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Anger Management: Cognitive Therapy Interventions
Anger Management: Cognitive Behavioral Interventions - 10 CEUs

Section 20
Association between Coping with Anger
and Feelings of Depression among Youths
Part Two: Results and Discussion

CEU Question 20 | CEU Answer Booklet | Table of Contents | Anger Management
Counselor CEUs, Psychologist CEs, Social Worker CEUs, MFT CEUs

Results
Whole-Sample Results of Factor Analysis

An exploratory factor analysis with an eigenvalues-greater-than-1.0 criterion for extraction (Kaiser rule) indicated a 4-factor solution: substance use factors (alcohol use, drug use, cigarette smoking); physical activity factors (exercising, bike riding, taking a walk); emotional coping factors (talking to someone, praying, listening to music); and aggressive behavior factors (fighting, arguing).
Factors 1, 3, and 4 were associated with significantly increased likelihood of depression, whereas factor 2 was associated with a significantly decreased likelihood of depression. Specifically, factor 1 (substance use) (OR=1.538; 95% CI=1.536, 1.54]), factor 3 (emotional coping) (OR=1.557; 95% CI=1.536, 1.559), and factor 4 (aggressive-behavior coping) (OR=1.579; 95% CI=1.577, 1.581) were associated with increased depression, whereas factor 2 was associated with decreased likelihood of depression (OR=0.928; 95% CI=0.927, 0.929).

Association Between Gender and Feelings of Depression
Male youths were less likely to report feeling depressed in the past year than female youths (25.90/0 vs 42.00/0, x=279.6, df=1, P<.0001) (data not shown). Female youths were more likely to report feelings of depression (OR=2.0; 95% CI=1.8, 2.2), even after adjustment for differences in sociodemographic characteristics.

Association Between Gender and Behavior When Angry
There were several significant differences between male and female youths in behavior when angry. Female youths were more likely to pray, go for a walk, talk to someone, argue, and listen to music. Male youths, in contrast, were more likely to fight physically, bike, exercise, drink alcohol, and use drugs. There was no gender difference in cigarette smoking.

Adjusted Association Between Coping Behaviors When Angry and Feelings of Depression
When specific coping behaviors and depression were compared, after adjustment for gender, parental education, and single-parent status, alcohol use, drug use, listening to music, fighting, arguing, smoking, praying, and taking a walk were associated with increased likelihood of depression.  In contrast, bike riding was associated with decreased likelihood of depression.
After additional adjustment for differences in sociodemographic characteristics (gender, age, race, single parent, parents' education) in the final model, drinking alcohol (adjusted odds ratio [AOR]=1.72; 95% CI=1.34, 2.2), arguing (AOR=1.32; 950/0 CI=1.16, 1.51), and smoking cigarettes (AOR=1.76; 95% CI=1.45, 2.14) when angry were associated with increased likelihood of feelings of depression among the whole sample of youths.

In contrast, riding a bike (AOR=0.72; 95% CI=0.62, 0.84) and talking to someone (AOR= 0.84; 95% CI=0.73, 0.95) were associated with a decreased prevalence of feelings of depression. Minority racial status (OR=1.33; 95% CI=1.17, 1.52) and having a single parent (OR=1.24; 95% CI=1.17, 1.52) were also independently associated with increased odds of feelings of depression. Higher maternal (OR=0.81; 95% CI=0.70, 0.93) and paternal education (OR=0.86; 95% CI=0.75, 0.98) were independently associated with decreased likelihood of depressive feelings.

Discussion
These data suggest that specific coping behaviors (e.g., smoking, arguing, drinking alcohol) when angry are associated with feelings of depression among youths. Specifically, these data suggest that after adjustment for differences in sociodemographic differences and potentially confounding social factors, bike riding is associated with decreased frequency of depressed feelings among youths. Factor analysis provided empirical data to show the clustering of coping behaviors into 4 groups: substance abuse, physical activity, emotional coping, aggressive behavior coping. Our results also suggest that there are gender differences in these behaviors. Whereas previous studies suggest that many of these behaviors (e.g., fighting, cigarette smoking) can be characteristic of depression in youths, previous studies have not examined these behaviors in relation to anger and the likelihood of feelings of depression in a large, nonclinical sample. Building on the long-studied relation between anger and depression, these data provide initial evidence to suggest that the gender difference in depression may be contributed to, at least in some part, by differences in behaviors used to cope with feelings of anger.

