Baseline Hostility Research Articles

Medication and procedural abortion uptake during a period of increasing abortion hostility

Hundreds of state-level abortion restrictions were implemented in the US between 2010 and 2020. Medication abortion was being widely adopted during this same period. Understanding the impact of health policies and political climate will improve the delivery of and access to reproductive healthcare in a period of rapid change. To measure the association between state abortion hostility and mifepristone and procedural abortion rates, we conducted a state-level repeated cross-sectional study using 2010–2020 employer-sponsored insurance claims data from Merative MarketScan. The exposure of interest was a 13-point state-level abortion hostility score based on the presence of policies which either reduce or protect access to abortion. Outcomes of interest were annual mifepristone and procedural abortion claims per 100,000 enrollees. We used a linear mixed model adjusting for urbanicity, age group, and year. We assessed whether temporal trends in abortion claims were modified by state abortion hostility by interacting year with two measurements of abortion hostility: baseline score in 2010 and change from baseline score. We found that median state-level mifepristone claims increased from 20 to 37 per 100,000 included enrollees; meanwhile, median procedural abortions claims decreased from 69 to 20 per 100. For mifepristone, every unit increase in a state's baseline abortion hostility score was associated with 7.5 (CI, −12 to −3.6) fewer mifepristone claims per 100,000 in 2010. For states with baseline hostility and change scores of zero, we did not observe a significant time trend over the 11 year study period. For every unit increase in baseline hostility, the time trend changed by 0.5 fewer claims (CI, −0.8 to −0.2) per 100,000 per year. States with higher baseline abortion hostility had fewer overall abortions, less uptake of mifepristone abortions, and slower decline in procedural abortions between 2010 and 2020. Changes in hostility from new restrictions during this time period did not significantly impact claims. Advocates for abortion access must simultaneously attend to individual abortion policies and the overall political climate. Updated research on the relationship between political climate and the evolving clinical landscape of abortion care is needed to inform this work.

Effects of cariprazine on reducing symptoms of irritability, hostility, and agitation in patients with manic or mixed episodes of bipolar I disorder

BackgroundHostility, irritability, and agitation are common in patients with bipolar I disorder. Post hoc analyses evaluated the effect of cariprazine on these symptoms in patients with bipolar I mania. MethodsData were pooled from three randomized, double-blind, placebo-controlled phase 3 cariprazine trials in adults with bipolar I manic/mixed episodes (NCT00488618, NCT01058096, NCT01058668); pooled cariprazine doses (3–12 mg/d) were analyzed. Patients were categorized into hostility/irritability and agitation subgroups by baseline scores: Young Mania Rating Scale (YMRS) irritability and disruptive-aggressive behavior items score ≥ 2; Positive and Negative Syndrome Scale (PANSS) hostility item ≥ 2; PANSS–Excited Component (PANSS-EC) total score ≥ 14 and score ≥ 4 on ≥ 1 individual item. Changes from baseline to week 3 in hostility/irritability- and agitation-related outcomes were evaluated. Adjustments were made for the presence of other manic symptoms, sedation, and akathisia. ResultsMost patients met subgroup inclusion criteria (YMRS hostility = 930; PANSS hostility = 841, PANSS-EC agitation = 486). In the YMRS subgroup, least squares mean differences in change from baseline were statistically significant for cariprazine versus placebo on YMRS hostility/irritability-related items (irritability [−0.93], disruptive-aggressive behavior [−0.79], combined [−1.75]; P ≤ 0.001 each), YMRS total score (−5.92, P ≤ 0.0001), and all individual YMRS items (−0.25 to −0.93, P ≤ 0.0001); differences remained significant after adjustment for other manic symptoms, sedation, and akathisia. Differences in PANSS hostility and PANSS-EC subgroups were significant for cariprazine versus placebo (P ≤ 0.001). LimitationsPost hoc analysis. ConclusionCariprazine demonstrated specific antihostility/irritability and anti-agitation effects in patients with manic/mixed episodes of bipolar I disorder and baseline hostility, irritability, or agitation.

