotional states. Psychosomatic Medicine,64,
714–726.
Giunta, C. T., & Compas, B. E. (1993). Coping in marital dyads: Patterns and associations with
psychological symptoms. Journal of Marriage and the Family,55, 1011–1017.
Gottman, J. M., & Krokoff, L. J. (1989). Marital interaction and satisfaction: A longitudinal view.
Journal of Consulting and Clinical Psychology,52, 47–52.
Gottman, J. M., & Levenson, R. W. (1986). Assessing the role of emotion in marriage. Behavioral
Assessment,8, 31–48.
Gottman, J. M., Levenson, R., & Woodin, E. (2001). Facial expressions during marital conflict.
Journal of Family Communication,1(1), 37–57.
Harburg, E. (1962). Covert hostility: Its social origins and relation to overt compliance. Unpublished
doctoral dissertation, University of Michigan, Ann Arbor.
Harburg, E., Blakelock, E. H., & Roeper, P. J. (1979). Resentful and reflective coping with arbitrary
authority and blood pressure: Detroit. Psychosomatic Medicine,41, 189–202.
Harburg, E., Erfurt, J. C., Hauenstein, L. S., Chape, C., Schull, W. J., & Schork, M. A. (1973).
Socio-ecological stress, suppressed hostility, skin color, and black-white male blood pressure:
Detroit. Psychosomatic Medicine,35, 276–296.
Harburg, E., Gleiberman, L., Russell, M., & Cooper, M. L. (1991). Anger-coping styles and
blood pressure in black and white males: Buffalo, New York. Psychosomatic Medicine,43,
153–164.
Harburg, E., Julius, M., Kaciroti, N., Gleiberman, L., & Schork, M. A. (2003). Expressive/
suppressive anger-coping types, gender and types of mortality: A 17-year follow-up (Tecumseh,
Michigan, 1971–1988). Psychosomatic Medicine,65, 588–597.
Harburg, E., Kasl, S. V., Tabor, M. A., & Cobb, S. (1969). The intrafamilial transmission of
rheumatoid arthritis-IV: Recalled parent-child relations by rheumatoid arthritics and controls.
Journal of Chronic Diseases,22, 223–238.
60 HARBURG ET AL.
Hoffman, L. R., Harburg, E., & Maier, N. R. F. (1962). Difference and disagreement as factors in
creative group problem solving. Journal of Abnormal Psychology, 3, 206.
Julius, M., Harburg, E., Cottington, E. M., & Johnson, E. H. (1986). Anger-coping types, blood
pressure, and all-cause mortality: A follow-up in Tecumseh, Michigan (1971–1983). American
Journal of Epidemiology,124, 220.
Julius, M., Lang, C. A., Gleiberman, L., Harburg, E., DiFranceisco, W., & Schork, A. (1994).
Glutathione and morbidity in a community-based sample of elderly. Journal of Clinical Epidemi-
ology,47, 1021–1026.
Kahn, H. A., Medalie, J. H., Neufeld, H. N., Riss, E., & Gouldbourt, U. (1972). The incidence
of hypertension and associated factors: The Israel ischemic heart disease study. American Heart
Journal,84, 171–182.
Kiecolt-Glaser, J. K., Malarkey, W. B., Chee, M., Newton, T., Cacioppo, J. T., Mao, H. et al (1993).
Negative behavior during marital conflict is associated with immunological down-regulation.
Psychosomatic Medicine,55, 395–409.
Kiecolt-Glaser, J. K., & Newton, T. L. (2001). Marriage and health: His and hers. Psychological
Bulletin,127(4), 472–503.
Kopper, B. A. (1993). Role of gender, sex role identity, and type A behavior in anger expression
and mental health functioning. Journal of Counseling Psychology,40(2), 232–237.
Kopper, B. A., & Epperson, D. L. (1991). Women and anger. Psychology of Women Quarterly,15,
7–14.
Kubzansky, L. D., & Kawachi, I. (2000). Affective states and health. In L. F. Berkman & I. Kawachi
(Eds.), Social epidemiology (pp. 213–241). New York: Oxford University Press.
Levenson, R. W., & Gottman, J. M. (1985). Physiological and affective predictors of change in
relationship satisfaction. Journal of Personality and Social Psychology,49, 85–94.