The mechanism of the association between activity-oriented behavior and decreased likelihood of feelings of depression is not known. It may be that behaviors such as riding a bicycle decrease depressive feelings through neurochemical changes, which have been shown in laboratory studies of depression and exercise. There are also community-based data from adults that corroborate this finding, showing an association between regular physical exercise and decreased likelihood of depressive symptoms.  It is also possible that feelings of enjoyment when riding a bicycle or the ability to remove oneself from a situation when angry (i.e., by bicycling) decreases the likelihood of feeling depressed. As the data do not describe the intensity/duration of bike riding, social/environmental effects are a plausible explanation as well. The same might apply for going on a walk.  Not having feelings of depression may also lead to an increased chance that a youth will choose to ride a bicycle, whereas children who are depressed may not choose this because of lethargy or anhedonia. Alternatively, there may be a third factor, either genetic or environmental, that is associated with a decreased likelihood of becoming depressed and an increased likelihood of engaging in active, rather than destructive, behaviors when feeling angry. This factor could be environmental/ learned (e.g., parents modeling behaviors) or individual (e.g., personality factors such as extraversion or conscientiousness). Physical activity may be a way of releasing feelings of anger that decrease the likelihood that these feelings will become internalized and lead to depression, despite the differences in functions employed when riding a bicycle compared with talking to someone. Previous data show that specific coping behaviors are associated with improved outcomes of physical health problems among youths. These results are consistent with and extend those findings to include mental health among youths.

The reason for the association between specific types of substance use behaviors and increased likelihood of depressed feelings is also not available from these data. There are, however, several possibilities suggested by these results that could be explored further in future studies, ideally with longitudinal data.  It may be that engaging in specific behaviors when angry leads to situations that are depressogenic. For instance, cigarette smoking when angry could lead to anxiety disorders, such as panic attacks, which are associated with an increased risk of depression. Also, consuming alcohol and taking illicit drugs may lead to decreased school performance, which could result in feeling sad and depressed because of lack of academic success. The use of drugs and alcohol could also lead to depressive feelings through neurobiological pathways.  It is also conceivable that a third factor, either parental influence or personality factors, may increase the likelihood that an individual may both engage in these behaviors and become depressed. For instance, violent behavior when angry (e.g., physical fighting), which is also common among youths with conduct disorder or other behavioral problems, is also associated with an increased likelihood of depression. Alternatively, it is also possible that being depressed, or having symptoms of depression, could have affected responses to the questionnaire by leading those who were depressed to endorse behaviors that are less active and more commonly associated with depression.

That gender differences in coping behavior when angry appear to moderate the relation between gender and the likelihood of feelings of depression among 6th- and 8th- but not 10th-grade students is a new finding among youths but is consistent with previous adult data. Previous literature has consistently shown that the gender difference in major depression emerges at the age of approximately 13 years. The finding that coping behavior when angry explains the observed gender difference in feelings of depression among 6th-grade students, who have a mean age of 11 years, and 8th-grade students, who have a mean age of 13 years, is not necessarily surprising or inconsistent with previous literature.

Although this explanatory function did not appear among 10th-grade students, coping behaviors when angry appear to have some ability to moderate the gender differences in depressive feelings among youths, and this may be a worthwhile avenue for future study, especially in efforts to identify effective, noninvasive methods of preventive intervention. The reason for the gender differences in coping behavior when angry is not known. Although male youths were more likely to participate in several potentially less productive coping behaviors (e.g., drinking alcohol, taking drugs), they were also more likely to engage in physical activity, which is associated with decreased depressive feelings.
-Goodwin, Renee D., American Journal of Public Health, Apr2006, Vol. 96, Issue 4
The article above contains foundational information. Articles below contain optional updates.

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Personal Reflection Exercise #6
The preceding section contained information about association between coping with anger and feelings of depression among youths. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 20
Building on the long-studied relation between anger and depression, what does the data in Goodwin’s study seem to provide? Record the letter of the correct answer the CEU Answer Booklet.

 
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