Juhani Julkunen

Anger expression and incident hypertension

Objective It has long been thought that anger is important in the development of essential hypertension. However, tests of this hypothesis have yielded conflicting findings. This study prospectively examined the relationship between anger expression style and incident hypertension in a population sample of middle-aged men. Methods Participants were 537 initially normotensive men from eastern Finland, who completed a medical examination and series of psychological questionnaires at baseline and at 4-year follow-up. Anger expression was assessed by Spielbergers Anger-out and Anger-in scales. Results At follow-up, 104 men (19.4%) were hypertensive (blood pressure >or=to 165 mm Hg systolic and/or 95 mm Hg diastolic). Age-adjusted logistic regression analyses revealed that each 1-point increase in Anger-out was associated with a 12% increase in risk of hypertension after 4 years of follow-up (p < .002), which corresponded to a two-fold increased risk of hypertension among men with scores in the top tertile of the Anger-out scale, relative to those with scores in the bottom tertile (odds ratio = 2.00, 95% confidence interval 1.20-3.38). Each 1-point increase on the Anger-in scale also was related to a 12% increased risk of hypertension (p < .01). Adjustments for body mass index, smoking, alcohol consumption, physical activity, a positive parental history of hypertension, and baseline resting diastolic blood pressure had little impact on the findings. Conclusions These data provide strong epidemiological evidence for a positive relationship between anger expression style and subsequent hypertension, independent of known risk factors. Findings support the hypothesis that extreme expression of anger in either direction has adverse cardiovascular consequences.

Alexithymia and risk of death in middle-aged men

We prospectively examined the association between alexithymia and risk of death over an average follow-up time of nearly 5.5 years in 42- to 60-year-old men (N = 2297) participating in the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). Alexithymia, impairment in identification, processing, and verbal expression of inner feelings, was assessed by the validated Toronto Alexithymia Scale (TAS) In age-adjusted survival analyses, men in the highest alexithymia quintile had a twofold greater risk of all-cause death (p < 0.001) and a threefold greater risk of death from accidents, injury, or violence (p < 0.02) relative to the men in the three lowest alexithymia quintiles. There was little evidence for confounding by behavioral factors (smoking, alcohol consumption, physical activity). physiological risk factors (LDL, HDL, body mass index, hypertension), socioeconomic status, marital status, perceived health, prior diseases and diagnoses, depressive symptoms or social connections. Consistent and even stronger associations between alexithymia and all-cause death were found in a healthy subgroup (N = 1650). Why difficulties in dealing with emotions associate with increased mortality remains unclear. Our findings suggest that the association is independent from the effect of well-known behavioral, biological, and psychosocial risk factors.

Psychometric properties of the Finnish 20-item Toronto Alexithymia Scale

The aim of this study was to examine the factor structure and the validity of the Finnish version of the 20-item Toronto Alexithymia Scale (TAS-20). As part of the Northern Finland 1966 Birth Cohort Project, the TAS-20 was presented to a sample of 5034 31-year old persons. A confirmatory factor analysis showed that the three-factor model, earlier established with the original TAS-20, was in agreement with the Finnish version of the scale. Three criteria of goodness-of-fit met the standards for adequacy of fit. For the total scale, internal reliability (Cronbachs alpha) was 0.83 and for the three subscales (factors 1, 2, and 3) it was 0.81, 0.77, and 0.66, respectively. Two- and one-factor models for TAS-20 were also examined, but the other models did not perform as well as the three-factor model. The factor model also worked well with a sample of 516 students with a mean age of 24.8 years. In conclusion, the TAS-20 scale is useful in the Finnish version, too.

Coping with Inner Feelings and Stress: Heavy Alcohol Use in the Context of Alexithymia

The authors conducted a population study to assess the relationship between heavy alcohol consumption and alexithymia, defined as difficulty in identifying and expressing feelings. The study sample consisted of 2,297 middle-aged men from eastern Finland. The proportion of men who reported either frequent intoxication or unpleasant aftereffects of heavy drinking increased linearly with alexithymia. Alexithymia and the heavy acute intake of different sorts of alcoholic drinks were also consistently associated. Long-term heavy use, taking into account both the dose and frequency, was also linearly related to the alexithymia measure. In multivariate models to assess whether high alcohol consumption in alexithymic individuals might relate to stress, the authors found nothing to support the stress-dampening hypothesis.

Alexithymia and Perceived Symptoms: Criterion Validity of the Toronto Alexithymia Scale

The associations between alexithymia and somatization, perceived symptoms and subjective health, were investigated in a population sample of 2,297 middle-aged Finnish men. A modified translated version of the Toronto Alexithymia Scale (TAS) was used to assess alexithymia. A graded and statistically significant relationship was observed between the TAS score for alexithymia and self-reported recent symptoms. The alexithymia score, adjusted for age, smoking and socioeconomic status, was also positively associated with the MMPI hypochondriasis index and inversely with perceived level of health. One of the factors of the TAS appeared to have a weak but significant correlation with a variety of diagnosed disorders that previously have been considered psychosomatic.