Hostility, forgiveness, and cognitive impairment over 10 years in a national sample of American adults.

We examined the extent to which self-forgiveness and forgiveness of others moderated the association of hostility with changes in cognitive impairment over 10 years in a nationally representative sample of adults in the United States. Participants were 1,084 respondents to the Americans' Changing Lives survey, a longitudinal study of American adults. Hostility, self-forgiveness, forgiveness of others, and cognitive impairment were measured at baseline, and cognitive impairment was assessed again at follow-up. Moderated multiple regression analyses tested whether self-forgiveness and forgiveness of others moderated the association of hostility with changes in cognitive impairment over time, controlling for baseline cognitive impairment and relevant sociodemographic and clinical factors. As hypothesized, greater hostility levels at baseline predicted more cognitive impairment 10 years later, β = .08, p < .01. In addition, self-forgiveness at baseline moderated the association between baseline hostility and cognitive impairment at follow-up, β = -.07, p < .01. Decomposing this interaction revealed that hostility significantly predicted increased cognitive impairment at follow-up for individuals with low, β = .15, p < .001, and average, β = .08, p = .001, levels of self-forgiveness but not for persons with high levels of self-forgiveness, β = .03, p = .34. In contrast, forgiveness of others was not a significant moderator. Greater hostility is associated with the development of more cognitive impairment over 10 years, and being more self-forgiving appears to mitigate these hostility-related effects on cognition. Enhancing self-forgiveness may thus represent one possible strategy for promoting cognitive resilience in adulthood. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Hostility, anger, and cardiovascular mortality among blacks and whites

Background: Despite the well-known impact of baseline hostility and anger on subsequent cardiovascular mortality, few studies have tested whether predictive role of hostility and anger on mortality varies as a function of race and gender. Objectives: Current study explored role of race and gender in modifying the effects of baseline hostility and anger on cardiovascular mortality in a nationally representative sample in U.S. Materials and Methods: We used data from the Americans’ changing lives study, a nationally representative longitudinal cohort of U.S. adults. The study followed 1,593 Blacks or Whites for 10 years from 2001 to 2011. Independent variables were baseline hostility and anger (anger-in, and anger-out), measured at 2001, using 4 item Cook-Medley cynical hostility scale and Spielberger Anger Expres- sion scales, respectively. Dependent variable was time to death due to cardiovascular disease since 2001. Covariates were baseline socio-demographics (age and education), behaviors (smoking and drinking), and health (number of chronic medical conditions, self-rated health, and depressive symptoms) measured at 2001. We used Cox proportional hazard models in the pooled sample and specific to race, in the absence and presence of health variables. Results: In the pooled sample, baseline hostility and anger-out predicted cardiovascular mortality in the next 10 years. We found significant interactions between race and baseline hostility and anger-in on cardiovascular mortality, suggesting that these associ- ations are stronger for Whites than Blacks. Race did not interact with baseline anger-out on cardiovascular mortality. Gender also did not have any interactions with baseline hostility, anger-in, or anger-out on cardiovascular mortality. Conclusions: Hostility and anger-in better predict cardiovascular mortality among Blacks than Whites in the United States. Black - White difference in the associations of hostility and anger with cardiovascular mortality suggest these factors may have some role in shaping health disparities across racial groups.

Hostile attitudes and effortful coping in young adulthood predict cognition 25 years later.

