Cook-Medley Hostility Scale Research Articles

Hostility is related to blunted beta-adrenergic receptor responsiveness among middle-aged women.

Based on previous findings in men, the hypothesis that hostility would be associated with blunted responsiveness of cardiovascular beta-adrenergic receptors was tested in a study sample of middle-aged women. The roles of the sympathetic nervous system and of social support in this putative relationship were also evaluated. Subjects were 80 healthy women (n = 23 African American; n = 57 white), aged 47 to 55 years. Hostility was assessed using the Cook-Medley Hostility Scale and social support was assessed with the Brief Social Support Questionnaire. Intravenous isoproterenol challenge was used to evaluate cardiac and vascular beta-adrenergic receptor responsiveness. Twenty-four-hour urinary catecholamine excretion was used to index sympathetic nervous system activity. Hostility was related to blunted cardiac (R = 0.33, p <.01) and vascular (R = 0.23, p <.05) beta-adrenergic receptor responsiveness in simple correlation analysis and in hierarchical regression analyses controlling for race, menopausal status, weight, and resting heart rate. Low social support was also related to blunted beta-adrenergic receptor responsiveness (R = 0.3, p <.01). Twenty-four-hour norepinephrine excretion was related both to hostility (R = 0.32, p <.01) and to cardiac (R = 0.25, p <.05) and vascular (R = 0.24, p <.05) beta-adrenergic receptor responsiveness. These observations replicate and extend previous findings in men by demonstrating that higher levels of hostility and low levels of social support are associated with blunted beta-adrenergic receptor responsiveness in middle-aged women. They also suggest that heightened sympathetic nervous system activity associated with hostility may contribute to beta-adrenergic receptor blunting. Because blunted beta-adrenergic receptor sensitivity is a characteristic feature of a broad range of cardiovascular diseases, these findings may reflect an early preclinical manifestation of pathophysiology accompanying hostility and low social support.

Hostility and facial affect recognition: Effects of a cold pressor stressor on accuracy and cardiovascular reactivity

The effects of hostility and a cold pressor stressor on the accuracy of facial affect perception were examined in the present experiment. A mechanism whereby physiological arousal level is mediated by systems which also mediate accuracy of an individual’s interpretation of affective cues is described. Right-handed participants were classified as high hostile ( N=28) or low hostile ( N=28) using the Cook Medley Hostility Scale. The high-hostile group met joint selection criteria. Only high-hostile participants who showed cardiovascular reactivity to the cold pressor, with systolic BP change exceeding the group mean were included. Groups were further subdivided into cold pressor and non-cold pressor test conditions. It was predicted that high-hostile men, relative to low-hostile men, would show decreased perceptual accuracy when presented with happy, angry, and neutral facial configurations within the left visual field (LVF). Results indicated that high-hostile men were less accurate than low-hostile men in the LVF. Further, pre-stress accuracy scores in the high-hostile men were similar to the post-stress accuracy scores of the low-hostile men. The lateralization of affective function and the role of physiological arousal in affective facial perception are discussed.

The Influence of Cardiorespiratory Fitness and Hostility on Cardiovascular Reactivity to Mental Stress

0612 The personality trait of hostility has recently been linked to an impressive range of cardiovascular risk factors including hypertension, engagement in healthcompromising behaviors, exaggerated cardiovascular responses to stress, and coronary artery disease. The influence of cardiorespiratory fitness on individuals varying in hostility has not yet been investigated. PURPOSE: This study examined the effects of cardiorespiratory fitness and trait hostility on psychophysiological stress responses in college-aged individuals. METHODS: Participants completed a maximal treadmill test for the determination of maximal oxygen consumption and on a subsequent day completed a laboratory-based stress reactivity protocol. This protocol consisted of a 6-min verbal serial subtraction task and a 6-min interpersonal speech. Measures of heart rate, heart rate variability, systolic blood pressure, and diastolic blood pressure were assessed during baseline, stress, and recovery periods. Participants also completed the Cook-Medley hostility scale along with measures of state anxiety and perceived difficulty following each mental stress task. RESULTS: Participants reporting high hostility displayed significantly greater heart rate and diastolic blood pressure responses to the serial subtraction task compared to low hostile individuals (P < .05). Highly fit individuals experienced reduced cardiovascular responses to stress than lower fit individuals (P < .05) even though these groups did not differ on hostility. CONCLUSION: These findings confirm that cardiorespiratory fitness and trait hostility both influence cardiovascular responses to mental stress. Future research investigating the relationship between exercise and/or fitness on stress reactivity should consider personality characteristics that may influence individuals' responses to psychosocial stress.

