Content uploaded by Usha Sharma
Author content
All content in this area was uploaded by Usha Sharma on May 27, 2021
Content may be subject to copyright.
Research Paper
The International Journal of Indian Psychology
ISSN 2348-5396 (Online) | ISSN: 2349-3429 (Print)
Volume 9, Issue 2, April- June, 2021
DIP: 18.01.052.20210902, DOI: 10.25215.0902.052
http://www.ijip.in
© 2021, Sharma U.; licensee IJIP. This is an Open Access Research distributed under the terms of the Creative
Commons Attribution License (www.creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any Medium, provided the original work is properly cited.
Comparative study of Anger Expression Styles and Optimism in
Hypertensive and Non-Hypertensive Women
Dr. Usha Sharma
1
*
ABSTRACT
A growing body of research have reported adverse health impact on women having
hypertension. The anger expression styles have prominent role in developing hypertension in
women. Also, studies have shown the role of optimism in preventing from developing
hypertension. The present study compared hypertensive and non-hypertensive women within
the age range of 45-60 years. The sample composed of 200 females i.e. (100 hypertensive and
100 non hypertensive), the sample was further divided in to 50 each (working and non-
working women having hypertension and without hypertension). Result analyses revealed
that the women having hypertension reported anger experienced and expression style as
compared to women having non hypertension. Further, discussion and conclusion were
discussed in the paper.
Keywords: Anger Expression Styles, Optimism, Hypertensive, Non-Hypertensive
he most acceptable definition of health is given by the WHO: Health is the state of
complete physical, mental, social and spiritual well-being, and not merely an absence
of disease or infirmity. Ottawa Charter for Health Promotion (1986) has defined
health as “a resource for everyday life, not the objective of living. Health is a positive
concept emphasizing social and personal resources, as well as physical capacities.” (Yadava,
Hooda & Sharma, 2012).
The eternal urge of mankind has been to attain good health. Today, the very face of health
and illness has undergone a tremendous change. In the early 1900’s, mortality and morbidity
was due to external pathogens causing infections. Advances in medical knowledge have
controlled these bacterial diseases and viral infections by and large. In the modern times,
people have died or exhibit disability/morbidity because of lifestyle diseases. A white paper
released by CII and academia, by Sushma Dey (2015) revealed that one out of four Indians
has been at risk of dying from non-communicable diseases like diabetes, hypertension,
cardiovascular ailments or cancer before the age of 70. Every year, roughly 5.8 million
Indians.
1
Assistant Professor, Amity Institute of Psychology and Allied Sciences, Amity university, Noida, India
*Corresponding Author
Received: March 24, 2021; Revision Received: April 17, 2021; Accepted: May 10, 2021
T
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 501
Women with hypertension have been found at significant increased risk for heart attack,
stroke, and kidney disease (James et al., 2014). Risk increases linearly with systolic and
diastolic blood pressure, even small increase in systolic and diastolic pressures have been
associated with higher risk of morbidity and mortality. Hypertension has been considered to
be highly preventable with dietary patterns, lifestyle modifications and pharmacological
treatments (Forman, Stampfer & Curhan, 2009). However, despite extensive knowledge of
etiology and the availability of effective treatments, the prevalence of hypertension in
women aged 18–39 years has increased nearly one-third since the mid-1990s and is expected
to increase upto seven percent (Tu, Chen & Lipscombe, 2008).
Manorenj et al. (2017) in a cross-sectional study reported that cardiovascular disease
especially stroke was the leading cause of death among women. Manorenj and associates
studied the prevalence, patterns, risk factors and outcome of stroke in women. The sample
was collected from ESIC Super speciality hospital of Hyderabad (India) which comprised of
thirty-one females having stroke. The patients were identified over a period of three months
and data was collected on the basis of clinical proforma developed for the purpose. Results
revealed that stroke was predominant among older women. Menopause was the predominant
risk factor followed by hypertension, dyslipidemia, physical inactivity and diabetes in
females respectively. When compared to males, women were found to be more disabled
after stroke. Thus, Stroke was common in older women and ischemic stroke was the
predominate type of stroke. Age was found to be an important non-modifiable risk factor for
stroke. Also, Physical inactivity was the significant risk factor in women when compared to
men. Women were more likely to be disabled after stroke than men.
A strong correlation between increased hypertension and changing lifestyle factors has been
reported. The problem which lies with the hypertension is that it cannot be cured completely
and its management requires lifelong medication with some lifestyle modifications.
Decreased physical activities coupled with increased mental tension are important
contributors of hypertension. A study conducted by Dudhani and Khandekar (2017) on
prevalence of hypertension and risk factors among Government Gazetted officers of
Maharashtra, India. Study was carried among gazetted officers working in various
departments of state government for a period of one year in Solapur district. 355 Gazetted
government officers of class I & class II cadre (both males and females) were studied. Blood
pressure was measured with a standard mercury sphygmomanometer. The prevalence of
hypertension among Gazetted officers was observed 20.28%. The significant positive
association was found between age and prevalence of hypertension. Both men and women
reported same associations.
