The Mediating Role of Social Anxiety in the Relationship of Anger and Depression

Purpose The occurrences of anger during depression have been acknowledged for many years; however, the mechanisms involved are hardly understood. This study presents a hypothesis: that perception of anger control and its resulting behavioral manifestations of anger predict depression. Growing evidence suggests that anxiety precedes depression in a continuum of proximal causality. Depression and anxiety share negative affectivity (e.g., anger), which accounts for overlapping psychological symptoms and comorbidity. Furthermore, research indicates that the perceptions of diminished control over aversive events play a significant role in the etiology and maintenance of anxiety and depression. Depression may be differently characterized from anxiety in terms of low positive affect. However, recent information suggests that social phobias may share this feature with depression, furthering obscuring the boundaries between the two. The current study responds to recent indications that depression emerges as hopelessness depression out of a state of anxiety. Applying hopelessness depression theory, we theorize that (a) social anxiety precedes depression, and (b) social anxiety and depression may occur anywhere along the continuum of perceptions of anger control and the resulting behavioral expressions of anger that characterize these states. 

Methods Data were derived from the Collaborative Psychiatric Epidemiology Surveys, where 2,827 participants met DSM-IV criteria for lifetime major depressive disorder (14.3%), and 1,905 participants met criteria for DSM-IV lifetime social anxiety disorder (9.6%). Behavioral expressions of anger resulting from perceived uncontrollability of anger were measured by two items intended to screen for intermittent explosive disorder. Among participants, 21.5% (n=4,250) reported that they perceived their anger as out of control and either broke items or hit others. A segment (11.2%; n=2,205) of participants indicated that they perceived uncontrollable anger and reacted both by breaking items and hitting others. Meditational hypotheses were tested with logistic regression models as recommended by Baron and Kenny (1981).

Results For each score increase in behavioral expressions of anger, the odds of social anxiety disorder were significantly increased after controlling for variance accounted for by all covariates (B =.713, OR=2.039, p < .001). Behavioral expressions of anger was significantly related to major depressive disorder after controlling for variance attributable to all covariates (B =.669, OR =1.951, p < .001). Finally, when behavioral expressions of anger and social anxiety disorder were entered simultaneously, both behavioral expressions of anger and social anxiety disorder significantly predicted major depressive disorder after controlling for all covariates (B = .579, OR = 1.784, p < .001 and B =1.172, OR = 3.227, p < .001, respectively). A significant (B = -.052, p <.001, 95% CI [-.071, -.033]), indirect effect of social anxiety disorder was detected through bootstrap analysis, supporting the partial mediation hypothesis.

Implications The roles of perception of anger control, behavioral expression of anger and anxiety disorders in depression have not been adequately discussed within current literature. These findings suggest that perception of anger control and its resulting behavioral expression of anger may be important factors for consideration in research aiming to understand a subtype of depression; namely, hopelessness depression.