title: Multiple sclerosis is associated with high trait anger: a case-control study.
abstract: BACKGROUND
  In recent years there has been a focus on health-related quality of life in multiple sclerosis (MS) and in particular the importance of non-motor problems such as fatigue, pain, depression, anxiety, and cognitive disorders. However, little attention has been focused on other negative emotions, such as anger. Our purpose was to evaluate whether trait anger (a predisposition to experience frequent and intense episodes of anger over time) is different between persons with and without MS after controlling for depression, anxiety, and other socio-demographic variables.
  
  
  METHODS
  157 consecutive MS patients were enrolled in the study and compared to eighty age, gender, and education-matched healthy controls. Participants were administered affective trait measures (Beck Depression Inventory, Beck Anxiety Inventory) and the trait anger measure (the Spanish adapted version of the State-Trait Anger Expression Inventory-2 [STAXI-2]).
  
  
  RESULTS
  MS patients had significantly higher scores on anger intensity (state anger) and trait anger than did controls. They also had a trend to experience direct anger toward other persons or objects in the environment (higher anger expression-out score) and to hold in or suppress angry feelings (higher anger expression-in score). However, in a regression analysis that adjusted for different demographic and clinical variables, we found that diagnosis category (MS patient vs. control) was associated with none of the highest quartiles of STAXI-2 scores, except for the Trait Anger scale (odds ratios between 2.35 and 3.50).
  
  
  CONCLUSIONS
  The present study provides further evidence that MS is independently associated with high trait anger.
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain. Electronic address: jbenitol@meditex.es.
authors.forename: Julián
authors.initials: J
authors.lastname: Benito-León
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Labiano-Fontcuberta
authors.affiliation: Department of Psycho-oncology and Liaison Psychiatry, University of Leicester, Leicester, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
authors.affiliation: Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain.
authors.forename: Sara
authors.initials: S
authors.lastname: Moreno-García
authors.affiliation: Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martínez-Martín
mesh_terms: D000328:Adult; D000786:Anger / Q000502:physiology*; D001526:Behavioral Symptoms / Q000209:etiology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology; D011569:Psychiatric Status Rating Scales
keywords: Anger; Case–control study; Emotion; Multiple sclerosis; Neuropsychiatric; Non-motor features