Medalie, J. H., & Gouldbourt, U. (1976). Angina pectoris among 10,000 men. II. Psychosocial and
other risk factors as evidenced by a multivariate analysis of a five year incidence study. American
Journal of Medicine,60, 910–921.
Medalie, J. H., Stange, K. C., Zyzanski, S. J., & Gouldbourt, U. (1992). The importance of biopsy-
chosocial factors in the development of duodenal ulcer in a cohort of middle-aged men. American
Journal of Epidemiology,136, 1280–1287.
Musante, L., Treiber, F. A., Strong, W. B., & Levy, M. (1990). Individual and cross-spouse corre-
lations of perceptions of family functioning, blood pressure and dimensions of anger. Journal of
Psychosomatic Research,34, 393–399.
Napier, J. A., Johnson, B. C., & Epstein, F. H. (1970). The Tecumseh Community Health Study.
In L. L. Kessler & M. L. Levin (Eds.), Casebook of community studies (pp. 25–46). Baltimore:
Johns Hopkins Press.
Newcomb, T. M. (1950). Social psychology (pp. 372–374; 452–457). New York: The Dryden Press.
Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depressive
symptoms. Journal of Personality and Social Psychology 77(5), 1061–1072.
Nunn, J. S., & Thomas, S. L. (1999). The angry male and the passive female: The role of gender
and self-esteem in anger expression. Social Behavior and Personality,27(2), 145-153.
Scheler, M. (1961). Ressentiment. Glencoe, IL: Free Press.
Schwartz, G. E., Weinberger, D. A., & Singer, J. A. (1981). Cardiovascular differentiation of
happiness, sadness, anger, and fear following imagery and exercise. Psychosomatic Medicine,43,
343–364.
Siegel, J. M. (1985). The measurement of anger as a multidimensional construct. In M. A. Chesney &
R. H. Rosenman (Eds.), Anger and hostility in cardiovascular and behavior disorders (pp. 59–82).
Washington, DC: Hemisphere.
Siegman, W., & Smith, T. W. (Eds.) (1994). Anger, hostility and the heart. Hillsdale, NJ: Lawrence
Erlbaum.
MARITAL PAIR ANGER-COPING AND MORTALITY 61
Smith, T. W. (1992). Hostility and health: Current status of a psychosomatic hypothesis. Health
Psychology,11, 139–150.
Somova, L. I., Diarra, K., & Jacobs, T. Q. (1995). Psychophysiological study of hypertension in
Black, Indian and White African students. Stress Medicine,11, 105–111.
Spielberger, C. D., Johnson, E. H., Russell, S. F., Crane, R. J., Jacobs, G. A., & Worden, T. J. (1985).
The experience and expression of anger: Construction and validation of an anger expression scale.
In M. A. Chesney & R. H. Rosenman (Eds.), Anger and hostility in cardiovascular and behavioral
disorders (pp. 5–30). New York: Hemisphere Publishing Corporation.
Thomas, S. A., Friedman, E., Wimbush, F., & Schron, E. (1997). Psychosocial factors and survival in
the cardiac arrhythmia suppression trial (CAST): A reexamination. American Journal of Critical
Care,6, 116–126.
Thomas, S. P., & Williams, R. L. (1991). Perceived stress, trait anger, modes of anger expression,
and health status of college men and women. Nursing Research,40(5), 303–307.
Zuckerman, D. M. Stress, self-esteem, and mental health: How does gender make a difference?
(1991). Sex Roles,20(7/8), 429–444.
... Application of the interpersonal approach broadly suggests that marriage may represent a case of Person  Environment fit characterized in part by the personality/interpersonal style match between partners (18,19), where both partners bring their own individual traits and behaviors that interact with their partners' characteristics in turn. One individual difference of note that might impact ongoing interpersonal dynamics is people's anger-coping response style (20,21). Anger-coping responses styles describe a continuum of behaviors people exhibit in response to challenging interpersonal stimuli that range from suppression-in which individuals hide their covert negative reactions to others' unfair or aggressive behavior-to expression, in which people overtly convey their anger in response to others' unfair behavior. ...
