Differences in Trait Anger Among Children with Varying Levels of Anger Expression Patterns

Differences in Trait Anger Among Children with Varying Levels of Anger Expression Patterns

Rice, Marti

PROBLEM: Little research has been done with children to determine effects of using various patterns of anger expression on trait anger. The purpose was to examine differences in trait anger of children who indicated high, moderate, or low use of three patterns of anger expression.

METHODS: A convenience sample of 1,060 third through sixth graders completed trait anger and patterns of expressing anger instruments.

FINDINGS: High users of anger-out (anger expressed outioardly) had the highest trait anger for every grade while high users of anger-reflection/control had the lowest.

CONCLUSIONS: Anger-reflection/control may be more effective than anger-out in reducing trait anger in school-age children.

Search terms: Trait anger, patterns of anger expression, children

Trait anger, or the extent of experiencing angry feelings over time, has been identified as a risk factor for the development of disease and is associated with negative health outcomes for both children and adults (Deffenbacher, 1992; Marion, 1994; Schum, Jorgensen, Verhaeghen, Sauro, & Thibodeau, 2003). Among the diseases and symptoms that have been linked to anger are hypertension and cardiovascular disease (Angerer et al, 2000; Harburg, Julius, Kaciroti, Gleiberman, & Schork, 2003; Koh, Choe, & An, 2003; Rosenberg et al., 2001; Smith & Furlong, 1994; Webber, Srinivasan, Wattigney, & Berenson, 1991; Yong & Kuller, 1994), headache (Nicholson, Gramling, Ong, & Buenevar, 2003), cancer (Cohen & Rabin, 1998; Harburg et al., 2003; Thomas et al., 2000), and asthma (Friedman & Booth-Kewley, 1987; Wright, Rodriquez, & Cohen, 1998). In children, more immediate outcomes from high levels of anger include higher diastolic blood pressure (Hauber, Rice, Howell, & Carmon, 1998), higher systolic blood pressure, and greater heart rate (Johnson, 1989; Lawler, Alien, Critcher, & Standard, 1981; Lundberg, 1983) as well as negative social behaviors such as aggressiveness and seeking revenge (Marion, 1994).

Research with adults on ways of expressing anger has noted that methods of anger expression can be either adaptive or maladaptive and more or less effective in the reduction of trait anger (anger that is of a more enduring nature), often noted as the level of experienced anger (Deffenbacher, Demm, & Brandon, 1986; Deffenbacher, Getting, Lynch, & Morris, 1996; Siegman & Snow, 1997; Williams & Williams, 1997). Little research with children has focused on the effects of different methods of expressing anger on trait anger or whether the effects on trait anger differ with age. If the way anger is expressed affects trait anger and trait anger affects health and well-being, it is important for healthcare professionals to determine the effects of various ways or patterns of expressing anger on the level of trait anger. Further, it would be helpful to know if these effects on trait anger change with the age of the child since patterns of expressing anger are established at an early age (Smith & Furlong, 1994).

The purpose of this study was to examine differences in Trait Anger scores of children who indicated high, moderate, or low use of three of the most widely identified patterns of expressing anger: anger-out (anger expressed outwardly), anger-suppression (anger held in), and anger-reflection/control (a more cognitive method of expressing anger) in grades 3, 4, 5, and 6. The data were collected as part of a larger study on selected psychological factors and blood pressure in children. The specific research question addressed was: Are there differences in Trait Anger scores of children in grades 3, 4, 5, and 6 who indicated high, moderate, or low use of anger-out, anger-reflection/control or anger-suppression?


