Αναδροµικές µνήµες των αρνητικών γεγονότων της ζωής και

∆ιεπιστηµονική Φροντίδα Υγείας(2012) Τόµος 4,Τεύχος 3, 98-104
ISSN 1791 - 9649
Αναδροµικές µνήµες των αρνητικών γεγονότων της ζωής και
καρδιοφοβία: Έλεγχος της διαµεσολάβησης της εχθρότητας.
∆ραγκιώτη E.1, Τσαρτσαλής ∆.2 , Γκούβα M.3
1
Ψυχολόγος, MSc, Ψυχιατρικό τµήµα, Νοσοκοµείο “ Σωτηρία”, Αθήνα, Ελλάδα
MD, MSc, Καρδιολογική Κλινική , Ιπποκράτειο Νοσοκοµείο Πανεπιστήµιο Αθηνών , Ελλάδα
3
Ψυχολόγος Επίκουρος Καθηγητής Νοσηλευτική σχολή Τεχνολογικό Εκπαιδευτικό Ίδρυµα Ηπείρου
2
ΠΕΡΙΛΗΨΗ
Εισαγωγή: Οι µνήµες των στρεσογόνων γεγονότων της παιδικής ηλικίας µπορεί να σχετίζονται µε ένα ευρύ φάσµα
συµπτωµάτων κατά την ενήλικη ζωή. Σκοπός: η διερεύνηση της σχέσης των αναµνήσεων στρεσογόνων γεγονότων
της παιδικής ηλικίας µε το άγχος για την καρδιακή λειτουργία στην ενήλικη ζωή. Μέθοδος: Το δείγµα αποτέλεσαν 300
άτοµα (100 άνδρες - 200 γυναίκες, µέσης ηλικίας 33(12,5) µε εύρος 18-75), οι οποίοι απάντησαν στην ελληνική
έκδοση των ερωτηµατολογίων α) άγχος για την καρδιακή λειτουργία (CAQ), β) εχθρότητα και Κατεύθυνση της
εχθρότητας (HDHQ), καθώς και ένα ερωτηµατολόγιο σχετικό µε τις αναµνήσεις στρεσογόνων εµπειριών της παιδικής
ηλικίας. Αποτελέσµατα: Οι µνήµες των στρεσογόνων γεγονότων της παιδικής ηλικίας συσχετίστηκαν µε υψηλότερα
επίπεδα τόσο του άγχους για την καρδιακή λειτουργία όσο και της εχθρότητας (r =.005). Ακόµη, τα υψηλά επίπεδα
του άγχους για την καρδιακή λειτουργία συσχετίστηκαν µε µια εχθρική στάση (r ≤ .001). Από τα µοντέλα
παλινδρόµησης διαπιστώθηκε ότι η κριτική των άλλων, η παρορµητική εχθρότητα, η ενοχή και η παρανοειδής
εχθρότητα διαµεσολαβούν πλήρως µεταξύ των αναµνήσεων στρεσογόνων γεγονότων παιδικής ηλικίας και του
άγχους για την καρδιακή λειτουργία στις γυναίκες (β=.416, β=. 379, β= 529 β=.323, p=<.004). Συµπέρασµα: Ο
έλεγχος της εχθρικής συµπεριφοράς µπορεί να παρέχει πληροφορίες για την ευαισθησία στο άγχος και τη
σωµατοποίηση σε άνδρες και γυναίκες, κάτι που θα µπορούσε να βοηθήσει τους επαγγελµατίες υγείας σε πιο
ποιοτική θεραπευτική αντιµετώπιση αυτών των ατόµων.