... Nevertheless, the interpersonal approach provides a general basis for predicting that a personality mismatch is predicted to have longitudinal health consequence. For example, levels of match or mismatch in terms of anger-coping response styles may operate as a moderator of chronic interpersonal stress leading to long-term health damage (21) to the extent that extent that these response styles "restrict" or "push" for similar responses from people in the immediate environment. This is particularly important in the case of marriage; one spouse's reactions to distressing or challenging stimuli impact and are impacted by their partner's behavior and vice versa (22). ...
... A subsample of the larger TCHS community sample completed a variety of psychosocial measures in 1971/1972, comprising the Life Change Event Study (LCES). In previous reports, Harburg and colleagues (20,21,23) found that suppressive anger-coping response style was associated with increased risk of mortality over 18 years. This was reflected both within individual outcomes in the broader LCES (23), as well as in couples in which both partner evidenced a suppressive anger-coping response style (21). ...
Article
Objective: Research in psychosomatic medicine includes a long history of studying how responses to anger-provoking situations are associated with health. In the context of a marriage, spouses may differ in their anger-coping response style. Where one person may express anger in response to unfair, aggressive interpersonal interactions, his/her partner may instead suppress anger. Discordant response styles within couples may lead to increased relational conflict, which, in turn, may undermine long-term health. The current study sought to examine the association between spouses' anger-coping response styles and mortality status 32 years later. Methods: The present study used data from a subsample of married couples (N = 192) drawn from the Life Change Event Study to create an actor-partner interdependence model. Results: Neither husbands' nor wives' response styles predicted their own or their partners' mortality. Wives' anger-coping response style, however, significantly moderated the association of husbands' response style on mortality risk 32 years later, β = -0.18, -0.35 to -0.01, p = .039. Similarly, husbands' response style significantly moderated the association of wives' response style and their later mortality, β = -0.24, -0.38 to -0.10, p < .001. These effects were such that the greater the mismatch between spouses' anger-coping response style, the greater the risk of early death. Conclusions: For a three-decade follow-up, husbands and wives were at greater risk of early death when their anger-coping response styles differed. Degree of mismatch between spouses' response styles may be an important long-term predictor of spouses' early mortality risk.
... Avoiding conflict can have negative health implications (e.g., Graham et al., 2006;Harburg, Kaciroti, Gleiberman, Julius, & Schork, 2008). Conflict occurs in family caregiving (e.g., Davis, 1997;Pecchioni & Nussbaum, 2001) and is suggested as a potentially important aspect of LDC (Bevan & Sparks, 2011). ...
... Our RQ's finding contrasts the substantial body of research that finds that conflict avoidance is negatively related to individual well-being (e.g., Graham et al., 2006;Harburg et al., 2008). Distant family caregivers reported that conflict avoidance (along with relationship protection, which was also unrelated to negative health perceptions) was a particularly strong (i.e., with a mean of 4.42 on a 7-point scale) topic avoidance motivation. ...
Article
Full-text available
This study examines topic avoidance motivations and frequency from a multiple goals perspective in relation to self-reported negative health perceptions in the distant family caregiving context. A sample of 130 self-identified distant family caregivers completed an online survey about their communication with their care recipient. Overall topic avoidance and the self-protection and partner unresponsiveness motivations were significant, positive predictors of distant family caregivers' self-reported negative health perceptions. The remaining topic avoidance motivations were not significant predictors. This study is one of the first known to examine communication in the distant family caregiving context, and it offers possibilities for future research on communication barriers and health issues that impact this growing population.
... Suppressing the emotions during conflict may lead to the re-accumulation of these emotions (Richards et al. 2003). In marital relationships where both parties restrain their anger, couples face a higher risk of early death than in couples where one or both express their anger (Harburg et al. 2008). Conflicts in close relationships affect inner-body processes, like virtue of blood circulation, endoctrine-, and immuno-system (Wright and Loving 2011). ...