A number of studies have examined the relationships between levels of anger and various patterns of expressing anger in adults (Deffenbacher et al., 1986; Siegman, Anderson, & Berger, 1990; Tafrate, Kassinove, & Dundin, 2002). Historically, the use of anger-out or the outward expression of anger was purported to reduce the level of anger and the accompanying physiological arousal (Dollard, Dobb, Miller, Mowrer, & Sears, 1939). However, more recent work with adults has noted increased levels of anger with the use of anger-out (Ausbrooks, Thomas, & Williams, 1995; Deffenbacher, 1992; Deffenbacher, Getting, et al., 1996; Drummond & Quah, 2001; Siegman et al., 1990; Siegman & Snow, 1997; Thomas & Williams, 1991). Among the first studies that found adverse effects with the use of anger-out was the work of Ebbesen, Duncan, and Konecni (1975) who measured attitudes toward their employers among groups of aerospace workers who had recently been laid off. Those workers who were encouraged to ventilate their angry feelings maintained higher degrees of anger thereafter than workers who did not ventilate. In later studies (Deffenbacher, Lynch, Getting, & Swaim, 2002; Drummond & Quah; Siegman et al; Siegman & Snow), researchers found that loudly expressing anger-arousing events or using anger-out caused participants to feel significantly angrier. Tafrate et al. noted, in a study of 93 community-dwelling adults, that high trait anger adults exhibited more negative verbal behaviors and physical actions than low trait anger adults and that the angry reactions were more frequent, intense, and enduring. Further, the high trait anger individuals demonstrated more negative feelings after their angry reactions.

In addition to the use of anger-out, researchers have also examined the relationship between trait anger and the use of anger-in or the suppression of anger with mixed results. Siegman and Snow (1997) noted that participants who used anger-in had lower ratings of level of anger than when anger-out was used. Similarly, Ausbrooks and colleagues (1995) found that college students who held anger-in had lower trait anger than those who used anger-out and had high trait anger. Conversely, Everson, Goldberg, Kaplan, Julkunen, and Salonen (1998) found, in a group of 537 men, that anger-in was related to prolonged feelings of anger whereas Wilson, Bienias, Mendes de Leon, Evans, and Bennett (2003) found a moderate correlation between trait anger and anger-in (r = .43) in a group of older adults.

Along with the use of anger-out and anger-in, the use of anger-control, a more cognitive pattern of anger expression has been examined with respect to levels of anger. Siegman and Snow (1997) found that participants who used soft and slow speech (anger-control) in describing angry events rated themselves as less angry. Using a single case study design, Burns, Bird, Leach, and Higgins (2003) also found reductions in level of anger in three forensic inpatients with the use of anger-control.

While studies examining trait anger and the use of various anger expression patterns have been conducted in adults, less work has been done with school-age children. Most of the research that has been done with children has been with adolescents (Deffenbacher, Lynch, Getting, Kemper, 1996; Deffenbacher, Getting, et al., 1996; Mueller, Grunbaum, & Labarthe, 2001; Stapely & Haviland, 1989) or with young preschool children (Eisenberg, Fabes, Nyman, Bernzwig, & Pinuelas, 1994; Fabes & Eisenberg, 1992). In a study with adolescents that examined, among other variables, trait anger and patterns of expression, Deffenbacher, Lynch, et al. (1996) found that trait anger was positively associated with aggression (anger-out) and with angerin and negatively with anger-control. Similarly, Mueller and others (2001 ) found positive associations between trait anger and both anger-in (r = .45) and anger-out (r = .67) in a sample of 167 14-year-old participants. However, those adolescents who used anger-control had lower levels of trait anger (r = -.40).

Work with preschool children has also yielded some interesting findings. In one of the earliest studies of the effects of anger expression in young children, Mallick and McCandless (1966) found that children who were encouraged to express their anger toward peers who had upset them later disliked the offending peer more than a control group who were not allowed to express anger. In more recent study, Eisenberg and colleagues (1994) found that young children high in emotional intensity tended to use acting out (anger-out) more than those low in emotional intensity. Those low in emotional intensity tended to use more avoidance or escaping (anger-in).

In summary, while findings are inconsistent, it seems that the level of anger, or trait anger, is affected by the method of anger expression used. Much of this research has been done with adults or adolescents, although some has been done with preschool children. Less has been done with school-aged children of different ages. In addition, much of the research has dealt with anger-in and anger-out and did not consider the effect of anger-control, a more health-enhancing pattern of anger expression. With the health-damaging effects of trait anger, it is important to consider effective methods of decreasing anger. Further, since patterns of expressing anger are determined early, it would be helpful to know the effects of various patterns of anger expression on school-age children of different ages.


