title: Anger expression, partner support, and quality of life in cancer patients.
abstract: OBJECTIVE
  Family members are the most important source of social support for cancer patients. The determinants of family support, however, are not well understood. In this study, the associations of anger-expression styles of both patients and their partners with patient-perceived partner support and the impact of these variables on long-term health-related quality of life (HRQL) of the patient were examined.
  
  
  METHODS
  The baseline data were collected at the time of diagnosis; a follow-up survey was conducted at 8 months. Questionnaires included the Spielberger AX scale, the Family Support scale, and the RAND-36 Health Survey. The sample comprised 153 patients and their partners. The theoretical model was tested with a path analysis using structural equation modeling, and gender differences were tested using multivariate analysis of covariance.
  
  
  RESULTS
  Path analyses indicated that partner support was an important mediator, partly explaining the associations between anger-expression styles and HRQL. As hypothesized, anger control had a positive relationship with perceived partner support, while habitual inhibition of anger (anger-in) showed a negative correlation with partner support. Analyses by gender revealed some clear differences: for the male patients, the wife's high level of anger expression (anger-out) was significantly positively related to patient mental HRQL, whereas for the female patients, their husband's anger-out was negatively correlated with the patient's mental HRQL. In addition, patient's own anger-out had a more pronounced negative effect on HRQL for women as compared to men.
  
  
  CONCLUSIONS
  The anger-expression styles of both patients and their partners seem to modify the family atmosphere, and together, they are important determinants of the long-term quality of life of the cancer patients. Interventions for couples facing cancer should include a focus on ways of dealing with anger and thereby support dyadic coping with cancer.
authors.affiliation: Department of Psychology, University of Helsinki, Helsinki, Finland; Rehabilitation Foundation, Helsinki, Finland. juhani.julkunen@helsinki.fi
authors.forename: Juhani
authors.initials: J
authors.lastname: Julkunen
authors.forename: Mila
authors.initials: M
authors.lastname: Gustavsson-Lilius
authors.forename: Päivi
authors.initials: P
authors.lastname: Hietanen
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000786:Anger; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009367:Neoplasm Staging; D009369:Neoplasms / Q000473:pathology / Q000523:psychology*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011379:Prognosis; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D012944:Social Support; D018454:Spouses / Q000523:psychology*; D011795:Surveys and Questionnaires