DYNAMIC LATERALIZATION: HOSTILITY, CARDIOVASCULAR REGULATION, AND TACHISTOSCOPIC RECOGNITION

This experiment tested a hypothesis linking the right cerebral regulation of hostility and cardiovascular arousal. It also replicates related research regarding hostility, cardiovascular regulation, and auditory recognition (Shenal and Harrison, 2003) through the visual modality. Thirty low- and high-hostile participants (n = 30) were identified using the Cook Medley Hostility Scale (CMHS). Only right-handed male participants with no significant medical or psychological history completed the experiment. All participants completed the cold pressor paradigm. Cardiovascular measures (systolic blood pressure [SBP] and diastolic blood pressure [DBP]) were recorded and tachistoscopic lexical recognition procedures were administered before and after the physical stressor.The primary finding of this research was greater left cerebral activation (decreased cardiovascular reactivity) following the tachistoscopic lexical recognition tasks and greater right cerebral activation following the painful (cold pressor) stressor

Joint Effect of Hostility and Severity of Depressive Symptoms on Plasma Interleukin-6 Concentration

Although interleukin (IL)-6 plays a significant role in cardiovascular disease, little is known about its relation to psychological risk factors, such as hostility and severity of depressive symptoms. The current study examined the joint effects of severity of depressive symptoms and hostility on plasma IL-6 in a sample of 90 healthy, nonsmoking men. After an overnight fast, blood samples for plasma IL-6 and fasting lipids were collected on the same day that the Beck Depression Inventory (BDI) and the Cook-Medley hostility (Ho) scale were administered. Plasma IL-6 was determined using enzymatic-linked immunosorbent assay (ELISA). Analyses of logarithmically normalized plasma IL-6 adjusting for age, body mass index (BMI), fasting total cholesterol, high density lipoprotein (HDL), and resting diastolic blood pressure (DBP) revealed a significant BDI by Ho interaction (p =.026). Post hoc decomposition revealed that Ho was correlated with log-normalized plasma IL-6 (r = 0.59, p =.025) but only among men with BDI scores of 10 and above. Alternatively, BDI was correlated with log-normalized plasma IL-6 (r = 0.61, p =.003) but only among men with Ho scores of 23 and higher. Comparisons among BDI/Ho groups indicated that men with high scores on both the BDI and the Ho exhibited the highest median levels of plasma IL-6. Hostile men who exhibited above normal levels of depressive symptoms had higher plasma levels of IL-6 suggestive of a subpopulation at increased risk for future cardiac events.

Hostile Hartlepool and genteel Guildford: hostility and health in 10 English towns

Research from the USA suggests that cities with high mortality rates have high levels of hostility. Our aim was to replicate this research in English towns. A telephone questionnaire, based on the Cook–Medley hostility scale, was administered to random samples of adults in 10 English towns: five with high standardized mortality ratios (SMR) and five with low SMRs. The point estimate for the age–sex-weighted mean hostility score of high SMR towns was higher than that of low SMR towns (mean difference 0.2). However, the 95% confidence interval on the estimate included no difference between the two groups (−0.3–0.8). Our study does not confirm beyond doubt the findings of earlier research in the USA.