Anger is a basic emotion that can be defined as a negative feeling state associated with
specific cognitive appraisals, physiological changes and action tendencies (Kassinove &
Sukhodolsky, 1995). Anger has many facets which affect the body equally, but are different
in nature and expression. According to Spielberger (1999) experience of anger can be
conceptualized as consisting of two main components, known as “state anger” and “trait
anger.” State anger is defined as a psychobiological emotional state or a condition
characterized by subjective feelings that vary in intensity from mild irritation or annoyance
to intense rage. Anger in the psychobiological emotional framework is usually accompanied
by muscular tension as well as by the arousal of the neuroendocrine and autonomic nervous
systems. As time progresses, the intensity of state anger varies as a function of such things
as perceived injustice, being treated unfairly or attacked, or frustration as a result of barriers
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 502
to goals. Trait anger is defined in terms of “individual differences in the disposition to
perceive a wide range of situations as annoying or frustrating and by the tendency to respond
to such situations with elevations in state anger.”
Speilberger (1988) distinguished between the three modes of Anger expression styles: Anger
out, Anger in and Anger control. Anger-out refers to the frequency with which a person
expresses angry feelings toward other people or objects in the environment in the forms of
verbal or aggressive behaviors. Anger-in or suppressed anger refers to the tendency to hold
one’s anger on the inside without any outlet. Anger control measures the frequency of
attempting to control the expression of anger by an individual. It refers to the tendency to
engage in behaviors intended to reduce overt anger expression (Sinclair, Czech, Joyner &
Munkasy, 2006; Mushtaq & Najam, 2015).
Optimism is an explanatory style that attributes positive events to internal permanent and
pervasive causes and negative events to external, temporary and situation specific ones.
Oxford English Dictionary defined optimism as having “hopefulness and confidence about
the future or successful outcome of something; a tendency to take a favorable or hopeful
view.” (Yadava, Hooda & Sharma, 2012).
Research has found that there are two forms associated with the Unrealistic optimism and
Unrealistic pessimism. Unrealistic optimism or optimistic bias, is defined as a tendency for
people to believe that they are more likely to experience positive events and less likely to
experience positive events, then similar others. The opposite tendency of believing that
positive events are less likely to happen to self than to others, and that negative events are
more likely to happen to self than to others is called unrealistic pessimism or pessimistic
bias (Weinstein, 1980).
The present study assumes a lot of relevance as previous research suggests that hypertension
is more harmful for women. According to the latest research (World Health Organization,
2013) hypertension was found to be more dangerous for women than men. Thus, the
primary aim of the present investigation was to compare Hypertensive and Non-
Hypertensive Women on Optimism, State Anger, Trait Anger; Anger Expression Styles viz.
Anger In, Anger Out and Anger Control, Perceived Health Status and Perceived Happiness
Status.
METHODOLOGY
The sample comprised of 200 Women i.e. 100 hypertensive (50 working and 50 non-
working) and 100 non-hypertensive (50 working and 50 non-working). The sample was
selected from outpatient departments of government and private hospitals of Chandigarh,
Mohali and Panchkula. The Non-hypertensive women were chosen randomly from various
parts of Chandigarh, Mohali and Panchkula. The four groups of women viz. hypertensive
working women, hypertensive non-working women, non-hypertensive working women and
non-hypertensive non-working women were administered tests to assess Optimism, Anger
Experienced and Anger Expression Styles, Perceived Health Status and Perceived Happiness
Status.
Sample
The sample of the investigation comprised of 200 women i.e. 100 hypertensive women 50
working and 50 non-working) and 100 non-hypertensive (50 working and 50 non-working).
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 503
Subjects were in the age range of 45-60 years. The hypertensive patients with confirmed
diagnosis of hypertension were collected from OPD’s of government and private hospitals
of Chandigarh, Mohali and Panchkula.
The Non-Hypertensive groups were without a history of any kind of disease and randomly
selected from Chandigarh, Mohali and Panchkula. Care was taken to select the sample from
middle socio-economic group.
All the subjects were explained about the nature and aim of the study and their role in the
study. Informed consent was obtained before they were enlisted as subjects in the study.
Care was taken that the sample comprising of hypertensive and non-hypertensive women
were homogeneous with respect to socio-economic status, age and educational background.
Inclusion Criteria
1. Only those hypertensive patients were included who had the disease for at least 5
years.
2. The hypertensive women with confirmed diagnosis were included.
3. Non hypertensive groups without any history of any kind of disease were included.
4. Working women from different work domains like administration, teaching,
medicine and banking sectors were included.
5. Only married women were included.
6. Subjects included were educated at least up to 10+2 level.
7. Sample was taken from middle socio-economic status to maintain homogeneity in
the sample. The middle socioeconomic group was identified on the basis of annual
income, which was supposed to be 2 to 5 lakh per annum (India’s National Council
of Applied Economic Research, 2011).
8. Sample was confined to those residing in urban areas only.
Exclusion Criteria
Those respondents who had any co-morbid chronic illnesses other than hypertension were
excluded from the sample.
Ethical Considerations
1. Informed consent of the participants was obtained.
2. The confidentiality of the information given by the participants was ensured.
Tests and Tools
The following standardized tests were used for the present investigation:
1. Life Orientation Test (Scheier, Cohen & Bridges 1994; Carver, 2013).
2. The State-Trait Anger Expression Inventory (Speilberger, 1988).
A general information schedule was also administered to the respondents for getting
demographic information on the following dimensions: name, age, education level, financial
status, height, weight, size of family, birth order, number of siblings, profession of self and
profession of spouse.