Design and Sample

The convenience sample for this descriptive, comparative design included 408 third-, 252 fourth-, 256 fifth-, and 144 sixth-grade students who attended five elementary schools in one southeastern school district. The schools were located in both suburban and urban locations. Children were enrolled if they had the consent of parent/guardian, gave assent to be in the study, and were able to read and understand English. Approval to conduct the study was obtained from the research committee of the school district and human subject concerns were addressed by the Institutional Review Board of the university.


For this investigation, anger was conceptualized as a trait characteristic of a more enduring nature. As defined by Speilberger, Reheiser, and Sydeman (1995), trait anger is more stable and reflects the extent of the experience of angry feelings over time. Patterns of anger expression were conceptualized to include anger-out in which the person’s anger is expressed openly, anger-suppression in which the individual possibly denies angry feelings or holds them inside, or both, and anger-reflection/control in which the individual uses behaviors with a more cognitive approach to resolve conflict (Jacobs, Phelps, & Rhors, 1989).

Trait anger was measured by the ??-item trait subscale of the Jacobs Pediatric Anger Scale (PANG Forms PPS-I and PPS-2) (Jacobs & Blumer, 1984) which was adapted from Speilberger’s State-Trait Anger Scale (Speilberger, Jacobs, Russell, & Crane, 1983) and input from focus groups. The Trait Anger subscale requires participants to rate the frequency with which they have experienced the specified personality characteristics through a three-point scale including 1 = hardly ever, 2 = sometimes, and 3 = often. Scores range from 10-30 with higher scores indicating higher trait anger. Reliability coefficients on the Trait subscale range from .77 to .84 (Jacobs & Blumer, 1984). For this study, the alpha coefficients on the Trait subscale ranged from .56 to .85 depending on grade.

Patterns of anger expression were measured by the 15-item Jacobs Pediatric Anger Expression Scale (PAES) (Jacobs & Mehlhaff, 1994), a self-report instrument for children. The patterns of anger expression or the manner in which the child responds to anger, the child’s anger stylistics, includes anger-out, anger-suppression, and anger-reflection/control. The PAES was adapted from the Anger Expression Scale developed by Speilberger, Johnson, and Jacobs (1982) and validity established by moderate correlations with the HunterWolf A-B Rating Scales, the Matthews Youth Test for Health, and the Pediatric Anxiety Scale (Jacobs et al., 1989). Each of the patterns of anger expression was measured by a five-item subscale in which participants rate the frequency that they use the specified manner of expression from 1 = hardly ever, 2 = sometimes, and 3 = often. Scores range from 5-15 with higher scores indicating higher use of a particular pattern. Reliability coefficients ranged from .74 to .78 for the anger-out subscale, from .57 to .76 for the angersuppression subscale, and from .63 to .68 for the angerreflection/control subscale (Jacobs & Mehlhaff, 1994). For this study, the alpha coefficients for the anger-out scale ranged from .68 to .77, for the anger-reflection/ control scale from .50 to .67, and for the angersuppression scale from .55 to .65 depending on grade.

The PANG and PAES were administered to all participants enrolled in the study by one researcher who read the directions for completing each scale prior to the participants’ answering the items. Each child completed the scales independently although the researcher answered individual questions about specific words or questions about directions that the research team had discussed prior to the administration. Participants were assured that the scales were not tests, that there were no “right” or “wrong” answers, and that their answers would be confidential.

Scores for each of the three patterns of anger expression were grouped into high, moderate, or low use based on the range of possible scores from the PAES (5-15 for any one pattern) and the range of scores from this sample. Low users for any one pattern of anger expression had scores from 5 to 7 on the PAES, medium users had scores from 8 to 11, and high users had scores from 12 to 15. The medium-user category contained the mean score for each of the patterns of anger expression.