Differences in Anger Expression Between Individuals With and Without Headache After Controlling for Depression and Anxiety

To evaluate whether anger and anger expression are different between persons with and without headache after controlling for depression and anxiety. Persons with headache may experience more problems with anger and its expression when compared with persons without headache. It is important to establish whether differences exist for persons with and without headache on trait anger and anger expression independent of depression and anxiety. To date, however, this issue has received little attention in the empirical literature. The current study measured trait anger, anger-in, hostility, anxiety, and depression among persons with and without headache, and evaluated whether trait anger and anger-in differentiated groups independent of depression and anxiety. Participants were 422 adults recruited from a larger study within a university setting. Of those, 171 suffered from headache (mean age, 21 years; 81% were female; 69% were white; mean years with pain, 7.53). Another 251 sex-matched individuals (mean age, 21 years; 81% female; 62% white) met criteria for the headache-free group. Participants provided information regarding their headache characteristics and were administered affective trait measures (Trait version of the State-Trait Anxiety Inventory, Brief Symptom Inventory-Depression), trait anger measures (Trait Anger Scale, Cook-Medley Hostility Scale), and a measure of the extent to which individuals hold their anger in. Multivariate analysis of variance revealed significant differences between the 2 groups (Wilks lambda =.86, P <.001, eta2 =.14). Step-down analysis revealed that even after controlling for all other variables, those in the headache group had higher levels of anger-in (P <.001, eta2 =.08; mean, 18.98 versus 15.68). Trait anger and hostility did not differ between groups after controlling for depression and anxiety. Logistic regression revealed that anger-in contributed most to predicting headache status (P <.001; partial r =.23). The current findings indicate that persons with headache hold their anger in more than those without headache even after controlling for levels of trait anger, depression, and anxiety. However, after controlling for depression and anxiety, individuals no longer differed on trait anger. Also, anger-in was the strongest predictor of headache. The current findings suggest that holding anger in is more common among headache sufferers. Given recent findings regarding the negative effect of holding anger in among persons with pain conditions, this may be an important factor to evaluate when considering psychological/emotional factors affecting headache.

Hostility disturbs learning.

Many studies have shown that there is a strong correlation between hostility and coronary artery disease; however, the pathogenic mechanisms by which hostility causes coronary artery disease have not been identified. Several studies have shown that hostility is associated with increased cardiovascular reactivity to mental stress. Sloan and colleagues used mental arithmetic and the Stroop Color-Word Task as psychological stressors and suggested that hostility is associated with diminished cardiac vagal control. It is supposed that the diminished cardiac vagal control results in uncontrollability of increased heart rate under stressful conditions so performance on mental stress tasks is poor. However, performance was not analyzed on the Stroop Color-Word Task. If hostility influences the autonomic nervous system, the performance of this mental stress task may also differ according to extent of hostility. In the present study, whether hostility disturbed performance of a mental stress task and the practice on it was examined. Subjects completed the Cook-Medley Hostility Scale and were divided into three groups (High, Middle, and Low) by their total scores and three subscales (Cynicism, Hostile Affect, and Aggressive Responding). They also completed the Stroop Color-Word Task. Analysis showed practice by High and Middle scoring groups on Aggressive Responding had a significantly smaller effect than that by Low scoring groups. The pathogenic mechanisms by which hostility may underlie coronary artery disease were discussed.

Healthy high-hostiles: reduced parasympathetic activity and decreased sympathovagal flexibility during negative emotional processing

This study was designed to assess the physiological impact of processing neutral, positive, and negative emotional stimuli among a group of low- and high-hostile individuals. Advances were made by (1) measuring both reactivity and recovery to mood induction and (2) using Heart Rate Variability (HRV) to more specifically quantify sympathovagal (Low Frequency divided by High Frequency power, or LF/HF, within the HRV power spectrum) and parasympathetic arousal (Respiratory Sinus Arrhythmia; RSA) at the myocardium. In the present study, men and women were equally divided into low- (N=30) and high-hostile (N=30) groups based on their scores on the Cook–Medley Hostility Scale. Electrocardiogram data were collected before, during, and after being given the negative, positive, or neutral version of the Affective Auditory Verbal Learning Test (AAVL). Results indicate that high-hostiles had reduced parasympathetic activity relative to low-hostiles, as measured by RSA. Moreover, relative to low-hostiles, high-hostile participants evidenced reduced sympathovagal reactivity and recovery to the negative AAVL. Results are discussed in terms of their potential value in understanding risk factors for coronary heart disease.