LIFE ORIENTATION TEST-REVISED (SCHEIER, CARVER & BRIDGES, 1994;
CARVER, 2013): The Life Orientation Test-Revised (LOT-R) (Scheier, Carver &
Bridges, 1994) was utilized to measure optimism and pessimism. The Life Orientation Test-
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 504
R consists of 10 coded items, 3 statements described in a positive manner, 3 statements
described in a negative manner, and 4 non-scored items. Subjects responded to the
statements by indicating the extent of their agreement along a 5-point Likert scale, ranging
from "strongly agree" to "strongly disagree." The Life Orientation Test–Revised measures
optimism and contains 6 items. Item ratings are summed up to yield a total score that ranges
from 6 to 30 (higher scores indicate greater optimism, and lower scores indicate greater
pessimism). Sample questionnaire items were as follows: “In unclear times, I usually expect
the best”; “If something can go wrong for me, it will.” The internal reliability (Cronbach'a
alpha=.78) and test-retest reliability (r=.68 over a four-week interval, r=.60 over twelve
months, r=.56 over twenty-four months, and r =.79 over twenty-eight months) for the
unidimensional use of the Life Orientation Test-R has been shown to be adequate.
SPEILBERGER’S STATE TRAIT ANGER EXPRESSION INVENTORY (STAXI)
(SPEILBERGER, 1988): This is a self-rating questionnaire. There are 44 questions in a 3
part questionnaire and it requires 15-20 minutes to complete. It assesses self-reported
feelings (experiences) of anger and its expression. It has 10 items to assess State Anger (how
you feel right now). The subject chooses from the response format. (1) Almost never (2)
Sometimes (3) Often (4) Almost always. It also has 10 questions to measure Trait anger
(how you generally feel) and four response options: (1) Almost never (2) Sometimes (3)
Often (4) Almost always. The range of possible scores for the two subscales varies from
minimum of 10 to maximum of 40.The third part has 24 question measuring three
dimensions of Anger Expression viz. Anger Out, Anger In, Anger Control. Anger Out,
Anger In and Anger Control subscales are computed by summing the column of item scores
for each scale. The range of possible scores for three subscales varies from a minimum of 8
to maximum of 32. A total of Anger Expression Score is obtained by the formula:
Anger Expression= Anger Out+ Anger In – Anger control + 16(a constant of 16 is added).
Hypotheses
• Hypertensive Women were expected to score higher than Non- Hypertensive Women
on State Anger, Trait Anger, Anger In, Anger Out, Total Anger Expressed and Anger
Rumination.
• Hypertensive Women were expected to score lower than Non- Hypertensive Women
on Anger Control.
• Hypertensive Women were expected to score lower than Non-Hypertensive Women
on Optimism and Perceived Happiness Status.
• Working and Non-Working women both groups were expected to differ on measured
variables viz. Anger Experienced, Anger Expression Styles and Optimism
Procedure
All the respondents for the testing sessions were contacted personally and requested to
volunteer for the testing schedule. These respondents were then given the questionnaire in
the form of a booklet and were requested to respond to them truthfully according to the
given instructions. They were assured that the information they provide about themselves
and their results will be kept strictly confidential and will be used for research purpose only.
The testing schedule was started by firstly asking the participants to fill the form comprising
of general information. Then groups of hypertensive and non-hypertensive women with and
without hypertension were identified. Selected subjects were given a booklet of
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 505
questionnaires for detailed analysis to find the factors affecting hypertension among working
and non-working women. The booklet of questionnaires was administered to a sample of
200 women. The respondents were from Chandigarh, Panchkula and Mohali. All the
respondents were given instructions for each questionnaire as specified in the respective
manuals, as follows:
RESULTS
The raw scores were analysed using appropriate statistical analyses viz. Descriptive
Statistics, t-test and 2 X 2 ANOVA.
t-ratios
t-ratios were calculated to find out significant differences between means of various groups
on the measured variables. Table 1.1 shows means, standard deviations and t- ratios
comparing Hypertensive and Non-Hypertensive Women. The comparison revealed the
following t-ratios to be significant. Hypertensive women scored higher than non-
hypertensive women on State Anger (t= 2.84, p< .01), Trait Anger (t= 3.03, p< .01), Anger
In (t= 4.53, p< .01), Anger Out (t= 2.62, p<.01), Total Anger Expressed (t= 4.68, p< .01).
Non-hypertensive women scored higher than hypertensive women on Optimism (t=
8.80, p< .01) and Anger Control (t = 2.96, p< .01).
Table 1.2 shows means, standard deviations and t- ratios comparing Hypertensive and
Non-Hypertensive Working and Non-Working Women. The comparison revealed the
following t-ratios to be significant. Working women scored higher than non-working
women on Anger In (t= 2.13, p< .05), Anger Out (t=1.99, p<.05). Non-working women
scored higher than working women on State Anger (t= 2.80, p<.01).
Table 1.1 Means, Standard Deviations and t-ratios comparing Hypertensive and Non-
Hypertensive Women
Sr. No.