At the time of data collection, children whose parents/ guardians had given consent were asked to sign assent forms. Once the assent forms had been signed, the PANG and PAES instruments were administered to the participants in a classroom setting. The instruments were administered by the same researcher over the course of the study. Each child responded individually to items on the instruments.


Of the 408 third graders who indicated gender and race, 172 were male, 224 were female, 234 were Black, and 108 were White. Among the 252 fourth graders, there were 113 males, 136 females, 140 Black, and 68 White participants. There were 105 males, 151 females, 153 Black, and 72 White participants among the 256 fifth graders. Finally, among the 144 sixth graders, there were 65 male, 77 female, 113 Black, and 22 White participants. Not all participants indicated gender or ethnicity so the totals for gender and race do not equal to the total number of participants.

Mean Trait Anger scores based on pattern of anger expression and level of use that anger expression pattern are included in Table 1. Mean Trait Anger scores of high users of anger-reflection/control were highest in the third grade and lowest in the fourth grade while mean Trait Anger scores were fairly consistent across grades in those with moderate use of anger-reflection control (see Figure 3). Low users of anger reflectioncontrol had the highest mean Trait Anger scores in fourth grade and the lowest scores in the sixth (see Figure 3). Low users of anger-out had fairly consistent mean Trait Anger scores across grades as did the high users of anger-out (see Figure 2). In comparison with anger-suppression and anger-reflection/control, mean Trait Anger scores were highest with high use of angerout regardless of grade (see Table 1).

Analysis of variance tests (ANOVA) were used to compare Trait Anger scores of high, moderate, and low users of each of three patterns of anger expression from four grades (third, fourth, fifth, sixth). Significant overall F statistics were followed by Scheffe planned group comparisons designed to investigate mean differences among the three groups. Comparing Trait Anger scores among high, moderate, and low users of anger-out yielded significant overall F statistics for third, fourth, fifth, and sixth grades (F^sub 2,23^, = 87.54, p

Differences in Trait Anger scores with high, moderate, and low use of anger-reflection/control were also noted in all grades (third, fourth, fifth, sixth ) (F^sub 2,316^ = 9.85, p = .001; F^sub 2,10^ = 25.56, p

With the use of anger-suppression, differences among high, moderate, and low users were not noted until the sixth grade (F^sub 2,119^ = 5.98, p = .003) (see Figure 1). Follow-up group comparisons indicated that high users of anger-suppression had lower Trait Anger scores than moderate and low users. There was no difference between moderate and low users in sixth grade. Additionally, there were no differences in Trait Anger scores in high, moderate, and low users of anger-suppression among third, fourth, or fifth graders.


Mean levels of trait anger changed with participants in different grades and with the use of the three patterns of anger expression. High users of anger-reflection/ control in the third grade had higher mean Trait Anger scores than high users in the other grades while moderate users had fairly consistent mean Trait Anger scores. Low users of anger-reflection control had the highest mean Trait Anger scores in the fourth grade. Interestingly, the mean scores of Trait Anger among the three levels of users of anger-out varied little across grades. Mean levels of trait anger among users of anger-suppression varied across the four grades. Trait anger was highest in low users of anger-suppression in third, fifth, and sixth grades. In fourth grade, moderate users of anger suppression had the highest level of trait anger. It is difficult to determine if these findings are remarkable since little research with the use of various patterns of anger expression have been done with school-age children or school-age children of different ages.

In this study of third, fourth, fifth, and sixth grade children, high users of anger-out in every grade had the highest levels of trait anger when compared with moderate and low users. Further, moderate users of anger-out had consistently higher Trait Anger scores than low users for every grade. This finding is consistent with those noted in a number of adult studies (Deffenbacher, 1992; Deffenbacher, Getting, et al., 1996; Drummond & Quah, 2001; Siegman et al., 1990; Siegman & Snow, 1997; Tafrate et al., 2002; Thomas & Williams, 1991) in which levels of anger increased with the use of anger-out. Likewise, this association between anger-out and trait anger was also noted in studies with adolescents (Deffenbacher, Lynch, et al., 1996; Mueller et al., 2001) and with preschool children (Eisenberg et al., 1994). In children as young as third grade, the frequent use of anger-out does not seem to decrease Trait Anger or the extent of experiencing angry feelings and may, in fact, serve to perpetuate or intensify trait anger. Frequent anger-out is thought to increase an individual’s sensitivity to environmental stimuli which evoke anger, as well as increasing the intensity of the anger (Drummond & Quah; Siegman & Snow). Siegman and Snow hypothesized that angerout intensifies the subjective feelings of anger and physiologic arousal which in turn could account for the escalation of anger. It is this mechanism that could explain the association of high trait anger with anger-out in this group of participants and perhaps throughout the life span.

