Angry body, angry mind - mediation analysis of anger suppression, psychopathology and quality of life in bodily distress.

Kahnert, SM; Kämpfer, N; Ramm, M; Geiser, F; Conrad, R.

Zusammenfassung

Background: Bodily distress is highly prevalent in the adult population and those affected exhibit a decreased quality of life (QoL). What contributes to this decreased QoL is incompletely understood. As bodily distress has been associated both with comorbidities and alterations in emotion regulation, in particular anger suppression, the relation between suppressed anger, psychopathology and QoL was studied. Methods: In a cross-sectional study of adult psychosomatic outpatients presenting with bodily distress classified as somatoform disorders, anger suppression (Anger-In scale from the State-Trait Anger Expression Inventory), psychopathology (Symptom Checklist 90-R) and QoL (short version of the World Health Organization's Quality of Life Questionnaire) were assessed. Firstly, the association between anger suppression and different domains of QoL was examined. Secondly, mediation analyses were employed to test whether the relationship between anger suppression and QoL was mediated by the level of psychopathological symptoms. Results: Data from 539 patients (63.1 % female, mean age 41.3 (SD: 15) years) were analysed. Higher Anger-In was associated with decreased QoL in all four domains (p < 0.001). Mediation analysis showed a direct effect of anger suppression on decreased psychological and social QoL. For the physical and environmental domains of QoL, however, this relationship was fully mediated by psychopathology (depression, somatisation). Conclusion: Anger suppression was strongly associated with decreased QoL in patients with bodily distress. While this was partly explained through basic psychopathology, there were some direct effects of anger suppression, in particular on social and psychological QoL. Anger management might hence be integrated in the treatment of bodily distress.