We studied the relation of early-life (mean age 25 years) and mid-life (mean age 50 years) cognitive function to early measures of hostile attitudes and effortful coping. In 3,126 black and white men and women (born in 1955-1968) from the Coronary Artery Risk Development in Young Adults Study (CARDIA), we used linear regression to examine the association of hostile attitudes (Cook-Medley questionnaire) and effortful coping assessed at baseline (1985-1986) to cognitive ability measured in 1987 and to a composite cognitive Z score of tests of verbal memory, psychomotor speed, and executive function ascertained in midlife (2010-2011). Baseline hostility and effortful coping were prospectively associated with lower cognitive function 25 years later, controlling for age, sex, race, education, long-term exposure to depression, discrimination, negative life events, and baseline cognitive ability. Compared to the lowest quartile, those in the highest quartile of hostility performed 0.21 SD units lower (95% confidence interval [CI] -0.39, -0.02). Those in the highest quartile of effortful coping performed 0.30 SD units lower (95% CI -0.48, -0.12) compared to those in the lowest quartile. Further adjustment for cumulative exposure to cardiovascular risk factors attenuated the association with the cognitive composite Z score for hostility. Worse cognition in midlife was independently associated with 2 psychological characteristics measured in young adulthood. This suggests that interventions that promote positive social interactions may have a role in reducing risk of late-age cognitive impairment.

The effect of cariprazine on hostility associated with schizophrenia: post hoc analyses from 3 randomized controlled trials.

Although most patients with schizophrenia are not aggressive, individuals with the disorder have increased risk of hostile behavior. Cariprazine, a dopamine D3 and D2 receptor partial agonist antipsychotic with preferential binding to D3 receptors, was evaluated for antihostility effects in patients with schizophrenia. Post hoc analyses were conducted using pooled data from 3 positive randomized, placebo-controlled, phase 2/3 studies in inpatients (18-60 years) with acute exacerbation of schizophrenia according to DSM-IV-TR criteria; data were collected between 2008 and 2011. The principal post hoc outcome was mean change from baseline to week 6 on the Positive and Negative Syndrome Scale (PANSS) hostility item (P7); separate analyses adjusted for certain PANSS positive symptoms and sedation covariates. Analyses were based on the pooled intent-to-treat population (N = 1,466) using a mixed-effects model for repeated measures approach; separate analyses were conducted in subgroups categorized by baseline hostility item scores (P7: ≥ 2, ≥ 3, ≥ 4). The least squares mean difference (LSMD) in change from baseline to week 6 was statistically significant on all PANSS hostility item analyses in favor of cariprazine versus placebo: unadjusted (-0.28; P < .0001), adjusted for PANSS positive symptoms (-0.12; P < .05), adjusted for positive symptoms plus sedation (-0.12; P < .05). The magnitude of change for cariprazine increased with greater baseline hostility (LSMD vs placebo for ≥ 2, ≥ 3, ≥ 4 subgroups: -0.32, -0.37, -0.51, respectively; P < .01 all). Significant improvement on the hostility item was seen in cariprazine- versus placebo-treated patients with schizophrenia; the effect of cariprazine increased with greater levels of baseline hostility. ClinicalTrials.gov identifiers: NCT00694707, NCT01104766, and NCT01104779.

Prediction of treatment discontinuation and recovery from Borderline Personality Disorder: Results from an RCT comparing Schema Therapy and Transference Focused Psychotherapy

Knowing what predicts discontinuation or success of psychotherapies for Borderline Personality Disorder (BPD) is important to improve treatments. Many variables have been reported in the literature, but replication is needed and investigating what therapy process underlies the findings is necessary to understand why variables predict outcome. Using data of an RCT comparing Schema Therapy and Transference Focused Psychotherapy as treatments for BPD, variables derived from the literature were tested as predictors of discontinuation and treatment success. Participants were 86 adult outpatients (80 women, mean age 30.5 years) with a primary diagnosis of BPD who had on average received 3 previous treatment modalities. First, single predictors were tested with logistic regression, controlling for treatment type (and medication use in case of treatment success). Next, with multivariate backward logistic regression essential predictors were detected. Baseline hostility and childhood physical abuse predicted treatment discontinuation. Baseline subjective burden of dissociation predicted a smaller chance of recovery. A second study demonstrated that in-session dissociation, assessed from session audiotapes, mediated the observed effects of baseline dissociation on recovery, indicating that dissociation during sessions interferes with treatment effectiveness. The results suggest that specifically addressing high hostility, childhood abuse, and in-session dissociation might reduce dropout and lack of effectiveness of treatment.

