From the Department of Social and Behavioral Sciences (Trudel-Fitzgerald, Kawachi, Kubzansky), Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and School of Psychology (Reduron), Laval University, Quebec City, Quebec, Canada.
Psychosom Med. 2021 Jun 1;83(5):402-409. doi: 10.1097/PSY.0000000000000948.
Although evidence has linked anger and hostility with all-cause mortality risk, less research has examined whether anger frequency and expression (outwardly expressing angry feelings) are linked to all-cause and cause-specific mortality.
In 1996, men (n = 17,352) free of medical conditions from the Health Professionals Follow-Up Study reported anger frequency and aggressive expression levels. Deaths were ascertained from participants' families, postal authorities, and death registries. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality risk until 2016 with a 2-year lag, adjusting for a range of relevant covariates.
There were 4881 deaths throughout follow-up. After adjustment for sociodemographics and health status, moderate and higher (versus lower) levels of anger frequency and aggressive expression were generally unrelated to the risk of death from all-cause, neurological, or respiratory diseases. However, cardiovascular mortality risk was greater with higher anger frequency (HR = 1.17, 95% CI = 1.01-1.34), whereas cancer mortality risk was greater with higher anger expression (HR = 1.14, 95% CI = 0.98-1.33). Results were similar after including all covariates and stronger when considering anger expression's interaction with frequency.
In this cohort of men, experiencing angry feelings and expressing them aggressively were related to an increased risk of dying from cardiovascular disease and cancer but not from other specific causes, over two decades. These results suggest that not only the experience of negative emotions but also how they are managed may be critical for some but not all health outcomes, highlighting the importance of considering causes of death separately when investigating psychosocial determinants of mortality.
尽管有证据表明愤怒和敌意与全因死亡率风险相关，但较少的研究探讨愤怒频率和表达（向外表达愤怒情绪）是否与全因和特定原因死亡率相关。
1996 年，来自健康专业人员随访研究的无医疗条件男性（n=17352）报告了愤怒频率和攻击性表达水平。通过参与者的家属、邮政当局和死亡登记处确定死亡情况。使用 Cox 比例风险回归模型，在 2 年的滞后时间内，估计死亡率风险的风险比（HR）和 95%置信区间（CI），并调整了一系列相关协变量。
在随访期间共发生了 4881 例死亡。在调整社会人口统计学和健康状况后，中等到更高（与更低相比）的愤怒频率和攻击性表达水平通常与全因、神经或呼吸道疾病死亡风险无关。然而，较高的愤怒频率与心血管疾病死亡率风险增加相关（HR=1.17，95%CI=1.01-1.34），而较高的愤怒表达与癌症死亡率风险增加相关（HR=1.14，95%CI=0.98-1.33）。当纳入所有协变量时，结果相似，当考虑愤怒表达与频率的相互作用时，结果更强。
在这个男性队列中，经历愤怒情绪和强烈表达愤怒与心血管疾病和癌症死亡风险增加有关，但与其他特定原因无关，超过二十年。这些结果表明，不仅负面情绪的体验，而且它们的管理方式，对于某些但不是所有的健康结果可能都是关键的，这突出了在调查心理社会因素对死亡率的影响时，分别考虑死因的重要性。