Variables
Hypertensive
Women
(n=100)
Non-Hypertensive
Women
(n=100)
t-ratios
Mean
SD
Mean
SD
1
Optimism
11.99
2.34
15.30
2.94
8.80
2
State Anger
15.74
4.56
13.85
4.87
2.84
3
Trait Anger
21.82
5.25
19.71
4.59
3.03
4
Anger In
17.88
3.62
15.58
3.52
4.53
5
Anger Out
16.98
3.92
15.69
2.96
2.62
6
Anger Control
20.92
4.38
22.91
5.09
2.96
7
Total Anger Expressed
29.84
8.01
24.57
7.91
4.68
* t-value significant at .05 Level = 1.97
** t-value significant at .01 Level = 2.60
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 506
Table 1.2 Means, Standard Deviations and t-ratios comparing Working and Non-Working
Women
Sr. No.
Variables
Working Women
(n=100)
Non-Working Women
(n=100)
t-ratios
Mean
SD
Mean
SD
1
Optimism
13.72
2.87
13.57
3.38
0.34
2
State Anger
13.86
3.87
15.73
5.43
2.80
3
Trait Anger
21.13
4.88
20.40
5.17
1.03
4
Anger In
17.29
3.81
16.17
3.62
2.13
5
Anger Out
16.83
3.08
15.84
3.88
1.99
6
Anger Control
22.03
5.05
21.80
4.64
0.34
7
Total Anger Expressed
28.19
7.82
26.22
8.81
1.67
* t-value significant at .05 Level = 1.97
** t-value significant at .01 Level = 2.60
Analysis of Variance (ANOVA)
Analysis of variance was conducted on women with health status and work status as
independent variables. 2x2 ANOVA was employed with two levels of Health Status viz.
Hypertensive and Non-Hypertensive Women and two levels of Work Status viz. Working
and Non-Working Women. The effect of these two variables was singly and jointly analyzed
for all the variables.
Analysis of variance for the variable Optimism (Table 2.1) revealed that F-ratio for health
status (F= 77.48, p ≤ .01) emerged to be highly significant. F-ratios for work status and the
interaction effect emerged to be insignificant.
Analysis of variance for the variable State Anger (Table 2.2) revealed that F-ratios for
health status (F= 8.43, p ≤ .01), work status (F=8.25, p ≤ .01) emerged to be highly
significant. F-ratio for the interaction effect was found to be insignificant.
Analysis of variance for the variable Trait Anger (Table 2.3) revealed that F-ratio for
health status (F= 9.20, p ≤ .01) emerged to be significant. F-ratios for work status and the
interaction effect emerged to be insignificant.
Analysis of variance for the variable Anger In (Table 2.4) revealed that F-ratios for health
status (F= 21.14, p ≤ .01), work status (F=5.01, p ≤ .05) emerged to be significant. The F-
ratio for the interaction effect was found to be insignificant.
Analysis of variance for the variable Anger Out (Table 2.5) revealed that F-ratios for health
status (F= 6.97, p ≤ .01), work status (F=4.10, p ≤ .05) emerged to be significant. F-ratio for
the interaction effect emerged to be insignificant.
Analysis of variance for the variable Anger Control (Table 2.6) revealed that F-ratio for
health status (F= 8.76, p ≤ .01) emerged to be highly significant. F-ratios for work status and
the interaction effect were found to be insignificant.
Analysis of variance for the variable Total Anger Expressed (Table 2.7) revealed that F-
ratio for health status (F= 22.08, p ≤ .01) emerged to be highly significant. F-ratios for the
work status and the interaction effect emerged to be insignificant.
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 507
Table 2.1 Analysis of Variance of Optimism
Sources of Variance
Sum of
Squares
df
Mean Sum of
Squares
F-
Value
Significance
Level
Health Status
55.81
1
53.81
77.48
.00
Work Status
1.13
1
1.13
0.16
ns
Health Status X Work Status
13.01
1
13.01
1.84
ns
Within Treatment
14.86
196
7.07
Total
19.79
199
Table 2.2 Analysis of Variance of State Anger
Sources of Variance
Sum of
Squares
df
Mean Sum of
Squares
F-
Value
Significance
Level
Health Status
18.61
1
18.61
8.43
.00
Work Status
17.85
1
17.85
8.25
.01
Health Status X Work Status
70.81
1
70.81
3.34
ns
Within Treatment
42.34
196
21.20
Total
46.60
199
Table 2.3 Analysis of Variance of Trait Anger
Sources of Variance
Sum of
Squares
df
Mean Sum of
Squares
F-
Value
Significance
Level
Health Status
22.61
1
22.61
9.20
.00
Work Status
26.65
1
26.65
1.10
ns
Health Status X Work Status
41.41
1
41.41
1.71
ns
Within Treatment
47.30
196
24.19
Total
50.96
199
Table 2.4 Analysis of Variance of Anger In
Sources of Variance
Sum of
Squares
df
Mean Sum of
Squares
F-
Value
Significance
Level
Health Status
26.50
1
26.50
21.14
.00
Work Status
62.72
1
62.72
5.01
.03
Health Status X Work Status
11.52
1
11.52
0.92
ns
Within Treatment
25.68
196
12.51
Total
28.42
199
Table 2.5 Analysis of Variance of Anger Out
Sources of Variance
Sum of
Squares
df
Mean Sum of
Squares
F-
Value
Significance
Level
Health Status
83.205
1
83.21
6.97
.01
Work Status
49.005
1
49.01
4.10
.04
Health Status X Work Status
4.205
1
4.21
0.35
ns
Within Treatment
2340.140
196
11.94
Total
2476.555
199
Table 2.6 Analysis of Variance of Anger Control
Sources of Variance
Sum of
Squares
df
Mean Sum of
Squares
F-Value
Significance
Level
Health Status
20.01
1
20.01
8.76
.00
Work Status
2.65
1
2.65
0.12
ns
Health Status X Work Status
31.21
1
31.21
1.38
ns
Within Treatment
44.70
196
22.61
Total
47.56
199
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 508
Table 2.7Analysis of Variance of Total Anger Expressed
Sources of Variance
Sum of
Squares
df
Mean Sum of
Squares
F-Value