INVESTIGATION OF THE LATERALITY OF HOSTILITY, CARDIOVASCULAR REGULATION, AND AUDITORY RECOGNITION

This experiment tested a hypothesis linking the right cerebral regulation of hostility and cardiovascular arousal. First, replication of previous research supporting heightened cardiovascular (systolic blood pressure [SBP] and diastolic blood pressure [DBP]) reactivity among high hostile participants was partially successful. Second, dynamic variations in functional cerebral asymmetry in response to emotional linguistic processing was measured. Thirty low- and high-hostile, undergraduate volunteer participants (n = 30) were identified using the Cook Medley Hostility Scale (CMHS). Only healthy, right-handed male participants completed the experiment. All participants completed the negative affective auditory verbal learning test (AAVLT). Cardiovascular measures (SBP and DBP) were recorded and dichotic listening procedures were administered before and after the cognitive affective stressor. The results support greater left cerebral activation among both groups following the dichotic phoneme listening tasks and greater right cerebral activation among both groups following an emotional linguistic (affective verbal learning) cognitive stressor.

The Aggression Questionnaire: a validation study in student samples.

The goal of this study was to examine the psychometric properties of the Aggression Questionnaire (AQ) in Spain. The AQ is a 29-item instrument designed to measure the different dimensions of the hostility/anger/aggression construct. It consists of 4 subscales that assess: (a) anger, (b) hostility, (c) verbal aggression, and (d) physical aggression. In Study 1, reliability, construct validity, and convergent validity were evaluated in a group of 384 male and female university students. Test-retest reliability was evaluated using a group of 154 male and female university students. The results of the factor analysis were similar to the scale structure claimed for this instrument. The subscales also showed internal consistency and stability over time. The AQ and its subscales were also compared with the scales and subscales of the Spielberger State-Trait Anger Expression Inventory (STAXI), the Cook-Medley Hostility Scale (Ho), the Buss-Durkee Hostility Inventory (BDHI), and the Jenkins Activity Survey-Form H (JASE-H). The results show that the AQ evaluates some aspects of anger, such as Anger-Trait and Anger-Out, rather than other elements, such as Anger-In or Anger-State. In Study 2, two new male groups were used to evaluate the criterion validity of the AQ: 57 prison inmates and 93 university students, finding that this instrument discriminated between the scores obtained by common offenders and university students.

Hostility, race, and glucose metabolism in nondiabetic individuals.

The present study was designed to determine whether hostility is differentially related to measures of glucose metabolism in African-Americans and Caucasians. The relationship of hostility, as measured by a subset of the Cook-Medley hostility scale (CMHOST) inventory items, to various parameters of glucose metabolism were examined in a young, healthy sample of male and female African-American and Caucasian volunteers. Fasting blood samples were collected during an inpatient admission, at which time the CMHOST was also administered. In the entire sample, the CMHOST was found to be significantly correlated with fasting glucose and insulin sensitivity, as measured by the homeostatic model assessment (HOMA). However, the relationship of hostility to these parameters of glucose metabolism was different in African-American and Caucasian subjects. Hostility was significantly related to fasting glucose in African-Americans and to insulin sensitivity and fasting insulin in Caucasian subjects. The relationship of hostility to insulin sensitivity and fasting insulin was partially dependent on BMI in Caucasians, but the relationship of hostility to fasting glucose was unrelated to BMI in African-Americans. Our data suggest that the relationship of hostility to measures of glucose metabolism is mediated differently in these two ethnic groups. Therefore, hostility seems to be part of a constellation of risk-related behaviors related to BMI in Caucasians but independently related to fasting glucose in African-Americans.

