MacArthur SES & Health Network
MacArthur SES & Health Network

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Summary prepared by Karen A. Matthews in collaboration with the Psychosocial Working Group. Last revised November, 1997.

Chapter Contents

  1. Definition
  2. Measurement
  3. Relation to Disease
  4. Relation to SES
  5. Limitations
  6. Network Usage
  7. Readings


Hostility is a multidimensional construct that is thought to have cognitive, affective, and behavioral components. The cognitive component is defined as negative beliefs about and attitudes toward others, including cynicism and mistrust. The affective component typically labeled as anger refers to an unpleasant emotion ranging from irritation to rage and can be assessed with regard to frequency, intensity, and target. The behavioral component is thought to result from the attitudinal and affective component and is an action intending to harm others, either verbally or physically.


There are at least 26 measures of hostility and these are reviewed in Matthews et al. 1984. Here we highlight a few frequently used measures. The cognitive component is usually assessed by the 50-item Cook-Medley Hostility Inventory. This scale was derived empirically from the MWI originally to identifv teachers who get along with pupils and has been subject to numerous validity studies documenting its ability to predict negative attitudes toward others. The affective component is often assessed by the 20 item Spielberger Trait Anger, which asks about frequency of feeling quick tempered, hot-headed, and flying off the handle. The intensity of angry feelings is assessed by the 90-item Novaco Anger Inventory; this scale asks for the intensity of reactions to hypothetical situations. The Buss-Durkee hostility scale is a self-rating scale with 76 true-false items, yielding 7 subscale scores that assess the cognitive, affective, and behavioral components. There are several interview ratings methods for assessing hostility from the Type A Structured Interview or Videotaped Structured Interview. These methods require extensive training in recognizing overt signs of annoyance and argumentativeness as well as more subtle signs of sullenness, uncooperativeness. There has been considerable interest in the expression of anger outwardly vs. holding it in because of psychosomatic hypotheses regarding the development of hypertension. Spielberger Anger Expression Scale allows the assessment of anger in vs. out independently.

Relation to Disease

There have been two recent reviews of hostility and physical health. Miller et al. (1996) showed that cognitive aspects of hostility predicted all cause mortality and to a lesser extent CHD, whereas the interview measures of hostility predicted CHD. Jorgensen et al.(1996) reported that lower affect expression and more negative affectivity and defensiveness were associated with the development of hypertension. Hostility is also associated with a variety of health behaviors, including smoking, alcohol consumption, and weight. It may also be related to sympathetic arousal during interpersonal circumstances.

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Relation to SES

High Cook-Medley Hostility scores are apparent in low SES individuals, men, and Blacks.


The concept is messy. Although the distinction between affective, cognitive, and behavioral dimensions has been useful theoretically, it is difficult to separately them operationally. The ratings of hostility made from interviews is time consuming and not easily transportable to different cultural groups, other than white upper middle class men. The cognitive and affective components of hostility correlate rather highly with other negative emotions, including anxiety and depressive symptoms.

Network Usage

Given the hypothesized role of reactive responding in the Network's thinking, it is important to measure hostile attitudes, feelings, and behavior in understanding how SES make get under the skin, especially in the context of the lower end of the distribution of SES.


Barefoot JC, Peterson BL, Dahlstrom WG, Siegler IC, Anderson NB, Williams RB (I 991). Hostility patterns and health implications. Correlates of Cook-Medley Hostility Scale scores in a national survey. Health Psychology, 10, 18-24.

Jorgensen RS, Johnson BT, Kolodziej ME, Schreer GE (I 996). Elevated blood pressure and personality: A meta-analytic review. Psychological Bulletin 120:293-320

Matthews KA, Jamison JW, Cottington EM Assessment of Type A, anger, and hostility: A review of scales through 1982. Measuring Psychosocial Variables in Epidemiologic Studies of Cardiovascular Disease. NIH Pub No. 85-2270 1985; also in Psychological Documents, 1984.

Miller TQ, Smith TW, Turner CW, Guijarro ML, Hallet AJ (1996) A meta-analytic review of research on hostility and physical health. Psychological Bulletin 119:322-48.

Siegler IC, Peterson BL, Barefoot JC, Williams RB Jr. (1992) Hostility during late adolescence predicts coronary risk factors at mid-life. American Journal of Epidemiology. 136:146-54.

Suls J, Wan CK (I 993) The relationship between trait hostility and cardiovascular reactivity: A quantitative review and analysis. Psychophysiology 30:615-26.

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