While anger-out seems to be ineffective in reducing trait anger, the use of anger-reflection/control by participants in every grade in this study was associated with lower levels of trait anger. The more that angerreflection/control is used, the lower the level of trait anger. While the use of anger-reflection/control has not been studied as frequently as anger-out, this finding coincides with that found by Burns and colleagues (2003) who noted reductions in trait anger with the use of anger-control by adult forensic patients. Additionally, Deffenbacher, Lynch, et al. (1996) found reductions in trait anger with the use of cognitive-relaxation coping skills in high-anger adolescents. This finding could be interpreted to mean that the use of anger-reflection/ control is an effective means of lowering trait anger. Or, perhaps, as Jacobs and colleagues (1989) have noted, children with less trait anger can more easily use angerreflection/control. Ausbrooks and associates (1995), on the other hand, found a positive association between anger discuss (anger-reflection) and trait anger in college students. This positive association between anger-reflection/control and trait anger has not been replicated in work with adolescents. Deffenbacher, Lynch, et al. (1996) noted negative associations of trait anger and anger-control in adolescents as did Mueller and colleagues (2001) who noted in their study that 14-year-olds who used anger-control had lower levels of trait anger. Few other studies have examined this association in school-age or younger participants, so it is difficult to determine if this is a consistent finding across younger age groups.

While the higher users of anger-out had the highest levels of trait anger across grades and higher users of anger-reflection/control had the lowest levels of trait anger across grades, the use of anger-suppression did not result in significant differences in trait anger until the sixth grade. High users of anger-suppression in third, fourth, and fifth grade did not differ in levels of trait anger from moderate or low users. High use of anger-suppression by sixth-grade participants, however, resulted in significantly lower levels of trait anger than moderate or low use. This coincides with the work of Siegman and Snow (1997) and Ausbrooks and colleagues (1995), who found that adults who used anger-in (suppression) had lower levels of trait anger. However, other researchers working with adults (Everson et al, 1998; Wilson et al., 2003) have noted higher levels of anger with the use of anger-in. This inconsistency is also apparent in studies of adolescents and of preschool children. In two studies, Deffenbacher, Lynch, et al. (1996) and Mueller and colleagues (2001) found positive associations of anger-in and trait anger in adolescents, while Eisenberg and colleagues (1994) found negative associations in young preschool children. It may be that there are different methods of suppressing anger at different ages with differing effects. Harburg and associates (1991) suggested that some individuals who initially suppressed anger may have then used anger-reflection/control to resolve the angry situation. Deffenbacher, Lynch, et al. (1996) have also suggested that there may be more methods of expressing anger and these may affect anger differently. These could account for differing effects on trait anger with the use of anger suppression. Finally, it may be that the use of anger-suppression is affected by development. case, Hayward, Lewis, and Hurst (1988) noted that children’s response to emotions is influenced by their cognitive development. Anger suppression and the effect on trait anger in school-age children may only become apparent as the children mature.


Several limitations of this study must be considered. The convenience sample located in one geographic area with Black and White participants limits the generalizability of the findings. Levels of trait anger and patterns of anger expression of these participants may be different than those of children in other geographic locations or of other races or ethnic groups. Participants who elected to be included in the study may have been less angry than those who elected not to participate; however, all levels of trait anger and patterns of anger expression were represented.

Trait anger and patterns of anger expression were measured only one time and may not be reflective of actual levels. However, the instruments used were designed to measure trait characteristics of both anger and the patterns of anger expression which by their nature are more stable. Thus, single measures should have been a fair representation of the participants’ levels of trait anger and patterns of anger expression.

