Anger Expression, Momentary Anger, and Symptom Severity in Patients with Chronic Disease

Abstract

Background: Anger expression styles are associated with physical health, and may affect health by modulating anger experience in daily life. Research examining this process in the daily lives of clinically relevant populations, such as patients with chronic disease, is needed.

Method: Community adults with asthma (N = 97) or rheumatoid arthritis (RA; N = 31) completed measures of trait-level anger expression styles (anger-in and anger-out), followed by ecological momentary assessments of anger and physical health five times daily for 7 days.

Results: High anger-in predicted greater momentary anger, physical limitations, and greater asthma symptoms. High anger-out predicted reduced RA symptoms. Momentary anger was robustly associated with more severe symptoms in daily life. Three-way interactions showed that anger-in moderated these momentary anger-symptom associations more consistently in men.

Conclusions: Anger expression styles, particularly anger-in, may affect the day-to-day adjustment of patients with chronic disease in part by altering the dimensions of everyday anger experience, in ways that appear to differ by gender.

Keywords: Anger expression and suppression; Arthritis; Asthma; Ecological momentary assessment; Gender differences.

Figure 1

Gender × Trait Anger-In × Momentary Anger predicting momentary health outcomes. Predicted values depicted in these graphs were generated from covariate adjusted models with all covariates held at their means. High anger-in and anger-out are equal to the mean of each measure + 1 SD; low anger-in and anger-out are equal to the mean of each measure – 1 SD. Panel A shows the three-way interaction predicting momentary physical health in the full sample (asthma and arthritis patients). Panel B shows the interaction predicting physical limitations only among pateints with asthma; Panel C shows this interaction only among patients with arthritis. Panel D shows the three-way interaction predicting coughing/wheezing symptoms in asthma patients.