Λέξεις-Κλειδιά: heart focused anxiety, hostility, somatization, trait anxiety
98
Υπέυθ. Αλ/φίας : Gouva M., As. Prof. Dep. of Nursing, TEI of Epirus, 4th Klm Nat. Str. .– 45500 - Ioannina, Greece. Email: gouva @ioa.teiep.gr
Interscientific Health Care (2012) Vol 4, Issue 3, 98-104
ISSN 1791 - 9649
Retrospectives memories of negative life events and cardiophobia:
testing the hypothesis of mediation of hostility
Dragioti E.1, Tsartsalis D.2 , Gouva M.3
1
Psychologists, MSc, Department of Psychiatry, “Sotiria” Hospital, Athens, Greece
MD, MSc, Cardiology Department, Hippokration Hospital, University of Athens, Greece
3
Psychologists, Assistant Professor, Department of Nursing, Higher Technological Educational Institution of Epirus, Greece
2
ABSTRACT
Introduction: Retrospective memories of stressful events during childhood have been related empirically with a wide
range of somatization symptoms in adulthood. Objective and Aim: The Objective of the present study was to clarify
the possible link between memories of childhood stressful events and adult heart focused anxiety. Method: A
community sample of 300 individuals (100 men – 200 women, mean age 33, SD = 12,5 ranged 18–75), completed the
Greek version of the Cardiac Anxiety Questionnaire and the Hostility and Direction of Hostility Questionnaire, along
with a questionnaire regarding retrospective memories of stressful experiences during childhood. Results: Childhood
stressful memories were associated with higher levels of both heart focused anxiety and hostility (r=.005). Elevated
levels of cardiac anxiety were also correlated with a hostile attitude (r≤.001) Regression models revealed that criticism
of others, acting-out hostility, guilt and paranoid hostility fully mediated the link between stressful memories and heart
focused anxiety for women (β=.416, β=. 379, β= 529 β=.323, p=<.004), after adjustments. Conclusion: Screening for
hostile attitudes may provide information for anxiety sensitivity and somatization males and females that could allow
health care providers to tailor treatment more effectively.
Keywords: heart focused anxiety, hostility, somatization, trait anxiety
.
INTRODUCTION
Retrospective memories of stressful events during
childhood have been related empirically with a wide
range of somatization symptoms in adulthood (Barsky
et al., 1994; Sansone et al., 2001). Its formation and
aetiology are considered multidimensional (Roelofs et
al., 2005). Histories of childhood sexual abuse,
physical abuse, emotional abuse, and neglect have
been found to be connected with medically
unexplained symptoms in adults (Spertus et al., 2003;
Sansone et al., 2001; Barsky et al., 1994). Although
many studies focused mainly that adult attachment
style mediates the relation between childhood trauma
and increased somatic symptom reporting in adults
(Taylor et al., 2000; Stuart & Noyes, 1999; Styron &
Janoff-Bulman, 1997; Alexander,1993) there is a
recent growing interest for personality traits is the key
factor between childhood trauma and psychopathology
(Somer et al., 2012 Sarchiapone et al. 2009).
A recent study found that anxiety, aggression
(particularly hostility), and impulsivity were found to be
Cor. Author:Gouva M., As.Prof.Dep.of Nursing, TEI of Epirus, 4th Klm Nat. Str. .– 45500 – Ioan., Greece. Email: gouva @ioa.teiep.gr
99
mediators of association between memories of trauma
and psychopathology in male substance-dependent
inpatients (Evren et al., 2012). However, there are
poor data concerning the effect of retrospective
memories of negative life events on heart-focused
anxiety and hostility. In an effort to improve
understanding of the mechanisms that link early
trauma to later outcomes, this study investigated the
mediation effects of adult hostility on the association
and
between childhood traumatic experience
cardiophobia among healthy individuals. To be more
specific, the authors aimed to investigate whether
retrospective stressful memories are associated with
cardiac anxiety and if this association is mediated
through hostility in adulthood
METHOD
A community sample of 300 individuals participated to
the present study (100 men – 200 women, mean age
33, SD = 12, 5 ranged 18–75). Participants were
recruited through telephone and eligible population
had to be recalling a history of trauma (psychical or
emotional) occurring between the ages of 7 and 18.
Then they completed the Greek version of the Cardiac
Anxiety Questionnaire (Dragioti et al., 2011) and the
Hostility and Direction of Hostility Questionnaire
(HDHQ; Caine et al., 1967) along with a questionnaire
regarding retrospective memories of stressful
experiences during childhood. Participants, also
thoroughly informed for the purpose of the study.