Finally, the reliability coefficients for the angersuppression and anger-reflection/control scales were somewhat low. It is possible that the scores obtained could change on retesting but it is noteworthy that findings were consistent across all grades for angerreflection/control and consistent across third, fourth, and fifth grades for anger-suppression.

Implications for Practice and Future Research

It appears that in this group of children using anger-out may serve to increase rather than decrease emotional arousal, thus contradicting the notion that anger release is desirable. Smith and Furlong (1994) noted that “the direct expression of anger, even when done in a socially acceptable manner, may serve to justify and perhaps increase angry feelings” (p. 20). This has been echoed by Drummond and Quah (2001), who noted that the verbal expression of anger may enhance rather than dissipate the experience of anger. Further, the use of anger-reflection/control seems to be most effective in reducing trait anger. Thus, in planning programs to help children deal with anger, the use of anger-out should be discouraged and the use of anger-reflection/control encouraged.

Since both the level of trait anger and the patterns of anger expression used have implications for health and well-being, it might be helpful to assess both how children handle anger and the level of anger experienced as part of well-child examinations. Those with high levels of anger need to be encouraged to develop constructive ways of dealing with the anger. Among the ways of dealing with anger are physical activity, cognitive behavioral strategies, and effective methods of expressing anger such as the use of anger-reflection/ control.

Children in this study consistently had higher levels of trait anger with high use of anger-out and lower levels of trait anger with the use of anger-reflection/control. It might be helpful, in future research, to determine if these results are apparent in other age groups, with different genders, differing levels of socioeconomic status, or in children in other geographical locations and other ethnic groups. Further, other studies could examine the use of anger-suppression since its effect on trait anger in the literature is inconsistent. In this study, anger-suppression seemed to be an effective method of reducing trait anger with sixth graders. Whether this finding is upheld in other studies with school-age child would be important to know in planning interventions aimed at decreasing trait anger. Additionally, it would be important to consider longitudinal effects of the use of certain patterns of anger expression on trait anger in children. If the effectiveness of patterns of anger expression on trait anger change with age and maturity, interventions aimed at reducing trait anger would need to consider this. Finally, since the higher use of anger-out seemed to increase trait anger in all grades, it might be important to examine the effect of the use of anger-out in the very young school-age child, kindergarten through second grade. If high trait anger is detrimental to health, interventions aimed at promoting healthy patterns of anger expression would need to be initiated early in life.


Angerer, P., Siebert, U., Kothny, W., Muhlbauer, D., Mudra, H., & von Schacky, C. (2000). Impact of social support, cynical hostility and anger expression on progression of coronary atherosclerosis. Journal of the American College of Cardiology, 36,1781-1788.

Ausbrooks, E., Thomas, S., & Williams, R. (1995). Relationships among self-efficacy, optimism, trait anger, and anger expression. Health Values, 29, 46-54.

Burns, M., Bird, D., Leach, C., & Higgins, K. (2003). Anger management training: The effects of a structured programme on the selfreported anger experience of forensic inpatients with learning disability. Journal of Psychiatric Mental Health Nursing, 10, 569-77.

Case, R., Hayward, S., Lewis, M., & Hurst, P. (1988). Toward a neoPiagetian theory of cognitive and emotional development. Developmental Review, 8, 1-51.

Cohen, S., & Rabin, B. (1998). Psychological stress, immunity, and cancer. Journal of the National Cancer Institute, 90, 30-36.

Deffenbacher, J. (1992). Trait anger: Theory, findings, and implications. In C. Speilberger & J. Butcher (Eds.), Advances in personality assessment (Vol. 9, pp. 177-201). Hillsdale, NJ: Erlbaum.

Deffenbacher, J., Demm, P., & Brandon, A. (1986). High general anger: Correlates and treatment. Behavior Research and Therapy, 24, 481-489.

Deffenbacher, J., Lynch, R., Getting, E., & Kemper, C. (1996). Anger reduction in early adolescents. Journal of Counseling Psychology, 43,149-157.

