Major Depressive Disorder

Med Student Anger a Harbinger of Depression, Heart Attack

By Pippa Wysong
The Medical Post, May 16, 1995

SAN DIEGO - Medical students with angry temperaments may end up becoming clinically depressed doctors.

This finding comes from a long-term study which tracked medical students through their careers.

In the Precursors Study, which was initiated in 1948, medical students answered extensive questionnaires about everything from how they react to stress to how much coffee they drank daily.

"There were even Rorschach tests," said Dr. Daniel Ford, associate professor of medicine at Johns Hopkins school of medicine in Baltimore. Baseline data was collected from students at the university until 1964.

"Those with a high level of anger responses had about twice the risk of developing clinical depression," Dr. Ford said.

The initial focus of the study was on cardiovascular disease, "but at the time it was thought of more in a behavioral way," he said at the annual meeting of the Society of General Internal Medicine.

Responses and follow-up information were attained from 1,146 students. They also represent a good cross section of the medical profession, with most having ended up in general practice. About 250 became medical specialists, including 50 psychiatrists.

Because the information was available, researchers decided to go through the data to see how anger might relate to depression. The information was of particular interest because subjects had been followed for 30 to 40 years.

Some research has indicated having an angry temperament is associated with depression, Dr. Ford said.

"There's been a lot of interest in trying to identify personality or temperament type that might be associated with risk for depression. There haven't been many data sets to look at that."

Over the years, about 10% (109) of the study group developed clinical depression.

Twenty-five of those had committed suicide.

One of the questions on the initial questionnaire related specifically to anger. It asked:

"Whenever you find yourself in situations with undue pressure or stress, how do you usually react?" Respondents were given a selection of about 20 items. For the current study, answers were counted if respondents chose anger, irritability or gripe.

Of the total sample, 9% said they got irritable under stress, 16% said they griped and 21% said they responded with anger.

Those who chose two or all three of the anger-related responses were at a significantly increased risk of depression, while people who only chose one or none were not at an increased risk.

Thirty-five students chose all three and it turns out they were at risk for more than depression. Over time, "about 40% of (the 35) had a heart attack."

"People with high levels of anger had two and a half times the risk of having a heart attack," Dr. Ford said.

There was also an association with coffee drinking and risk for heart attack. "This is one of the few data sets that shows coffee drinking is associated with coronary artery disease," he said.

At the same time, people's use of substances such as coffee and tobacco changed over the years, and one has to be careful about interpreting what their use means, he said. At baseline about 65% of the subjects were smokers, now only about 8% still smoke.

As well, the way people prepared coffee in the 1970s underwent a change. "Coffee drinking before the 1970s predicts the risk of heart disease and that's about when Americans switched from boiled coffee to drip coffee."

Copyright 1995 Maclean Hunter Publishing Limited
Reprinted with permission.

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