Cardiac-Anxiety-Questionaire
Cardiac anxiety questionnaire (CAQ) was designed to
measure the anxiety of the bodily senses with regard
to the heart function (Eifert et al., 2000). It is a selfreport questionnaire which was recently standarized in
Greece (Dragioti et al. 2011).This sort version is
consisted of 10 sentences which describe dimensions
relevant to the bodily senses of the heart function on a
five-degree Likert scale, which is extended from
“never” (0) until “always” (5). CAQ provides a total
result along with three results of its subscales
regarding (1) the fear and worry for chest and cardiac
disturbances, (2) the avoidance of activities and (3) the
focus on heart function (Dragioti et al. 2011).
Hostility and Direction of Hostility Questionnaire
Hostility and Direction of Hostility Questionnaire
(HDHQ) is a selfreport instrument that access
hostility and the direction of hostility. HDHQ consists of
5 subscales in the 52 features of the Minnesota
Multiphasic Personality Inventory (MMPI). Three
subscales, the acting-out hostility (AH), criticism of
others (CO) and paranoid hostility (PH) refer to the
extrapunitiveness (Caine et al., 1967). Two subscales,
self-criticism (SC) and Guilt (G) refer to the
intropunitiveness and constitute measures of selfpunishment. The sum of all five subscales reflects the
total hostility (Caine et al., 1967).
Analyses
Distributions and descriptive statistics were examined
for all variables. All analyses were conducted
separately for men and for women. Relations between
all measures were examined by calculating matrices of
Pearson correlation coefficients. hierarchical linear
regression analyses are used to test whether hostility
100
mediate the link between childhood trauma and heart
function anxiety.
RESULTS
Demographic characteristics of the sample are
presented in Table 1. Age did not differ significantly
between the two sexes (t = 0.5, df = 345, p =.60). The
loss of subject/object was the most commonly reported
memory of stressful events (47%), followed by
physical abuse (29%), severe illness in family (20%),
school assault (7%), natural disasters (4%) and sexual
abuse (3%). Sexual abuse was reported by 100% of
women in this sample and 0,0% of men. No significant
differences were found among both sexes, as far as
heart focused anxiety (t=-.964, p=.336) and total
hostility (t=.342, p=.733) are concerned (Graph 1, 2).
Correlations among variables
Childhood stressful memories were associated with
higher levels of both heart focused anxiety and hostility
(r=.005). Elevated levels of cardiac anxiety were also
correlated with a hostile attitude (r≤.001) (Table 2).
Testing the Mediational Model
Regression models revealed that criticism of others,
acting-out hostility, guilt and paranoid hostility fully
mediated the link between stressful memories and
heart focused anxiety for women (β=.416, β=. 379, β=
529 β=.323, p=<.004), after adjustments. No such
mediation was proved in men, thus both retrospective
stressful memories during childhood and hostile
attitudes were independent contributors for anxiety of
heart function (Table 3).
DISCUSSION
This study tested a model that linking childhood
trauma with adult cardiac anxiety, hostility with cardiac
anxiety, and retrospectives memories of childhood
trauma with hostile attitudes. To our knowledge, this is
the first published study to test the mediating role of
hostility in accounting for associations between
childhood trauma and somatization in adulthood.
Findings are consistent with the hypothesis that, for
women, childhood stressful memories influences adult
levels of fear of cardiac sensations by fostering
paranoid hostility. These results are also in
accordance with the hypothesis that personality traits
were mediates for this association (Somer et al., 2012;
Sarchiapone et al. 2009). For men, findings suggest
that these memories and hostility are both important
independent predictors of adult cardiac anxiety
sensitivity according previous research data (Spertus
et al., 2003; Sansone et al., 2001; Barsky et al., 1994).
Our findings thus support differential associations for
men and women. However, because men in our
sample did not report sexual abuse, this difference
may be connected to the types of trauma experiences
in each group. Along with the fact that the
multidimensional nature of memories of trauma
influences on different levels of hostility (Somer et al.,
2012; Sarchiapone et al. 2009) gender related to type
of trauma can impact also both in cardiac anxiety and
hostile behaviours.
