The purpose of this study was to identify the relationship between depression, perceived stress, fatigue and anger in clinical nurses.

A descriptive survey was conducted using a convenient sample. Data was collected by questionnaires from four hundred clinical nurses who worked at a university hospital. Radloff's CES-D for depression, Cohen, Kamarck & Mermelstein's Perceived Stress Scale, VAS for Fatigue, and Spielberger's STAXI for anger were used. The data was analyzed using the pearson correlation coefficient, students' t-test, ANOVA, and stepwise multiple regression with SPSS/WIN 12.0.

The depression of clinical nurses showed a significantly positive correlation to perceived stress(r=.360, p=.000), mental fatigue(r=.471, p=.000), physical fatigue(r=.350, p=.000), trait anger(r=.370, p=.000), anger-in expression(r=.231, p=.000), and anger-control expression(r=.120, p=.016). There was a negative correlation between depression and age(r=-.146, p=.003). The mean score of depression of nurses, 26, was a very high score and 40.8% of clinical nurses were included in a depression group. The main significant predictors influencing depression of clinical nurses were mental fatigue, trait anger, perceived stress, anger-in expression, and state anger, which explained about 32.7%.

These results indicate that clinical nurses with a high degree of perceived stress, mental fatigue and anger-in expression are likely to be depressed.

The purpose of this study was to evaluate a cognitive behavioral anger management intervention in order to increase self-consciousness and decrease anger among Korean military men.

A quasi-experimental design was used for this study. Ninety two soldiers were screened for unhealthy anger expression using a questionnaire. Among them, 26 soldiers who showed unhealthy anger expression were selected for this study. They were matched by rank and assigned to either a treatment or control group. The treatment group received the intervention three consecutive times, once a week and for 120 minutes per session. Participants were assessed before and after the intervention for anger (the State-Trait Anger Scale) and self-consciousness (Self-consciousness Scale). Data was analyzed using descriptive statistics, χ²-test, Mann-Whitney test, and Wilcox on signed rank test.

There was no statistically significant decrease in anger or increase in self-consciousness between the two groups following treatment. However, there was a significant increase in private self-consciousness in the treatment group after the intervention(p=.006).

The cognitive behavioral anger management program improves private self-consciousness in soldiers. However, Additional research is needed to explore whether long-term intervention is more effective for anger control in the military setting. The findings from this study suggest that more attention should be given to mental health care for Korean soldiers.

This study was designed to examine the relation of trait anger and anger expression to blood pressure, cholesterol, and depression in middle-aged Korean women.

This descriptive correlational design was conducted using a convenient sample taken from the health center of K University Hospital located in Kyungki province, Korea. The subjects were 252 women aged 40 to 64 years. Spielberger's state trait anger expression inventory - Korean version and Beck's depression inventory were used for measuring trait anger, state anger, anger expression and depression. Data was analyzed by descriptive statistics, t-test, Pearson correlation, two-way ANOVA, and cluster analysis using a pc-SAS program.

The anger expression types by cluster analysis were Anger out/in type, Low anger expression type, and Anger control type. The level of cholesterol and depression were significantly higher in women with high anger in and high trait anger. In addition, the level of depression was significantly higher in women with a high anger temperament.

Trait anger and anger in might be related to cholesterol and depression in women. However, this study does not reveal the relation between blood pressure and trait anger and anger expression.

This cross-sectional study was designed to identify anger-expression types in late school-age children and investigate the relation between the identified anger-expression types and their health status.

One thousand twenty seven children in elementary school fifth and sixth grades were recruited from November to December, 2004. Data was analyzed using descriptive statistics, cluster analysis, 2-test, ANOVA, Duncan's multiple comparison test, and Wilcoxon rank sum test.

Three anger-expression types in late school-age children were found; Anger-out/in, Anger-control, and Low anger-expression types. Children frequently using the anger-out/in type among the three types and with a higher state anger reported higher psychosomatic symptoms and depression. Children from a divorced or separated family reported higher state anger.

This study suggests that a specific anger management program needs to be developed for late school-age children with high state anger and frequently using the anger out/in expression type. For understanding the anger level and the anger expression types of Korean school-age children, further research needs to be done with large samples using a randomized sampling method.

This study was to identify the relationship between perceived stress, anger expression, and level of depression in cancer patients.

A cross-sectional descriptive study design was used. Data was collected by questionnaires from 185 in- and out-patients who were diagnosed with cancer at 3 university hospitals and the National Cancer Center using Spielberger et al.'s Anger Expression Scale, Cohen, Kamarch & Mermelstein's Perceived Stress, and Derogatise's SCL-90. The data was analyzed using descriptive statistics, Pearson correlation coefficient, and stepwise multiple regression with SAS/PC.