ASYMMETRY IN HAND GRIP STRENGTH AND FATIGUE IN LOW- AND HIGH-HOSTILE MEN

The present study examined the relationship between hostility level and cerebral hemispheric motor functioning of 70 left cerebral dominant men. Using the Cook-Medley Hostility Scale, the subject group was divided into thirds: One-third (N = 23) were classified as low-hostile, one-third (N = 23) were classified as high-hostile, and the remainder (N = 24) were excluded from analysis. A hand dynamometer was used to assess hand grip strength, perseveration, and fatigue, as measures of hemispheric motor functioning. Results yielded a hand-by-hostility group interaction, which indicated that high-hostile men evidenced sig nificantly less hand grip strength at the right hand and significantly greater hand grip strength at the left hand relative to low-hostile men. These results suggest that high-hostile men may experience relatively greater right-cerebral arousal relative to their low-hostile counterparts. In other results, both groups showed greater perseveration at the left hand than at the right hand. Both groups also showed significant fatigue across trials at both hands. Analysis also revealed a hand-by-trial interaction, indicating that the right hand fatigued more quickly than the left hand across trials. Resistance to fatigue at the left hand and overestimation or relative imprecision in motor movement at the left hand are discussed in terms of arousal theory. These results and others are cited as contributing inroads into distinguishing between the emotional problems of depression, anxiety, and hostility.

HOSTILITY AS A MODERATOR OF PHYSICAL REACTIVITY AND RECOVERY TO STRESS

This experiment was designed to assess differences in physiological reactivity and recovery to stress among low- and high-hostile men. Specifically, 25 low- and 25 high-hostile undergraduates were identified using the Cook-Medley Hostility Scale (Cook & Medley, 1954). To ensure homogeneity, all subjects were right-handed and had a general right hemibody preference, as indicated by a score of +7 or higher on the Coren, Porac, and Duncan Laterality Test (Corer, Porac, & Duncan, 1979). All subjects underwent a traditional cold-pressor stressor test. Physiological measures heart rate, systolic blood pressure, and diastolic blood pressure were recorded before the stressor (Prestress), after the stressor (Poststress), and then again 9 min later (Recovery). Increased physiological arousal between pre- and poststress measurements was used as an indicator of reactivity. Subsequent decreases in physiological arousal were used as recover measures. Given the current models of negative emotion and hostility, it was expected that high-hostiles, relative to low-hostiles, would evidence increased physio logical arousal and decreased recovery to stress. Interestingly, high-hostiles experienced significantly greater reactivity to stress in heart rate only, and no group differences were found with regard to recovery. Results are discussed in terms of previous research and current models of emotion.

Hostility explains some of the discrepancy between daytime ambulatory and clinic blood pressure.

The authors examined whether hostility explained the discrepancy commonly observed between clinic and daytime ambulatory blood pressures. Daytime ambulatory blood pressure (DABP) was assessed every 45 min over 6 days in healthy adults (N = 120). After controlling for demographic variables, time-varying covariates such as position and activity level, and clinic blood pressure (CBP), the Cook-Medley Hostility Scale was significantly associated with daytime ambulatory diastolic blood pressure. No support was obtained for mediation by psychological factors. Discrepancies between DABP and CBP may be due, in part, to differences in the degree to which these 2 types of measures are associated with individual differences in hostility. These results suggest that the addition of hostility to CBP may improve its predictive power.

Hostility, the metabolic syndrome, and incident coronary heart disease.

This invesgation examined the impact of hostility and the metabolic syndrome on coronary heart disease (CHD) using prospective data from the Normative Aging Study. Seven hundred seventy-four older, unmedicated men free of cardiovascular disease were included in the study. The total Cook-Medley Hostility (Ho) Scale score, anthropometric data, serum lipids, fasting insulin concentrations, blood pressure, cigarette smoking, alcohol consumption, and total dietary calories were used to predict incident CHD during a 3-year follow-up interval. Multivariate analysis indicated that only Ho positively predicted and high-density lipoprotein cholesterol level negatively predicted incident CHD. Ho's effects on CHD may be mediated though mechanisms other than factors that constitute the metabolic syndrome.