Our work has several limitations. First, the crosssectional design establishes associations but cannot
determine causality. It is also possible the
retrospective nature of the data raises the potential for
reporting biases. However the strong mediation of
hostility on cardiophobia due to past stressful
experience may give an explanation that hostility
accounting as a protection mechanism against trauma
exposure that occurs other somatisation problems.
Hostility feelings seem to be consequences of
childhood trauma, and individuals with these negative
affect and cognition may be trying to manage with
these painful experiences in maladaptive way like
cardiac health concerns (Evren et al., 2012).
In sum screening for hostile attitudes may provide
information for anxiety sensitivity and somatization
patients that could allow health care providers to tailor
treatment more effectively.
AKNOWLEGMENTS
We would like to thank the people who participated in
this study and the anonymous reviewers for their
helpful and insightful comments.
6.
7.
8.
9.
10.
11.
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Table 1. Sample characteristics
Characteristic
Mean age in years
Men (n=100)
Women (n=200)
Percent married
Employment
Unemployed/Student
33.17 (SD=10.6)
33.05 (SD=12.8)
36.0%
28.0%
Housekeeping
5.3%
Self-Employed
14.3%
Private Sectors
22.0%
Public Sectors
30.4%
Educational Background
Primary Education
5.7%
Secondary Education (3 Years)
3.7%
Secondary Education (6 Years)
12.7%
Higher Education (Graduate)
36.3%
Postgraduate (Μaster Degree)
10.3%
Postgraduate (P.H.D Degree)
0.7%
Undergraduate Student
30.7%
*AGE is expressed as Mean ± Standard deviation
Table 2. Pearson Correlations of retrospectives memories of negative life events, hostility, Age,
employment and Educational Background with Heart Focused Anxiety
Heart Focused Anxiety
Women
(n=200)
Men
(n=100)
p
102
Stressful life events
r
.214
.005
r
.199
p
.005
Age
.027
.685
.074
.557
Employment
-.063
.338
-.099
.428
Educational Background
-.137
.037
.134
.285
Criticism Of Others
.271
<.001
480
<.001
Acting-Out Hostility
.232
<.001
.267
.001
Paranoid Hostility
.294
<.001
.442
<.001
Self-Criticism
.251
<.001
.417
<.001
Guilt
.299
<.001
.378
.001
Extrapunitiveness
.354
<.001
.493
<.001
Intropunitiveness
.306
<.001
.435
<.001
Total Hostility
.388
<.001
.532
<.001
Graph 1
HFA scores by gender
4
3,8
3,6
3,4
3,2
3
2,8
2,6
2,4
2,2
Fear CAQ
Avoidance CAQ
2
HFAttention CAQ
1,8
Total CAQ
1,6
1,4
1,32
1,4
1,2
1,03
0,94
1
0,96
0,86
0,79
0,75
0,8
0,6
0,4
0,2
0
WOMEN
MEN
t=-.964, p=.336
Graph 2
Hostility scores by gender
20
18,53
18,38
18
16
14
12,68
11,8
12
Extrapunitiveness
Intropunitiveness
10
Total Hostility
8
6,57
5,85
6
4
2
0
WOMEN
MEN
t=.342, p=.733
103
Table 3. Hierarchical Regression Analysis for Variables Predicting Cardiac Anxiety (HFA) Scores
for Women and Men (n = 200 Women, 100 Men)
Cardiac Anxiety Score
Women
Men
(n=200)
(n=100)
Variable
B
seβ
∆R2
β
Model 1
seβ
∆R2
β
.14***
.34***
Stressful life events
.121
.039
.429*
.101
.037
.416*
Criticism Of Others
.101
.037
.416**
.063
.076
.304
Acting-Out Hostility
.115
.041
.379**
.001
.062
.008
Paranoid Hostility
.291
.139
.529**
.069
.064
.264
Self-Criticism
.077
.041
.305
-.029
.060
-.130
Guilt
.106
.043
.323*
-.044
.072
-.155
Extrapunitiveness
-.154
.118
-.268
.036
.199
.083
Intropunitiveness
-.059
.119
-.079
.331
.208
.485
Total Hostility
-.239
.123
-.617ms
-.037
.193
-.118
Model 1 Methods=enter
*<.05;**<.01;***<.001; ms>.10
104
B

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