Deffenbacher, J., Lynch, R., Getting, E., & Swaim, R. (2002). The driving anger expression inventory: A measure of how people express their anger on the road. Behaviour Research and Therapy, 40, 717-737.

Deffenbacher, J., Getting, E., Lynch, R., & Morris. (1996). The expression of anger and its consequences. Behavior Research and Therapy, 34, 575-590.

Dollard, J., Dobb, L., Miller, N., Mowrer, G., & Sears, R. (1939). Frustration and aggression. New Haven, CT: Yale University Press.

Drummond, P., & Quah, S. (2001). The effect of expressing anger on cardiovascular reactivity and facial blood flow in Chinese and Caucasians. Psychophysiology, 38,190-196.

Ebbesen, E., Duncan, B., & Konecni, V. (1975). The effects of context of verbal aggression on future verbal aggression: A field experiment. Journal of Experimental Psychology, 11, 192-204.

Eisenberg, N., Fabes, R., Nyman, M., Bernzwig, J., & Pinuelas, A. (1994). The relations of emotionality and regulation to children’s anger-related reactions. Child Development, 65,109-128.

Everson, S., Goldberg, D., Kaplan, G., Julkunen, J., & Salonen, J. (1998). Anger expression and incident hypertension. Psychosomatic Medicine, 60, 730-735.

Fabes, R., & Eisenberg, N. (1992). Young children’s coping with interpersonal anger. Child Development, 63,116-128.

Friedman, H., & Booth-Kewley, S. (1987). The “disease-prone personality”: A meta-analytic view of the construct. American Psychologist, 42, 539-555.

Harburg, E., Gleiberman, L., Russell, M., & Cooper, M. (1991). Anger-coping styles and blood pressure in Black and White males: Buffalo, New York. Psychosomatic Medicine, 53,153-164.

Harburg, E., Julius, M., Kaciroti, N., Gleiberman, L., & Schork, M. (2003). Expressive/suppressive anger-coping responses, gender, and type of mortality: A 17-year follow-up (Tecumseh, Michigan, 1971-1988). Psychosomatic Medicine, 65, 588-97.

Hauber, R., Rice, M., Howell, C., & Carmon, M. (1998). Anger and blood pressure readings in children. Applied Nursing Research, 11, 2-11.

Jacobs, G., & Blumer, C. (1984). The Pediatric Anger Scale. Department of Psychology, University of South Dakota.

Jacobs, G., & Mehlhaff, C. (1994). Children’s stress and the expression and experience of anger. Unpublished manuscript, University of South Dakota, Vermillion.

Jacobs, G., Phelps, M., & Rhors, B. (1989). Assessment of anger in children: The Pediatric Anger Expression Scale. Personality and Individual Differences, 30, 59-65.

Johnson, E. (1989). The role of the experience and expression of anger and anxiety in elevated blood pressure among Black and White adolescents. Journal of the National Medical Association, 81, 573-584.

Koh, K., Choe, K., & An, S. (2003). Anger and coronary calcification in individuals with and without risk factors or coronary artery disease. Yonsei Medical Journal, 44, 793-9.

Lawler, K., Alien, M., Critcher, E., & Standard, B. (1981). The relationship of physiological responses to the coronary-prone behavior pattern in children. Journal of Behavioral Medicine. 4, 203-216.

Lundberg, U. (1983). Note on Type A behavior and cardiovascular responses to challenge in 3-6-yr old children, journal of Psychosomatic Research, 27, 39-42.

Mallick, S., & McCandless, B. (1966). A study of catharsis aggression. Journal of Personality and Social Psychology, 4, 591-596.

Marion, M. (1994). Encouraging the development of responsible anger management in young children. Early Child Development and Care, 97,155-163.

Mueller, W., Grunbaum, J., & Labarthe, D. (2001). Anger expression, body, fat, and blood pressure in adolescents: Project HeartBeat! American Journal of Human Biology, 13, 531-538.

