Repressed hostility and coronary heart disease: Reappraisal of a relationship in terms of a meaning-focussed approach to psychological measurement

Abstract

Repressed Hostility, a psychological construct hypothesized to correlate with CHD in middle-aged men, was theoretically derived from Ibrahim's formulation of the relationship between three psychological dimensions: Repression, Anxiety, and Manifest Hostility. The Three dimensions, as measured by corresponding scales of the MMPI, were rank ordered for each subject (S), by the S's score on each scale, into six profiles, ranging on a continuum from the scale type for Repressed Hostility, Hostility < Anxiety < Repression (HAR) to the non-scale type, Repression < Anxiety < Hostility (RAH). Ss were drawn from two distinctly different study populations. Prior to classifying Ss into psychological profiles, the three MMPI scales were modified to more sensitively reflect the greater “psychological meaningfulness” of the sub-sampled items from each of the three scales. The criterion for assessing the efficacy of the modification procedure was the empirical relationship between Repressed Hostility and CHD. Repressed Hostility was measured by profile characterization and CHD was determined by presence or absence of CHD and, if absent, by graded categories of physiological risk (the average ranks of three indicators: systolic, diastolic blood pressure, and serum cholesterol.) The assessment was made by jointly classifying Ss by CHD or physiological risk (independent variable) and Repressed Hostility status—Original MMPI scales (dependent variable₁) and Modified MMPI scales (dependent variable₂.) Modifications of Ibrahim's original design were made having to do with profile designation, method of scoring S's scale responses, reclassification of physiological risk, social class and age. The data powerfully supported the hypothesis that scale modification was responsible for finding a well-defined, consistent and general relationship (across two studies and five social classes) between Repressed Hostility and the physiological risk of developing CHD in men below 60 years of age. Although the Original scale data revealed some association between the physiological and psychological variables, the extent of the association can be shown to be a result of the influence of Modified scale items on Original scale scores.