Relationship of anger trait and anger expression to c-reactive protein in post-menopausal women

99 Pages·2015·1.59 MB·English

University of South Florida
Scholar Commons
Graduate Theses and Dissertations Graduate School
2008
Relationship of anger trait and anger expression to
c-reactive protein in post-menopausal women
Rosalyn Gross
University of South Florida
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Gross, Rosalyn, "Relationship of anger trait and anger expression to c-reactive protein in post-menopausal women" (2008).Graduate
Theses and Dissertations.
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Relationship of Anger Trait and Anger Expression to

C-Reactive Protein in Post-Menopausal Women

by

Rosalyn Gross

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
College of Nursing
University of South Florida

Major Professor: Maureen E. Groer, Ph.D.
Lois O. Gonzalez, Ph.D.
Jeffrey D. Kromrey, Ph.D.
Sandra P. Thomas, Ph.D.
Mary S. Webb, Ph.D.

Date of Approval:
September 22, 2008

Keywords: Psychoneuroimmunology, cytokines, inflammatory
response, stress response, negative emotions

©Copyright 2008, Rosalyn Gross
Dedicated to
E’desanya’m Irenk’a

I would not exist except by your grace and the grace of God. For
my dear Mother, who always told me I could do anything I set my
mind to, become whatever I wished, and always cheered me on, in
good times and bad.
Your dream has finally been achieved for now you finally have a
doctor in the family. I miss you very much and wish you were here to
celebrate my lifelong goal. Szeretlek anyuka’m, Rozi’ka.
Acknowledgements

I express my deepest gratitude to Dr. Maureen Groer for her
expert guidance and support as chairperson of my committee and
research mentor. Your passion for truly innovative nursing research
will continue to inspire me along my new professional path. I also
graciously thank Dr. Sandra Thomas for writing the definitive book on
women’s anger, which ten years ago sent me on a quest to understand
this difficult emotion and brought me here today. To Dr. Mary Webb,
my sincerest appreciation for being my first mentor at the College of
Nursing and for her continued and unfailing belief in my goals and
ability to succeed. To Dr. Jeffrey Kromrey, my thanks for schooling me
in the statistical sciences, which I now not only understand, but enjoy.
To Dr. Lois Gonzalez, I thank you for your expertise and support for
my research. To Dr. Charles Spielberger, I thank you for allowing me
to use the STAXI-2 gratis.
To my dear friend and spiritual mentor, Dr. Marydelle Polk, no
words could ever express how much your undying faith in me has
meant, especially these past five years. Without your words of wisdom
and unconditional love, I doubt that I would have been able to be
here. You are truly one of the very special people on this earth.
To my VBFF Jill Peterson, my kindred spirit who has stuck by my
side through good times and bad for the past 14 years, I thank you
and love you for all the loving kindness you, Pete, and Drake have
shared with me as part of your family.
To my son Dave, who never failed to keep me on track by
repeating the very words that guided him to success as a young man.
Your own pursuit of excellence and inspiration pushed me along more
than you’ll ever know.
To my dear Aunt Joyce, thank you for your love, wisdom and
support and also being my big sister and second mother. Yes, I am
finally done with school.
I would also like to thank the Florida Gulf Coast University
community, including the women who volunteered their time, the staff
of the student health center, and especially Juanita Mottley who
provided a virtually painless experience for the participants.
Table of Contents

List of Tables iii

List of Figures iv

Abstract v

Chapter One: Introduction to the Study 1
Statement of the Problem 1
Background and Significance 1
Purpose of the Study 6

Chapter Two: Review of Literature 8
Overview of Cardiovascular Responses to Anger 9
Overview of Inflammatory Responses to Anger 10
Research on Cardiovascular Reactivity Responses to Anger 12
Research on Inflammatory and Immunological Responses
to Anger 21
Summary of Review of Literature 32

Chapter Three: Methodology 35
Study Design, Setting, and Sample 35
Procedures 37
Assessment of Trait Anger and Anger Expression 40
Statistical Analysis 41

Chapter Four: Results 43
Descriptive Statistics 43
Mean CRP Differences between High and Low Trait
Anger Women 46
Mean CRP Differences between High and Low Anger
Expression Women 47
Other Findings 47

Chapter Five: Discussion 52
Discussion of Findings 53
i
Strengths and Limitations 56
Implications for Future Research and Practice 57

List of References 60

Bibliography 73

Appendices
Appendix A: Recruitment Poster 76
Appendix B: Informed Consent Form 78
Appendix C: Subject Screening Form 84
Appendix D: State Trait Anger Expression Inventory-2 86

About the Author End Page

ii
List of Tables

Table 1 Definitions of Anger Constructs 9

Table 2 STAXI-2 Subscale Descriptions 41

Table 3 Descriptive Statistics of Cohort, Sample, and Trait
Groups 44

Table 4 Correlations among C-reactive protein, Waist
Circumference, Anger Trait, Anger Control, and
Anger Expression 48

iii
List of Figures

Figure 1. Conceptual Model of Study 6

Figure 2. Scatterplot of CRP and Waist Circumference 49

Figure 3. Scatterplot of CRP and Anger Control Out 50

Figure 4. Scatterplot of CRP and Anger Control In 51

iv
Relationship of Anger Trait and Anger Expression to
C-Reactive Protein in Post-Menopausal Women

Rosalyn Gross

ABSTRACT

Coronary heart disease is the leading cause of death in American
women, accounting for one in six deaths in 2004. One third of women
over the age of forty will develop coronary heart disease in their
lifetime. The role of chronic and excessive inflammation and risk
factors, such as smoking and high cholesterol, are now well-
established factors contributing to coronary heart disease pathology. A
knowledge gap exists in that little is known about the mechanisms by
which psychosocial factors, such as anger, may be associated with
pro-inflammatory processes that contribute to cardiovascular morbidity
and mortality in women. The purpose of this study was to determine if
there were differences in serum levels of the proinflammatory
biomarker, C-reactive protein, in post-menopausal women who scored
high on anger characteristics compared to those with low anger
characteristics. Mean levels of C-reactive protein were not found to be
different in a sample of 42 women with high trait anger or high anger
expression compared to those with low trait anger or low anger
expression. Significant relationships were found in C-reactive protein
v