Hostility, Health Behaviors, and Risk of Recurrent Events in Patients With Stable Coronary Heart Disease: Findings From the Heart and Soul Study

BackgroundHostility is a significant predictor of mortality and cardiovascular events in patients with coronary heart disease (CHD), but the mechanisms that explain this association are not well understood. The purpose of this study was to evaluate potential mechanisms of association between hostility and adverse cardiovascular outcomes.Methods and ResultsWe prospectively examined the association between self‐reported hostility and secondary events (myocardial infarction, heart failure, stroke, transient ischemic attack, and death) in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8‐item Cynical Distrust scale. Cox proportional hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and secondary events. During an average follow‐up time of 7.4±2.7 years, the age‐adjusted annual rate of secondary events was 9.5% among subjects in the highest quartile of hostility and 5.7% among subjects in the lowest quartile (age‐adjusted hazard ratio [HR]: 1.68, 95% confidence interval [CI]: 1.30 to 2.17; P<0.0001). After adjustment for cardiovascular risk factors, participants with hostility scores in the highest quartile had a 58% greater risk of secondary events than those in the lowest quartile (HR: 1.58, 95% CI: 1.19 to 2.09; P=0.001). This association was mildly attenuated after adjustment for C‐reactive protein (HR: 1.41, 95% CI, 1.06 to 1.87; P=0.02) and no longer significant after further adjustment for smoking and physical inactivity (HR: 1.25, 95% CI: 0.94 to 1.67; P=0.13).ConclusionsHostility was a significant predictor of secondary events in this sample of outpatients with baseline stable CHD. Much of this association was moderated by poor health behaviors, specifically physical inactivity and smoking.

Abstract P083: Poor Health Behaviors Explain Increased Risk of Cardiovascular Events in Hostile Patients with Coronary Heart Disease: Findings from the Heart and Soul Study

Background: Hostility is a significant predictor of adverse cardiovascular (CV) events in patients with coronary heart disease (CHD) but the mechanisms that explain this association are unknown. Hypothesis: We assessed the hypothesis that controlling for poor health behaviors (physical inactivity, medication nonadherence, and smoking) would eliminate the association between hostility and future CV events. Methods: We prospectively examined the association between self-reported hostility and CV events in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8-item Cynical Distrust Scale. Log hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and CV events (myocardial infarction, heart failure, stroke, transient ischemic attack, or death). Results: A total of 592 CV events occurred during 8 years of follow-up. Each standard-deviation increase in hostility score was associated with a 20% increased risk of CV events (age-adjusted hazard ratio [HR] 1.20; 95% CI, 1.09-1.31; P=0.0001). The age-adjusted annual rate of CV events was 10.4% among the 185 subjects in the highest quartile of hostility and 6.2% among the 333 subject in the lowest quartile of hostility (HR 1.67; 95% CI, 1.27-2.18; P=0.0002). After adjustment for comorbid diseases and cardiac disease severity, participants with hostility scores in the highest quartile had a 46% higher rate of CV events than those with scores in the lowest quartile (HR 1.46; 95% CI, 1.09-1.98; P=0.01). This association was no longer statistically significant after adjustment for smoking, medication non-adherence and physical inactivity (HR 1.12; 95% CI, 0.87-1.63; P=0.27). Conclusions: Hostility was a significant predictor of adverse CV events in this sample of patients with stable CHD, but the association was eliminated after adjustment for poor health behaviors. Association Between Baseline Hostility (Quartile IV vs. I) and Subsequent Cardiovascular Events * Model Adjusted for † HR (95% CI) P value Age 1.67 (1.27-2.18) 0.0002 Above + Male, White 1.70 (1.29-2.24) 0.0002 Above + depressive symptoms 1.56 (1.17-2.08) 0.003 Above + MI, diabetes, LVEF 1.46 (1.09-1.98) 0.01 Above + CRP 1.36 (1.00-1.84) 0.05 Above + smoking 1.31 (0.97-1.78) 0.08 Above + medication nonadherence 1.26 (0.92-1.72) 0.14 Above + physical inactivity 1.19 (0.87-1.63) 0.27 * Cardiovascular events include myocardial infarction, heart failure, stroke, transient ischemic attack, and death; † Each model adjusts for the variables from the preceding rows, such that the final row adjusts for every variable listed in the table

