Hostility Now, Depression Later? Longitudinal Associations Among Emotional Risk Factors for Coronary Artery Disease

Background/Purpose Given that emotional risk factors for coronary artery disease (CAD) tend to cluster within individuals, surprisingly little is known about how these negative emotions might influence one another over time. We examined the longitudinal associations among measures of depressive symptoms and hostility/anger in a cohort of 296 healthy, older adults. Methods Participants completed the Beck Depression Inventory-II (BDI-II), Cook-Medley Hostility (Ho) scale, and Anger-In and Anger-Out subscales of the State-Trait Anger Expression Inventory at baseline and 6-year followup. We conducted a series of path analyses to evaluate the directionality of the depression-hostility/anger relationship. Results Baseline Ho scale was a predictor of 6-year increases in BDI-II (beta=0.15, p=0.004), Anger-In (beta=0.14, p=0.002), and Anger-Out (beta=0.11, p=0.01). In contrast, baseline BDI-II, Anger-In, and Anger-Out did not predict change in any of the emotional variables. Additional path analytic models revealed that the pattern of relationships was not altered after controlling for demo-graphic, biomedical, and behavioral covariates; anxiety symptoms; social support; and subjective sleep quality. Conclusions The present results suggest that the cognitive aspects of hostility/anger may precede and independently predict future increases in depressive symptoms but not vice versa. Our findings lead us to speculate that (a) hostility may exert part of its cardiotoxic influence by acting to precipitate and/or maintain symptoms of depression and that (b) the potency of depression interventions designed to improve cardiovascular outcomes might be enhanced by incorporating treatments addressing hostility.