Nicholson, R., Gramling, S., Ong, J., & Buenevar, L. (2003). Differences in anger expression between individuals with and without headache after controlling for depression and anxiety. Headache, 43, 651-663.

Rosenberg, E., Ekman, P., Jiang, W., Babyak, M., Coleman, R., Hanson, M., et al. (2001). Linkages between facial expressions of anger and transient myocardial ischemia in men with coronary artery disease. Emotion, 1, 107-115.

Schum, J., Jorgensen, R., Verhaeghen, P., Sauro, M., & Thibodeau, R. (2003). Trait anger, anger expression, and ambulatory blood pressure: Meta-analytic review. Journal of Behavioral Medicine, 26, 395-415.

Siegman, A., Anderson, A., & Berger, T. (1990). The angry voice: Its effects on the experience of anger and cardiovascular reactivity. Psychosomatic Medicine, 52, 631-643.

Siegman, A., & Snow, S. (1997). The outward expression of anger, the inward experience of anger and CVR: The role of vocal expression, journal of Behavioral Medicine, 20, 29-45.

Smith, D., & Furlong, M. (1994). Correlates of anger, hostility and aggression in children and adolescents. In M. Furlong & D. Smith (Eds.), Anger, hostility and aggression (pp. 15-38). Brandon, VT: Clinical Psychology Publishing.

Speilberger, C., Johnson, E., & Jacobs, G., (1982). The anger expression scale. Human Resources Institute, University of South Florida, Tampa, FL.

Speilberger, C., Jacobs, G., Russell, S., & Crane, R. (1983). Assessment of anger: The state-trait anger scale. In J. Butcher & C. Speilberger (Eds.), Advances in personality assessment (Vol. 2, pp. 161-189). Hillsdale, NJ: LEA.

Speilberger, C., Reheiser, R., & Sydeman, S. (1995). Measuring the experience, expression, and control of anger. In H. Kassinove (Ed.). Anger disorders: Definitions, diagnosis, & treatment (pp. 4967). Washington, D.C.: Taylor & Francis.

Stapely, J., & Haviland, J. (1989). Beyond depression: Gender differences in normal adolescents’ emotional experiences. Sex Roles, 20, 295-308.

Tafrate, R., Kassinove, H., & Dundin, L. (2002). Anger episodes in high-and low-trait-anger community adults. Journal of Clinical Psychology, 55,1573-90.

Thomas, S., Groer, M., Davis, M., Droppleman, P., Mozingo, J., & Pierce, M. (2000). Anger and cancer: An analysis of the linkages. Cancer Nursing, 23, 344-49.

Thomas, S., & Williams, R. (1991). Perceived stress, trait anger, modes of anger expression, and health status of college men and women. Nursing Research, 40, 303-307.

Webber, L., Srinivasan, S., Wattigney, W., & Berenson, G. (1991). Tracking of serum lipids and lipoproteins from childhood to adulthood. American Journal of Epidemiology, 133, 884-899.

Williams, V., & Williams, R. (1997). Lifeskills: 8 simple ways to build stronger relationships, communicate more clearly, and improve uour health. New York: Three Rivers Press.

Wilson, R., Bienias, J., Mendes de Leon, C., Evans, D., & Bennet, D. (2003). Negative affect and mortality in older persons. American Journal of Epidemiology, 158, 827-835.

Wright, R., Rodriquez, M., & Cohen, S. (1998). Review of psychosocial stress and asthma: An integrated biopsychosocial approach. Thorax, 53, 1066-1074.

Yong, L., & Kuller, L. (1994). Tracking of blood pressure from adolescence to middle age: The Dormont High School Study. Preventive Medicine, 23, 418-426.

Marti Rice, PhD, RN, and Carol Howell, PhD, RN

Marti Rice is Associate Professor, University of Alabama at Birmingham, Graduate Studies, School of Nursing, Birmingham, AL. Carol Howell is Associate Professor, Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, GA.

Author contact: schauf@uab.edu, with a copy to the Editor: poster@uta.edu

Copyright Nursecom, Inc. May 2006

Provided by ProQuest Information and Learning Company. All rights Reserved