Effects of Writing About Emotions Versus Goals on Psychological and Physical Health Among Third‐Year Medical Students

A randomized, controlled trial compared writing about emotional topics (EMO) to writing about goals as the "best possible self" (BPS; after King, 2001) and evaluated emotional approach coping, i.e., efforts to cope through processing and expressing emotion, as a moderator of writing effects on psychological and physical health in 64 third-year medical students. In participants with higher baseline hostility, the EMO condition was associated with less hostility at 3 months compared to the BPS and control conditions. Emotional processing (EP) and emotional expression (EE) moderated the effect of experimental condition on depressive symptoms at 3 months; high EP/EE participants reported fewer depressive symptoms in the EMO condition, whereas low EP/EE individuals reported fewer depressive symptoms in the BPS condition compared to the EMO and control conditions. A moderating effect of EP on physical health was also identified, such that low EP individuals who wrote about goals (BPS) had fewer health care visits at 3 months compared to low EP participants in the EMO and control conditions.

A post hoc analysis of the impact on hostility and agitation of quetiapine and haloperidol among patients with schizophrenia

Quetiapine, a drug with a broad pharmacologic profile (similar to that of clozapine), may show benefits for agitation in patients with psychoses. Also, quetiapine may be superior to placebo and either equal or superior to haloperidol in treating this symptom. Available data for other second-generation antipsychotic agents show that quetiapine may have better efficacy in improving agitation compared with haloperidol.This reanalysis of a previously reported pivotal clinical trial assessed whether quetiapine or haloperidol has benefits for the treatment of hostility and agitation among patients experiencing an acute exacerbation of schizophrenia.Patients aged 18 to 65 years of either sex and any ethnicity who had a diagnosis of schizophrenia based on the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria and who were experiencing an acute exacerbation were recruited into the study. A priori, data from patients assigned to 4 therapeutically effective quetiapine treatment groups (150, 300, 600, and 750 mg) in a previously reported 6-week, double-blind, placebo-controlled clinical trial were combined and compared with data from patients given haloperidol 12 mg or placebo on an agitation measure derived from the Brief Psychiatric Rating Scale (BPRS). Patients who received at least 2 weeks of treatment who had a baseline assessment and at least 1 postbaseline assessment after the 2 weeks of treatment were included. An analysis of variance with the baseline hostility score and center as covariates was used to assess treatment effects of quetiapine or haloperidol versus placebo for changes in agitation scores. A path analysis was used to separate the direct from the indirect effects (via improvements in psychoses and/or overall psychopathology) on agitation scores of quetiapine relative to haloperidol.A total of 257 patients (193 men, 64 women) were studied. The combined quetiapine groups comprised 175 patients; the haloperidol group, 42 patients; and the placebo group, 40 patients. Quetiapine treatment reduced agitation scores significantly among patients with acute psychoses compared with placebo. A slight reduction in agitation scores was found when haloperidol treatment was compared with placebo, but this difference was not statistically significant. Compared with haloperidol, quetiapine treatment had a direct and significant effect on agitation that was independent of the improvement in psychotic symptoms.The data in this study suggest that quetiapine treatment has benefits for hostility and agitation among patients experiencing an acute exacerbation of schizophrenia. Furthermore, the path analysis indicated that, relative to haloperidol, quetiapine appeared to have direct effects on agitation that were independent of improvements in psychoses or overall psychopathology, as assessed by the BPRS.