Significance
Level
Health Status
14.65
1
14.61
22.08
.00
Work Status
19.05
1
19.01
3.09
ns
Health Status X Work Status
25.21
1
25.21
0.40
ns
Within Treatment
12.70
196
62.90
Total
14.60
199
DISCUSSION
India has been experiencing an epidemiological transition and hypertension has emerged as
a major threat to people’s health. Hypertension has turned out to be a significant public
health problem in both urban and rural areas of India. According to the Register General of
India, the prevalence of hypertension in urban and rural populations of India was 25% and
10% respectively (Reports on the cause of deaths in India, 2010). Cardiovascular diseases
such as coronary heart disease and stroke have been the largest cause of deaths in most
developing countries (World Health Organization, 2005). Moreover, Hypertension has been
shown to be directly responsible for 42% of coronary heart disease deaths and 57% of stroke
deaths in India (Gupta, 2006; World Health Organisation, 2014).
There have been many misconceptions about cardiovascular diseases in women. In reality it
affects as many women as men. The risk of cardiovascular disease including hypertension in
women is often underestimated because of the notion that it is a “man’s disease”. Ischemic
heart disease and stroke are the most important causes of death, years of life lost and
disability in women (Lozano et al., 2013).
A glance at t-ratios (Table 1.1) comparing Hypertensive and Non-HypertensiveWomen
revealed that Hypertensive women scored higher on State Anger, Trait Anger, Anger In,
Anger Out, Total Anger Expressed and Anger Rumination than Non-Hypertensive women.
Hypertensive women scored lower than Non-Hypertensive women on Anger Control and
Optimism.
The Analysis of Variance tables (Tables 2.2-2.7) revealed significant F-ratios for State
Anger, Trait Anger, Anger In, Anger Out, Total Anger Expressed and Anger Control. The
mean scores were found to be higher in Hypertensive women on State Anger, Trait Anger,
Anger In, Anger Out and Total Anger Expressed whereas on Anger Control non
hypertensive women were found to higher.
Analysis of Variance table (Table 2.1) revealed the F-ratio to be significant for Optimism.
The mean scores were found to higher for Non-hypertensive women on Optimism.
Thus, the hypotheses were upheld in the case of Optimism. For anger Expression styles,
hypotheses were upheld in the predicted direction. Hypertensive women were found to be
higher on State Anger, Trait Anger, Anger In, Anger Out, Total Anger Expressed and Anger
Rumination. Non hypertensive women were found to be higher on Anger Control.
For working versus non-working women No significant differences emerged on Trait Anger,
Anger Control and Total Anger Expressed in case of working and non-working women.
Also, Working and Non-Working women showed no significant differences on Optimism.
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 509
Thus, the hypotheses were upheld partially for Anger In, Anger Out and State Anger. The
working women were found to be higher on Anger in and Anger Out whereas non-working
women were found to be higher on State Anger.
Many studies done earlier lend support to the present findings for role of Anger
Experienced, Anger Expression styles with hypertension.
In a study by Poverny (2010), women who expressed their anger during work were mostly
viewed as out of control or as difficult people to work with. If a woman becomes angry over
an unreasonable expectation or demand, she has been thought to be of an angry nature or
short tempered. Whereas, a man’s angry reaction to the same event has been attributed to
circumstances outside of himself or beyond his control. This sort of subtle gender
discrimination encourages women to suppress their anger. Consequently, most working
women report an “Anger-In” style, at least at the workplace. Anger is associated with
adverse social, psychological, and physical consequences. Much of the recent empirical
attention devoted to anger suggested a link between anger and the development of physical
disorders, such as heart disease. Physicians have speculated that chronic anger contributes to
illness since the time of Galen; however, systematic data addressing this association were
unavailable until the advent of the behavioral sciences. Females have been found to cry
when angry and to use avoidance, calm discussion, and suppression (Palaparthi & Rani,
2012).
Sadiq and Ali (2014) conducted a study to examine the psychological ill-being in married
working women as a consequence of dual responsibility at home and workplace. A sample
of fifty married working women was compared with fifty married non-working women.
Sample was taken from general population. Data was collected using semi-structured brief
interview form, General Health Questionnaire (ghq-28), Anger and Hostility Subscales of
Aggression questionnaire. Results showed that working women significantly reported more
cases of somatic complaints, social dysfunction, hostility, anger and depression. The dual
responsibility of working women have made them prone to psychological problems and
chronic ailments like heart disease, high blood pressure, type 2 diabetes and cancer.
