The Relation Between Anger Expression, Depression, and Somatic Symptoms in Depressive Disorders and Somatoform Disorders

Kyung Bong Koh, M.D., Ph.D.; Dong Kee Kim, Ph.D.; Shin Young Kim, B.S.; and Joong Kyu Park, Ph.D.

Background: In previous studies, the relationship between either anger suppression and depression or anger suppression and somatic symptoms was examined. However, the relationship between anger expression, depression, and somatic symptoms was not examined in depressive disorders and somatoform disorders.

Method: The DSM-IV-diagnosed subjects included 73 patients with depressive disorders and 47 patients with somatoform disorders. The Anger Expression Scale was used to assess the level of anger expression or suppression. The severity of depression was assessed using the Symptom Checklist-90-Revised (SCL-90-R). The Somatization Rating Scale and the SCL-90-R somatization subscale were used to assess the severity of somatic symptoms. Data were collected from March 2000 to March 2001.

Results: The results of the path analyses showed that in depressive disorder patients, anger expression had a stronger effect on somatic symptoms through depression than did anger suppression, although both anger expression and anger suppression had a significant indirect effect on somatic symptoms. The depressive disorder group also showed a significant but negative direct effect of anger suppression on anger expression in the path from anger suppression to anger expression to depression to somatic symptoms. However, only anger suppression had an indirect effect on somatic symptoms through depression in somatoform disorder patients.

Conclusions: The results suggest that anger expression might play a more predominant role in depression and somatic symptoms of depressive disorder patients than anger suppression, but only anger suppression might be associated with depression and somatic symptoms of somatoform disorder patients. In addition, incomplete anger suppression followed by anger expression is likely to be associated with depression and somatic symptoms in depressive disorders.

(J Clin Psychiatry 2005;66:485-491)

Received March 18, 2004; accepted Sept. 22, 2004. From the Department of Psychiatry (Dr. Koh) and the Department of Biostatistics (Dr. D. K. Kim and Ms. Y. Kim), Yonsei University College of Medicine; the Department of Neuropsychiatry (Clinical Psychology), Inje University Ilsanpaik Hospital (Dr. Park); and the Brain Korea 21 Project for Medical Sciences (Dr. Koh), Yonsei University, Seoul, Korea.

The authors report no financial affiliation or other relationship relevant to the subject matter of this article.

Corresponding author and reprints: Kyung Bong Koh, M.D., Ph.D., Department of Psychiatry, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea (e-mail: kbkoh@yumc.yonsei.ac.kr).