The perceived stress in cancer patients indicated a significant positive correlation to anger-in(r=.288, p=.000), anger-out(r=.232, p=.001), and depression(r=.68, p=.000), but no significant correlation to anger-control. The anger-in of cancer patients showed a significant positive relationship to anger-out(r=.53, p=.000), and depression(r=.383, p=.000), but no significant correlation to anger-control. Anger-out showed a significantly negative correlation to anger-control(r=-.248, p=.001) and a positive correlation to depression(r=.240, p=.001). The most significant predictor which influenced depression in cancer patients was perceived stress, followed by anger-in and hobby, and these factors explained their depression with a variance of 54%.

These results suggested that cancer patients with a high degree of perceived stress are likely to be high in anger-out and anger-in. Perceived stress and anger-in are major factors which affect depression in cancer patients.

This cross-sectional study was designed to identify anger-expression typesof adolescent women and investigate the relation between the identified anger-expression types and their problem behaviors and health status.

One hundred ninety nine high school freshmen were recruited from September to November, 2003. Data wasanalyzed using descriptive statistics, cluster analysis, χ²-test, ANOVA, and Duncan's multiple comparison test.

Three anger-expression types in adolescent women were found; Anger-out/in, Anger-control/in, and Anger-control type. Adolescent women with frequently using the anger-out/in type and with higher state anger reported more delinquent behaviors, more health risk behaviors, and higher psychosomatic symptoms. However, adolescent women with lower state anger and frequently using the anger-control type reported more depression scores.

There is a need to further clarify the relationship between anger-expression typesand depression in adolescent women. The findings suggest the necessity of a development of the program for lowering the anger level and controlling the unfavorable anger expression types such as the anger-out in.

This one group experimentation was designed to develop a program for relieving ‘ Hwa-Byung’(HB) symptoms and examine its effects on HB symptoms, pain threshold emotions like anger, anxiety and depression.

The program consisted of three components the change of the cognitive thoughts, the formation of a supportive network, and induction of mind-body relaxation. Sixteen middle-aged women with HB were divided into three groups for group dynamics according to the time of the recruitment. Data was collected for nine months at three time points, before, immediately after, and one month later of its application.

There were statistically significant differences in the severity level of state anger, state anxiety, depression, and HB symptoms according to the time interval. The means of state anger and state anxiety were reduced after the intervention, but it was slightly increased one month later. The means of depression and HB symptoms were continuously reduced after the intervention and one month later.

This was the first management program for HB women in Korea. A future study must be done with the research design formethodological strength revision of the program.

This study was designed to construct a structural model for explaining negative outcomes of anger in female adolescents.

Data was collected by questionnaires from 199 female adolescents ina female high school in Seoul. Data analysis was done with SAS for descriptive statistics and a PC-LISREL Program for Covariance structural analysis.

The fit of the hypothetical model to the data was moderate, thus it was modified by excluding 7 paths and adding free parameters to it. The modified model withthe paths showed a good fit to the empirical data(χ² =5.62, p=.69, GFI=.99, AGFI=.97, NFI=.99, NNFI=1.01, RMSR=.02, RMSEA=.00). Trait anger, state anger, and psychosocial problems were found to have a significant direct effect on psychosomatic symptoms. State anger, psychosocial problems, and learning behaviorswere found to have direct effects on depression of female adolescents.

The derived modelis considered appropriate for explaining and predicting negative outcomes of anger in female adolescents. Therefore, it can effectively be used as a reference model for further studies and is a suggested direction in nursing practice.

This study was to identify the relationships of trait anger, mode of anger expression, and perceived stress to mental health status in middle aged women.

The subjects were 157 middle aged women from 40s to 60s who lived in Seoul. Data was collected by questionnaire surveys using the convenience sampling. The instruments used for this study were Spielberger's trait anger scale and anger expression scale, Cohen, Kamarck, and Mermelstein's perceived stress and Derogatis's SCL-90-R. The collected data was analyzed using descriptive statistics, Pearson correlation coefficient, and Stepwise multiple regression with SAS/PC.

The trait anger of middle aged women indicated a significantly positive correlation to perceived stress(r=.180, p=.023) and mental health status(r.=021, p=.014). Anger-in(r=.237, p<.05), and perceived stress(p=.461, p<.01) showed significantly positive correlation to mental health status. The most significant predictor influencing health status of middle aged women was perceived stress, and anger-in and the variance explained was 27%.