Mushtaq and Najam (2015) studied the relationship of hypertension with psychological
states of anger, stress and anxiety. The sample comprised of 200 subjects out of which 110
were men and 90 were women having hypertension and the control group comprised of 170
of which 90 were men and 80 were women within the age range of 30-65 years. The
measures used were Spielberger State Trait Anger Expression Inventory (Spielberger, 1988)
and Depression Anxiety Stress Scale (Lovebind & Lovebind, 1995). The logistic regression
analysis was applied and it was found that anger, anxiety and stress acted as the best
predictor contributing to the hypertension. The findings stated that all dimensions of anger
have significant correlation with hypertension. This might be explained as people with
hypertension often experience irrational judgment of reality, low level of frustration
tolerance, unrealistic expectations and face disappointment and helplessness. Moreover,
stress was found to be statistically significant and a strong predictor of hypertension. These
findings are in line with earlier findings which have reported that stress has significant and
positive relationship with hypertension. Job strain model of occupational stress predicts
hypertension on the grounds of an individual’s control over his job and circumstances. In the
presence of uncontrollable job demands and pressures from the superiors often lead the
individual insurmountable stress and ultimately becomes hypertensive (Flaa, Eide, Kjeldsen
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 510
& Rostrup, 2008). Thus, the findings of this research have suggestions for understanding the
role of emotional and psychological condition of individual in developing hypertension and
in introducing effective preventive measures for the prevalence of hypertension.
A study was conducted by Shankarrao (2016) on psychological well-being and emotional
maturity among working and non-working women. The sample comprised of 240 women
(120 working and 120 non-working women). The measures used were Ryff’s Psychological
Well-Being Scale (Ryff, 1995) and Emotional maturity Scale by Singh and Bhargava
(1999). Results revealed that working women were significantly higher on having positive
attitude towards oneself (being optimistic), sense of self-determination, independence,
freedom, having life goals, ability to manage life and being open to new experiences as
compared to non-working women. Thus, it was found that working women had better
psychological well-being, having positive attitude and were happier than non-working
women.
Moxoto and Malagris (2015) investigated the differences between hypertensive and
normotensives on anger expression and stress. 112 subjects (56 hypertensives and 56
normotensives) who were not homogeneous with respect to educational level, gender and
age formed the sample. The measures used were Lipp’s Inventory of Stress Symptoms
(Lipp,2000) and the State Trait Anger Expression Inventory by Spielberger, (1988). It was
found that hypertensive participants were more likely to suppress their anger (anger in) and
were more stressed as compared to normotensives. By frequently suppressing anger, the
individuals with hypertension often fail to make the claim of their own rights, defense of
their opinions and desires. The inhibiting of emotions has an immediate protective effect in
people with hypertension, and thus the search for adaptive expression for these emotions
through psychological interventions must be taken into account. Other way to understand the
emotional factors associated with hypertension, such as stress and anger, is the
understanding of the concept of cardiovascular reactivity, which refers to changes in blood
pressure or heart rate due to specific stimuli. Though the general tendency of most people is
to demonstrate cardiovascular reactivity in the form of blood pressure elevations facing
stressful situations, individuals with hypertension are at higher elevations and more frequent
than people without this diagnosis in similar situations which are transitory, these increases
do not produce harmful effects in individuals with no tendency to hypertension because the
normal adaptability of arteries allows the recovery of the body without causing cry. There is
also the possibility that the direction of the expression of anger is also influenced by
learning, resulting from observation of parenting styles (Lipp, 2005). Since hypertension has
a strong hereditary component, it is possible that many individuals who have developed
hypertension because of domestic chores where expression is predominant. Thus, it should
be emphasized that clear communication is necessary to promote gratifying and functional
interpersonal relationships, communication failures due to excessive inhibition of anger can
be considered as predictors of deterioration in the quality of life in the social area of the
person with hypertension, including both family and marital contexts, as well as
occupational contexts. This damage is likely to cause stress, which in turn, may intensify
anger. The health of this person will also be affected, because they occur excessively, both
inhibition of anger and stress, can cause elevation of cardiovascular reactivity and increase
the negative impact in the life of the individual having hypertension.
Similarly, Sahrain et al. (2015) studied scores of anger in hypertensive patients in
comparison to individuals without hypertension. The study was conducted on 100
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 511
hypertensive patients and 107 normal controls with the mean age of 52.48. The results
showed that hypertensive group scored higher on anger dimension that is anger in, anger out
and hostile outlook as compared to normal controls. In line with the previous researches, the
study indicated that high level of anger was significantly related to high blood pressure.
Carver and Scheier (2014) found that optimists took a proactive approach to health
promotion. They were less likely to smoke, more likely to exercise, have more healthy diets,
and were more likely to improve their diets than pessimists, which promoted their recovery
from coronary heart disease. Another reason for better health followed from the better
profile of emotional responses to adversity displayed by optimists- less distress and more
positive emotions. This pattern of overall emotional experiences, which followed in part
from the coping reactions that optimists used (Carver, Scheier & Segerstorm, 2010),
doubtlessly resulted in lower physiological strain over time, resulting in better health and
improvement in their blood pressure readings.