Validity and reliability of the Toronto Alexithymia scale (TAS) in a population study

Alexithymia refers to the difficulties an individual has to experience and express his feelings. Various self-report questionnaires have been introduced to measure alexithymia, but only a few rigorous validity studies of this concept have been carried out in nonclinical populations. The aim of this study was to evaluate the psychometric properties of the Toronto Alexithymia Scale (TAS) in a population sample of 1560 middle-aged men from eastern Finland. The modified version of the TAS applied in this study had a factor structure that matched the previous results and the theoretical concept of alexithymia. Internal consistency of the total TAS scale, as well as the 8 month retest reliability, were adequate. The TAS correlated fairly well with an interview-based evaluation of alexithymic features. The results suggest that the TAS could be a useful screening instrument for alexithymic features in a population study, but the scale would probably need some revisions.

Components of type a behavior and the first-year prognosis of a myocardial infarction

This study examined prospectively the role of Type A behavior and its subcomponents in the first-year prognosis of myocardial infarction (MI). Anger expression, irritability, and cynicism were assessed as traits related to the hostility component of the construct. The sample comprised 92 patients, less than 65 yr old, who survived the acute phase of their first MI. Psychological data was collected by self-report questionnaires during the initial hospital stay. Type A behavior was measured by the Jenkins Activity Survey and by the Finnish Type A Scale. Factors were controlled for age, sex, social status, and the MI severity. The results showed that patient who had a reinfarction or died during the first year reported more irritability and experienced anger more often than patients surviving without any complications. From the standard subcomponents only the Speed-Impatience factor of the JAS predicted poor prognosis. Our results indicated that the global Type A scores were not associated with the prognosis of MI.

Components of Type A behavior pattern and occupational stressor-strain relationship: testing different models in a sample of industrial managers.

The authors analyzed empirically the roles of impatience-irritability and ambition-energy components of the Type A behavior pattern (TABP) in the occupational stressor-strain relationship. They tested three models, using a sample of 659 industrial managers to determine whether the TABP components affected strain independently from perceived stressors (the direct effects model); or indirectly, by moderating effects of perceived stressors (the moderated effects model); or whether perceived stressors provoked TABP components, which influenced the number of strain symptoms (the mediated effects model). Multiple regression procedures showed, as expected, that the two TABP components acted quite differently in the stress process. With the direct effects model, the impatience-irritability component consistently increased numbers of psychological and physiological symptoms, regardless of perceived occupational stressors. The ambition-energy component, on the other hand, was activated by an abundance of development possibilities experienced at work. This, in turn, partly explained the decrease in perceived levels of psychological and physiological symptoms. The results relating to the ambition-energy component supported the mediated effects model and demonstrated a positive effect on subjective health perceptions.

Psychosocial predictors of recovery after a myocardial infarction: Development of a comprehensive assessment method

A comprehensive self-report questionnaire was constructed for the assessment of psychological risk factors in coronary patients during the acute care phase. Factors assessed were reactive anxiety and depression. coping with illness. Type A behaviour, anger, and work stress. Based on these measures a risk index was created. The validity of the method was examined in a clinical trial. Baseline data including social and medical information was collected in three hospitals. The sample comprised 243 patients, aged under 60 years, who were hospitalised because of a myocardial infarction. A 12 month follow-up was conducted by a mailed questionnaire. Results showed a 3% total mortality and successful return to work was recorded in 54% of the subjects during the year. Of the measures included on the risk index, the two coping subscales, depressive resignation and denial of illness, were the best separate predictors of both return to work and self-rated health after 12 months. The dichotomised psychological risk in...

Depressive symptoms and serum lipid fractions in middle-aged men: physiologic and health behavior links.

Objective: To investigate alternative hypothetical models that could clarify the relationship between depressive symptoms and serum cholesterol fractions, i.e., high-density lipoprotein (HDL) and low-density lipoprotein (LDL). It was hypothesized that the impact of the depressive symptoms on cholesterol fractions is mediated through health behavior and body mass index, and at the same time there would be a direct link from depression to cholesterol. Methods: The study sample consisted of 893 middle-age men who participated in a trial aimed at preventing the metabolic syndrome, Type 2 diabetes and cardiovascular diseases. Serum cholesterol was measured by the enzymatic method. Participants completed self-report questionnaires assessing health behavior and depressive symptoms. Results: Depressive symptoms consistently correlated statistically significantly with adverse lifestyle factors and, as hypothesized, positively with HDL. Path analyses supported the parallel existence of two main pathways: from depression through adverse health behavior to unfavorable cholesterol fraction balance, and a direct physiological link indicative of beneficial effect of depression on cholesterol levels. Conclusions: It is concluded that, among a sample of men, depressive symptoms are linked to cholesterol fractions through two different pathways. An adverse relationship of depression with serum lipids HDL-LDL balance is partly mediated through harmful health behaviors. At the same time, the results indicate a direct, physiological link between depressive symptoms and cholesterol that has a beneficial influence on the HDL-LDL balance. AIC = Akaike information criterion; BDI = Beck Depression Inventory; BMI = body mass index; BP = blood pressure; CAD = coronary artery disease; CFI = comparative fit index; CVD = cardiovascular diseases; EM = expectation-maximization; GFI = goodness-of-fit index; HDL = high-density lipoprotein; HMSP = Helsinki Metabolic Syndrome Prevention Trial; LDL = low-density lipoprotein; NFI = normed fit index; PGFI = parsimony goodness of fit index; RMSEA = root mean square error of approximation.