These results suggested that middle aged women with high degree of trait anger is likely to be high in stress perception. Perceived stress and anger-in are major factors influencing mental health status.

The purpose of this study was to examine the mediation of self-efficacy in the relationship between anger and the functional health of homeless men in order to provide a basis for planning nursing interventions to improve the functional health of homeless persons.

The participants were 137 homeless men who lived in homeless shelters or visited one center serving free meals for homeless persons in Seoul. Data were collected using self-report questionnaires and analyzed with the SPSS-WIN 20.0 program. The instruments were the Functional Health Pattern Screening Assessment Tool (FHPAST), Self-efficacy Scale (SES), and State-trait Anger Expression Inventory-Korean version (STAXI-K).

The mean score for functional health was 2.41. Overall self-efficacy was 70.82. state anger was 16.53, trait anger was 19.54, and anger expression was 25.31. There were signigicant correlations among the 3 variables, functional health, self-efficacy, and anger. Also, self-efficacy had a complete mediating effect in the relationship between anger and functional health.

Based on the findings of this study, health management programs focusing on anger management and self-efficacy improvement are highly recommended to promote functional health in homeless persons.

This study was done to examine the intervention effects on the family of a family education program for pathological gamblers based on Community Reinforcement and Family Training (CRAFT).

A quasi-experimental, nonequivalent control group pretest-posttest design was used. The participants were 44 families of pathological gamblers from G center in Gyung-gi Province and 5 Gam-Anon groups in Seoul City and Gyung-gi Province. The experimental group (n=22) attended the 6 weekly 2 hour-long CRAFT family education program. The control group (n=22) attended the 12-step program of Gam-Anon. Data were collected from November, 2011 to May, 2012.

Compared with the control group, the experimental group showed significant decrease in depression (p=.001) and state anger (p=.039). There were no significant differences between groups in the level of interpersonal communication, trait anger, the mode of anger expression and self-esteem.

Findings from this study suggest that the CRAFT family education program is effective in decreasing depression and state anger in families of pathological gamblers.

This study was done to describe nurses' experience of incivility in hospitals and to consider nurses' work environment.

Data were collected through in-depth interviews and analyzed using Colaizzi' phenomenological analysis methodology. Participants were seven experienced clinical nurses working on a general ward (2 nurses), or in an intensive care unit (2 nurses), emergency room (2 nurses), or operating room (1 nurse).

The incivility that nurses experienced was categorized as follows: 'being afflicted as a weak person', 'being treated as less than a professional', 'being overwhelmed by shock and anger', 'experiencing an untenable situation', 'struggling to survive', and 'pursuing professional growth'.

Behavior guidelines should be developed to reduce incivility, and incivility cases should be continuously monitored by the nursing department. Also, to handle incivility problems in clinical nursing areas, a reporting and counseling system and education programs are needed.

The purpose of this study was to identify the characteristics of anger expression in middle-aged Korean women by categorizing their patterns of expression while considering the complexity and multidimensionality of anger, and by investigating the characteristics relative to the patterns.

The research design was a descriptive design using Q methodology, which is a method of measuring subjectivity. A convenience sample of 42 participants aged 40–60 years and living in the community in Korea was recruited. The PC-QUANL software program (a factor analysis program for the Q technique) was used to analyze the Q-sort data.

Four factors were extracted that described different expressions of anger among middle-aged Korean women; these factors explained 50.1% of the total variance. The frames of reference of the four factors were a) direct diversion, b) silent masking with remaining anger, c) self digestion, and d) controlling anger with objectification.

In this study has identified patterns and characteristics of anger expression among middle-aged Korean women were identified, which will aid the development of effective anger-management programs for controlling anger in this population. In future studies, it would be helpful to investigate how the patterns of anger expression established herein are associated with specific health problems such as cardiovascular disorder and cancer.

The purpose of this study was to identify type of anger expression and mental health in middle aged women.

From August to October 2005, survey data were collected by using the State Trait Anger Expression Inventory and Symptom Check List-90-Revision (SCL). Participants (1,442) were classified into four types of anger expression by K-mean cluster analysis. For collecting interview data for content analysis, 18 participants (4-5 participants from each type of anger expression) were recruited. The interview data were collected between March and September 2006.

The average score of the state anger of middle-aged women was 11.95, and that of the trait anger was 18.75. The average anger expression scores were 12.72 for Anger-In, 13.45 for Anger-Out, and 18.51 for Anger-Control. The average SCL scores were 45.03 for somatization, 42.23 for obsessive-compulsiveness, 42.44 for interpersonal sensitivity, 42.45 for depression, 42.40 for anxiety, 42.62 for hostility, 44.44 for phobic anxiety, 43.65 for paranoid ideation, and 43.08 for psychoticism. The anger expression types identified in this study were 1) anger-out in secret, 2) anger-control with a patience, 3) anger-out with suppression, and 4) low anger expression type. The psychosomatic symptom scores were the highest in type III (anger-out with suppression), and the lowest in type IV (low anger expression type).