Optimism is a psychological trait characterized by positive expectations about future
outcomes. It is a significant predictor of physical health and was associated with enhanced
physical recovery in a number of conditions and procedures such as traumatic brain injury,
lung cancer, breast cancer, heart diseases, hypertension and bone marrow transplant. The
protective effects of optimism have extended to both pain and physical symptom reporting,
and negative associations between optimism and pain have been reported in a number of
chronic illnesses. Post-operative pain reported lower among patients who were higher in
optimism and this association has been demonstrated in patients who have undergone breast
cancer surgery, heart surgery, and knee surgery. Ronaldson et al. (2014) reported that
Optimism was a modest, yet significant, predictor of pain intensity and physical symptom
reporting. Having positive expectations may promote better recovery with cardiovascular
disease. A study by Ronaldson et al. (2014) investigated the association between optimism
and post-operative pain and physical symptoms in coronary artery bypass graft surgery
patients. The subjects comprised of 197 adults undergoing coronary artery bypass graft
surgery surgery. The patients were followed up to 6–8 weeks after the procedure to measure
affective pain, pain intensity and physical symptom reporting directly pertaining to coronary
artery bypass graft surgery. Optimism was measured at baseline using the revised Life
Orientation Test (Scheier & Carver, 1994). The results revealed that more optimistic patients
have less intense pain up to two months after coronary artery bypass graft surgery.
Furthermore, patients who were higher in optimism reported fewer physical symptoms
pertaining to coronary revascularisation. These associations were independent of
demographic and clinical factors. The finding of the study indicated that a more optimistic
disposition predicts less pain and fewer physical symptoms pertaining to coronary
revascularisation approximately two months after coronary artery bypass graft surgery —
the time at which most patients are expected to be able to do most normal activities and
return to work. Therefore, having positive expectations may promote better recovery of the
cardiovascular disease (Sehgal, 2015). In a study by Vaughan, Bushnell, Bell and Espeland
(2016) investigated a sample of women at the time of ischemic stroke. 159 women stroke
survivors were included. Researchers found that higher body mass index, hypertension,
higher physical functions were associated with stroke and women with low optimism had
decreased cognition and poor health recovery.
A large number of studies in the field of hypertension among working versus non-working
women appear to be similar but have different measures and emphasis. That’s why the
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 512
present study investigation gains its significance. Certainly, hypertension is emerging as an
important problem among working women. Therefore, attention has to be paid to train them
to overcome stress and empower them to employ psychosocial medical strategies for fuller
and healthier lifestyle.
The results of the present study emphasize the need to focus greater attention on women
having hypertension. Health professionals must become aware of the female coronary risk
profile as distinct from that of men. Comparisons of rural and urban populations on these
parameters can be an important avenue for further research. Also, international comparisons
may be an important basis for designing prevention programs globally.
The study also provides strong evidence for the detrimental effects of Anger, Stress, Type A
Behavior and Anger Rumination. Thus, there are various programs which should be given to
patients that help them to modify their behavior and promote different ways to enhance
Optimism, Subjective Well Being and Effective Coping among women and consequently
reduce the risk of hypertension.
REFERENCES
Carver, C. S. (2013). Life Orientation Test-Revised. Measurement Instrument Database for
the Social Science. Retrieved from www.midss.ie.
Carver, C. S., & Connor-Smith, J. (2010). Personality and coping. Annual Review of
Psychology, 61, 679-704.
Carver, C. S., & Scheier, M. F. (2014). Dispositional optimism. Trends in Cognitive
Sciences, 18(6), 293-299.
Dudhani, P., & Khandekar, S. (2017). Study on prevalence of hypertension in gazetted
officers. International Journal of Community Medicine & Public Health.
Flaa, A., Eide, I. K., Kjeldsen, S. E., & Rostrup, M. (2008). Sympathoadrenal stress
reactivity is a predictor of future blood pressure an 18-year follow-up
study. Hypertension, 52(2), 336-341.
Forman, J. P., Stampfer, M. J., & Curhan, G. C. (2009). Diet and lifestyle risk factors
associated with incident hypertension in women. Journal of American Medical
Association, 302(4), 401-411.
Gupta, R. (2006). Rethinking diseases of affluence; coronary heart disease in developing
countries. South Asian Journal of Preventive Cardiology, 10(2), 65-78.
India’s National Council of Applied Economic Research. (2011). Calculation based on
national council of applied economic research 2004-2005 and India national sample
survey organization socio economic survey.
James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler,
J., ... & Smith, S. C. (2014). 2014 evidence-based guideline for the management of
high blood pressure in adults: report from the panel members appointed to the Eighth
Joint National Committee (JNC 8). Journal of American Medical
Association, 311(5), 507-520.
Kassinove, H., & Sukhodolsky, D. G. (1995). Anger disorders: Basic science and practice
issues. Issues in Comprehensive Pediatric Nursing, 18(3), 173-205.
Lipp, M. (2005). Stress and Anger Swirling. São Paulo: House of the Psychologist.
Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., ... & AlMazroa,
M. A. (2013). Global and regional mortality from 235 causes of death for 20 age
groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease
Study 2010. The Lancet, 380(9859), 2095-2128.