Article
Full-text available
Although the World Health Assembly emphasized as early as in 1996 the need for violence prevention, there is still no generally accepted index for interpersonal destructiveness in a society. Hereby we propose a Societal Index of Interpersonal Destructiveness (SIID) that could be used to compare interpersonal violence in different societies. SIID is a composite of two sub-indices: (1) Index of Interpersonal Destructiveness Prerequisites, and (2) Index of Interpersonal Destructiveness Consequences. This study addresses the construction and internal consistency analysis of SIID. The Indices for periods 1989–1993, 1994–1999, 1999–2004, 2005–2007 and 2008–2010 are computed and for 28–48 countries, depending on availability of high quality and comparative data across time. We conclude that SIID has considerable potential as an internally consistent yardstick for evaluating and comparing the level of interpersonal destructiveness of societies worldwide.
Article
Full-text available
Mismanaged anger is associated with adverse health outcomes. This study examined whether dimensions of religiousness/spirituality could predict healthy anger management in a sample of 82 community-dwelling older Americans. A correlational research design was employed using the Deffenbacher Anger Scale and the Brief Multidimensional Measure of Religiousness/Spirituality. Higher scores on Forgiveness, Daily Spiritual Experiences, Religiousness/Spirituality as Coping, and Self-Ranking of Religiousness/Spirituality were correlated with healthier anger management; however forgiveness was the only significant predictor in the regression analysis. Interventions to facilitate forgiveness may promote healthy anger management and minimize the adverse health effects of mismanaged anger.
Article
It was hypothesized that women are more vulnerable to depressive symptoms than men because they are more likely to experience chronic negative circumstances (or strain), to have a low sense of mastery, and to engage in ruminative coping. The hypotheses were tested in a 2-wave study of approximately 1,100 community-based adults who were 25 to 75 years old. Chronic strain, low mastery, and rumination were each more common in women than in men and mediated the gender difference in depressive symptoms. Rumination amplified the effects of mastery and, to some extent, chronic strain on depressive symptoms. In addition, chronic strain and rumination had reciprocal effects on each other over time, and low mastery also contributed to more rumination. Finally, depressive symptoms contributed to more rumination and less mastery over time.
Article
This article reviews recent research in the area of marital interaction. It suggests that sufficient consistency exists in the observational results to begin theory construction to explain three basic patterns. Theory reconstruction is then described that is designed to assess the role that emotional expression and control play in accounting for variation in marital satisfaction. Next the argument is made that the key to the assessment of emotion is specificity, and a case is made for a dialectic between specific features and cultural informants coding systems. On the basis of this discussion, the role of the autonomic nervous system is discussed in the construction of a sociophysiological theory of marriage.
Article
Recent research has renewed interest in the potential influence of hostility on physical health. This review indicates that the evidence available from prospective studies, although not entirely consistent, suggests that hostile persons may be at increased risk for subsequent coronary heart disease and other life-threatening illnesses. Further, several plausible mechanisms possibly linking hostility and health have been articulated and subjected to initial evaluation. Hostile individuals display heightened physiological reactivity in some situations, report greater degrees of interpersonal conflict and less social support, and may have more unhealthy daily habits. Additional research is needed, and it must address a variety of past conceptual and methodological limitations. Perhaps the most central of these concerns are the assessment of individual differences in hostility and the role of social contexts in the psychosomatic process.
Article
This study examined data from 153 married couples to determine their patterns of coping with stress and the association between couples' coping and psychological symptoms in each spouse. We investigated whether information about the dyadic pattern of coping added to the understanding of psychological symptoms in husbands and wives beyond that gleaned from examining each partner's coping. Cluster analysis yielded eight distinguishable patterns of dyadic coping. Two of these patterns were associated with high levels of psychological symptoms in one or both spouses. Most notably, a pattern of dyadic coping marked by strong reliance on escape-avoidance coping by both husband and wife was associated with high levels of symptoms in both spouses. In regression analyses, wives' escape-avoidance coping predicted both their own and their husbands' psychological symptoms. Husbands' escape-avoidance coping predicted only their own symptoms.
Article
This study investigated the relationship of sex and sex-role identity with the expression of anger. In particular, a number of common assertions about women's experience and expression of anger were examined empirically. Female (242) and male (213) college students completed several questionnaires assessing sex-role identity and multiple dimensions of the subjective experience and expression of anger. Univariate analyses revealed consistent relationships between sex-role identity and anger proneness, outward expression of anger, modulation or control of anger expression, and suppression of anger. Significant sex differences were not observed. Viewed unidimensionally, sex did not appear to be the determining factor in anger expression or the tendency to suppress anger.