Hostility, the metabolic syndrome, and incident coronary heart disease.

This invesgation examined the impact of hostility and the metabolic syndrome on coronary heart disease (CHD) using prospective data from the Normative Aging Study. Seven hundred seventy-four older, unmedicated men free of cardiovascular disease were included in the study. The total Cook-Medley Hostility (Ho) Scale score, anthropometric data, serum lipids, fasting insulin concentrations, blood pressure, cigarette smoking, alcohol consumption, and total dietary calories were used to predict incident CHD during a 3-year follow-up interval. Multivariate analysis indicated that only Ho positively predicted and high-density lipoprotein cholesterol level negatively predicted incident CHD. Ho's effects on CHD may be mediated though mechanisms other than factors that constitute the metabolic syndrome.

Meyer Friedman, MD

Meyer Friedman, MD, died at the University of California Medical Center in San Francisco on Friday, April 27, 2001⇓. He was 90 years of age. After earning his undergraduate degree at Yale University (New Haven, Conn) in 1931, he obtained his doctorate in medicine at the Johns Hopkins University (Baltimore, Md) in 1935. During a research career that spanned 62 years, he served first as director of the Harold Brunn Institute for Cardiovascular Research in San Francisco (1939 to 1984), then as director of the Meyer Friedman Institute (San Francisco), which was founded in his honor in 1984. He published 542 articles in peer-reviewed journals, as well as 5 books. Friedman was the first to show that cholesterol was absorbed by the lymphatic vessels of the distal ileum. He discovered further that the liver esterifies this cholesterol, providing it with an envelope composed of a protein, a phosphatide, and triglycerides, and that in the absence of dietary cholesterol, …

The Relationship between Hostility and Behavioral Risk Factors for Poor Health in Women Veterans

Background. While previous research has generally supported a relationship between hostility and health risk behaviors, the majority of this research has been conducted in predominately male, highly educated, Caucasian samples. The current study was designed to further examine the relationship between hostility and health risk behaviors in a sample of women.Methods. Measures of health risk behavior and scores from the Cook-Medley hostility scale were obtained from 409 women veterans. Linear and logistic regression analyses were used to examine the relationship between hostility and health behaviors including tobacco smoking, alcohol use, body-mass index, caffeine use, and level of physical activity, after sociodemographic factors were accounted for.Results. In a cohort of women veterans using VA health care, ages 35–81, hostility was significantly associated with tobacco smoking (OR = 2.10; 95% CI = 1.34 to 3.30), caffeine use (OR = 2.12; 95% CI = 1.16 to 3.85), and the number of alcoholic beverages consumed by women who drink alcohol. Hostility was not associated with body mass index (OR = 1.15; 95% CI = 0.77 to 1.72) or a lack of physical exercise (OR = 0.89; 95% CI = 0.55 to 1.43).Conclusions. Results are generally consistent with previous research and support the relationship between hostility and health risk behaviors. Awareness that hostility contributes to risk behaviors and disease may help in the design of interventions aimed at risk reduction.

U-curved relation between total fasting serum cholesterol and hostility: A population-based study

Some researchers have found higher cholesterol levels linearly related to hostility, whereas others have found no relation. Even so, it remains unclear whether research should seek to find a linear relation between hostility and cholesterol levels. We hypothesized that a U-curved association was the proper test of the relation between hostility and cholesterol. Total fasting and low-density lipoprotein (LDL) cholesterol levels were collected from a population-based sample of 2,306 Canadians. Barefoot’s (1989) scoring of the Cook-Medley Hostility Scale was used to assess hostility levels. Both a linear and a U-curved relation among hostility scores, fasting total, and LDL cholesterol levels were significant. Participants with low and high cholesterol levels had significantly higher hostility scores than the normal cholesterol group. A U-curved relation between hostility and serum cholesterol levels may be a more appropriate function to consider given the all-cause mortality findings we seek to explain.