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 513
Manorenj, S., Inturi, S., Jyotsna, B., Savya, V. S., Areli, D., & Reddy, O. B. (2017).
Prevalence, pattern, risk factors and outcome of stroke in women: a clinical study of
100 cases from a tertiary care center in South India. International Journal of
Research in Medical Sciences, 4(6), 2388-2393.
Moxotó, G. D. F. A., & Malagris, L. E. N. (2015). Anger, Stress and Hypertension: A
Comparative Study. Psicologia: Teoria e Pesquisa, 31(2), 221-227.
Mushtaq, M., & Najam, N. (2015). Hypertension: Does psychological state of an individual
cause to develop?. Professional Medical Journal, 22(2), 215-220.
Mushtaq, M., & Najam, N. (2015). Hypertension: Does psychological state of an individual
cause to develop?. Professional Medical Journal, 22(2), 215-220.
Palaparthi, N., & Rani, D. K. J. (2012). A study on anger expression as a dimension of
workplace emotion. ZENITH International Journal of Multidisciplinary
Research, 2(5), 276-289.
Poverny, L. (2010, January, 14). Anger and the working woman. Retrieved from:
http://completewellbeing.com/article/anger-and-the-working-woman/
Report on Causes of Deaths in India 2001-2003. (2010). New Delhi: Office of the Registrar
General of India, Government of India, 42-5.
Ronaldson, A., Poole, L., Kidd, T., Leigh, E., Jahangiri, M., & Steptoe, A. (2014) Optimism
measured pre-operatively is associated with reduced pain intensity and physical
symptom reporting after coronary artery bypass graft surgery. Journal of
Psychosomatic Research, 77, 278-282.
Sadiq, R., & Ali, A. Z. (2014). Dual responsibility: a contributing factor to psychological ill-
being in married working women. Academic Research International, 5(2), 300-308.
Sahraian, A., Mokhtari, M., Moaref, A., Rezaee, V., Moghimi, E., & Mani, A. (2015).
Hypertensive Patients and Normotensive Individuals: Differences in Anger
Inventory. International Cardivascular Research Journal, 9(4), 216-219.
Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from
neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the
Life Orientation Test. Journal of personality & social psychology, 67(6), 1063.
Sehgal, M. (2015). Excellence in Health: A Multidimensional Perspective. In J. Mohan
(Ed.). Excellence: A Multidimensional Appraisal (pp.160-199). Chandigarh: P.U.
Press.
Shankarrao, K. P. (2016). A study of frustration on psychological well being and emotional
maturity among working and non-working women (Unpublished Doctoral Thesis).
Babasaheb Ambedkar Marathwada University. Aurangabad. Retrieved from
http://hdl.handle.net/10603/101157.
Sinclair, J., Czech, D. R., Joyner, A. B., & Munkasy, B. A. (2006). An exploration stat and
trait anger, anger expression and perfectionism in collegiate springboard divers. The
Sport Journal, 9(2).
Spielberger, C. D. (1988). State-trait anger expression inventory research
edition. Professional manual. Odessa, FL: Psychological Assessment Resources.
Spielberger, C. D. (1988). State-trait anger expression inventory research
edition. Professional manual. Odessa, FL: Psychological Assessment Resources.
Spielberger, C. D. (1999). State-trait anger expression inventory-2. Psychological
Assessment Resouces.
Tu, K., Chen, Z., Lipscombe, L. L., & Canadian Hypertension Education Program
Outcomes Research Taskforce. (2008). Prevalence and incidence of hypertension
from 1995 to 2005: a population-based study. Canadian Medical Association
Journal, 178(11), 1429-1435.
Comparative study of Anger Expression Styles and Optimism in Hypertensive and Non-
Hypertensive Women
© The International Journal of Indian Psychology, ISSN 2348-5396 (e)| ISSN: 2349-3429 (p) | 514
Vaughan, L., Bushnell, C., Bell, C. L., & Espeland, M. A. (2016). Global cognitive function
before, surrounding, and after ischemic stroke: the role of risk and protective factors
varies with time among ischemic stroke survivors. Aging, Neuropsychology &
Cognition, 23(1), 117-131.
Weinstein, N. D. (1980). Unrealistic optimism about future life events. Journal of
Personality and Social Psychology, 39(5), 806-820.
World Health Organisation South East Asia Region. (2013). World health Day. Delhi.
World Health Organization. (2005). Reducing Risks, Promoting Healthy Life.
Geneva.Available from: http://www.who.int/whr/2002/en/whr02_ en.pdf.
World Health Organization. (2014). World Health Statistics 2014. Geneva.
Yadava, A., Hooda, D., & Sharma, N. R. (2012). Positive Capacities as Indicators of Mental
Health. Bio-Psycho Social Issues in Positive Health. Global Vision Publishing
House Delhi. 978-81-8220-491-1.
Acknowledgement
The author(s) appreciates all those who participated in the study and helped to facilitate the
research process.
Conflict of Interest
The author(s) declared no conflict of interest.
How to cite this article: Sharma U. (2021). Comparative study of Anger Expression Styles
and Optimism in Hypertensive and Non-Hypertensive Women. International Journal of
Indian Psychology, 9(2), 500-514. DIP:18.01.052.20210902, DOI:10.25215.0902.052