This study can be helpful in assisting middle aged women to control their anger effectively and may contribute to the improvement of their mental health.

This study was done to develop a school-based anger management program (SAMP) of 4 sessions and examine its effects on the anger, anger expression, psychosomatic responses, psychosocial responses, and immunologic responses in adolescents.

A quasi-experimental study using a nonequivalent control group, pre-post design with repeated measures was used. Chi-square test, t-test, paired t-test, and Fisher’s exact test were used to analyze the data.

There were no differences between the experimental and control groups in outcome variables except for lymphocytes. However, following additional analyses, statistically significant differences by time point were observed for pain sensitivity, T cell, Helper T (Th) cell, Suppressor (Ts) cell and Natural Killer (NK) cell post-treatment, entrapment and psychosomatic symptoms at the 4-week follow-up, and resilience at the 10-week follow-up for the experimental group.

Although some modifications in contents and administration will be required to increase the effectiveness of the program for anger management, SAMP can be used to promote anger management ability in adolescents.

The purpose of this study was to identify the types of anger expression in adolescent women.

The Q-Methodology which provides a method of analyzing the individual's subjectivity was used. The 32 subjects classified 50 selected Q-statements on a 9 point scale to make a normal distribution. The collected data was analyzed by a PC-QUANL program.

Five types of anger expression in adolescent women were identified. Type I: Direct attacking expression type, Type II: Mature consideration type, Type III: Passive indirect expression type, Type IV: Avoidance conversion type, and Type V: Expression control type.

This study revealed that different approaches of nursing intervention strategies are recommended based on the five types of anger expression and their characteristics.

The purpose of this study was to evaluate the contribution of group therapy to the improvement of self-esteem, anger, stress coping and communication of those who were violent in to family.

The research design was a one-group-pretest-posttest design in quasi-experimental research, and the period of this study was from March to October, 2005. Participants were 14 offenders who were ordered to be counseled according to 'the special exemption law for punishing domestic violence.' Group therapy was applied once a week for 8 weeks. Results were collected by using a questionnaire for self-esteem, anger, stress coping and communication. In the data analysis, Wilcoxon signed test with SPSS/WIN 12.0 program was used.

The scores of self-esteem and communication showed statistically significant improvement from pre to post therapy. However, the scores of anger and stress coping were not significantly changed from pre to post therapy.

This group therapy was effective in improving the self-esteem and communication in offenders of family violence.

A descriptive correlational study was designed to examine the relationship of trait anger and anger expression to blood pressure, cholesterol, and depression in middle-aged Korean men. In addition, this study investigated the mediating effect of social support in relation to anger and other variables.

Two hundred and ninety nine men aged 40 to 64 years were recruited from a health center at K University Hospital located in Ansan City, Kyungki province, Korea. The instruments used were Spielberger's state trait anger expression inventory-the Korean version for trait anger and anger expression, Beck's depression inventory for depression, and a Personal resource questionnaire for perceived social support.

Men with high trait anger showed significantly higher systolic blood pressure(BP) and diastolic BP. The level of cholesterol did not have a significant relationship with trait anger and anger expression. The severity of depression was significantly higher in men with high trait anger or more frequent uses of anger-in or anger-out. The perceived social support had a significant mediating effect in relation to trait anger and depression.

Various nursing interventions for managing anger or improving social support need to be developed in a future study.

The purpose of this study was to examine anger-expression patterns and their association with state and trait anger and physical and psychological health status in health care workers.

Four hundred and forty eight nurses, physicians and technicians from a large medical center completed standardized questionnaires of anger, anger-expression patterns and mood. They also had blood pressure, cholesterol, blood glucose and body mass index measured during their annual physical examinations. Data was analyzed using descriptive statistics, independent t-test, chi-square and ANOVA.

Subjects showed two major clusters of anger-expression patterns: anger-control and anger-in/out. Subjects with the anger-in/out pattern reported higher state and trait anger and more anxiety, depression and fatigue than subjects with the anger-control pattern. Physical health indicators, however, were not significantly different between the two clusters of anger-expression patterns.

Anger-expression patterns are associated with psychological health status but not with physical health status. Anger-expression patterns, however, need to be examined over time to assess their long-term effects on the physical and psychological health status in future studies.