1. Introduction
1.1 Research Background
Depression is a disease ranked third out of ten diseases reported by the WHO, causing disorder in important functional regions, bringing out pain to individual patients, and laying a social burden on their family and surrounding people [1,2].
Aggression stands for harmful behavior in social interaction, destructive and punitive upon another individuals [3].
Cognitive error causing negative automatic thought by exaggerating and distorting the meaning of incident in experiencing negative life event is a signature dysfunctional belief of patients with depression, and animosity reflecting the onset, maintenance, and seriousness of depression is a grave error in cognitive side of depression, which can cause aggression.
In practice, patients with depression tend to easily respond to insignificant stimulation or additional stress and show higher aggression, compared to normal persons [4,5], and aggression can lead to self-destructive
Convergence Factors Affecting Aggression of Depressed Adults
Younghee Kim
1, MyoungjinKwon
2*1Dept. of Nursing, Daejeon institute of science and technology
2Dept. of nursing, Daejeon University
우울감이 있는 성인의 공격성에 영향을 주는 융합적 요인
김영희1, 권명진2*
1대전과학기술대학교, 간호학과, 2대전대학교, 간호학과
Abstract The objective of this study was to the effects of depression, anxiety and stress on the aggression among depressed adults. Subjects are 91 depressed adults in D city. The structured and self-reported questionnaires were administered to subjects and IBM SPSS 21.1 program were performed for data analysis.
All of aggression and depression(r=.62, p<.001), aggression and anxiety(r=.58, p<.001), aggression and stress(r=.62, p<.001) showed positive correlation. Depression affects the aggression that is significant explanatory variables(42.3%). The findings suggested that depressed adult’s aggression for managing psychological management programs with interventions seem to be necessary.
Key Words : Aggression, Anxiety, Depression, Stress, Convergence
요 약 본 연구는 우울감이 있는 대상자의 우울, 불안, 스트레스가 공격성에 미치는 영향정도를 확인하기 위해 시행되었
다. 대상자는 91명의 우울감이 있는 대상자이다. 구조적설문지를 이용하여 자료 조사하였으며 분석은 IBM SPSS 21.1프로 그램을 이용하였다. 공격성과 우울(r=.62, p<.001), 공격성과 불안(r=.58, p<.001), 공격성과 스트레스(r=.62, p<.001) 간에는 유의한 양의 상관관계가 나타났다. 우울은 공격성의 유의한 영향요인으로 설명력은 42.3%이었다. 이러한 결과를 바탕으로 우울증환자의 공격성을 중재하기 위해서는 심리적인 관리프로그램이 필요해 보인다.
주제어 : 공격성, 불안, 우울, 스트레스, 융합
*Corresponding Author : Myoun-Gjin Kwon([email protected]) Received November 13, 2017
Accepted January 20, 2018
Revised November 17, 2017 Published January 28, 2018
behavior such as suicide and assault if such aggression turns inwards and outward, respectively.
Therefore, controlling aggression in patients with depression has its significance in that it protects patients and their surrounding people.
As stress is related to cognitive function such as distortion and wrong interpretation on emotional state and situation such as anxiety and depression, stress-acute people tend to make a unilateral, extreme judgment and extreme behavior such as aggression [6,7].
According to research of Koh, et al. [8], patients with depression are more sensitive to anxiety and stress, compared to patients with more mental disorders, indicating that depression, anxiety, and stress are significantly related to aggression.
Depressed people experienced more negative incidents and considered them as more negative, compared to normal persons, showing more sensitive response to aversive stimulus and getting less positive reinforcement [9].
Increased anxiety and sensitive stimulus of patients with depression can lead to aggression, which will affect vulnerability on additional stress and causing incidents.
Hence, intervention program is required to help reducing aggression by managing depression, anxiety, and stress.
This research aims to provide basic data that help the management through a survey on depression, anxiety, stress, and aggression of patients with depression.
As there are not much research on aggression, depression, anxiety, and stress of depressed adults, the results of this research will help developing aggression reduction program of depressed adults.
1.2 Research Purposes
This research aims to provide useful data that help emotional stability by grasping the effect of depression, anxiety, and stress on aggression of depressed adults,
and the specific purposes are as follows:
⦁To grasp general characteristics of the subjects.
⦁To grasp correlation of aggression with depression, anxiety, and stress.
⦁To grasp the level of the effect of depression, anxiety, and stress on aggression.
2. Research Method
2.1 Research Design
This research is correlation, descriptive research, aiming to grasp the effect on depression, anxiety, and stress on aggression of depressed adults.
2.2 Research Subjects
This research subjects are 91 depressed adults.
The number of subjects in this study was Calculated by G * Power ver. 3.1.9.2 program. When the mean effect size was .15, significance level .05, power of .95, and 6 variables were calculated based on multiple regression analysis, the required number of samples was at least 89.
Questionnaires were distributed to only those who agreed to participate in the research after explaining the purpose of research, anonymity, and non-risk, and voluntary participation in research to the subjects, any subjects can withdraw themselves from the research at anytime, and their responses to the survey would be kept confidential and be used only for the purpose of research.
2.3 Research Tools 2.2.1 Aggression
The Aggression Questionnaire developed by Buss and Perry [10] was used to measure aggression. The Aggression Questionnaire consists of a total of 27 questions which use a 5-point Likert scale, with 4 lower measures of 9 questions for physical aggression, 5 questions for verbal aggression, 5 questions for anger, and 8 questions for hostility. Physical aggression
were adjusted for reverse coding. Whereas Cronbach's alpha value was .86 in Kwon and Seo [11]'s research, it was .90 in this research.
2.2.2 Depression, Anxiety, Stress
In this research, a Lee [12]'s version of The Depression Anxiety Stress Scale developed by Lovibond and Lovibond [13] was used. The Depression Anxiety Stress Scale consists of a total 21 questions that use a 4-point Likert Scale, with 3 lower measures of 7 questions each for depression, anxiety, and stress.
Whereas Cronbach`s alpha values of depression, anxiety, and stress were 88, .89, and .86, respectively, in Song [14]'s research; Cronbach`s alpha values of depression, anxiety, and stress were .86, .90, and .90, respectively in the research.
2.4 Analysis Methods
SPSS 21.1 was used to analyze the data collected for this research.
⦁Descriptive statistics were used to measure the general characteristics of the subjects.
⦁Pearson's correlation coefficient was used to measure the correlation between the subjects' aggression and their depression, anxiety, and stress.
⦁Multiple regression was used to measure the level of effect of depression, anxiety, and stress of the subjects on aggression.
3. Research Results
3.1 The General Characteristics of the Subjects
The average age of the subjects was 40.2 years, and the number of women, married, and high school graduates was 59 (64.8%), 63 (69.2%), and 57 (62.6%), respectively, accounting for highest share, and the average was 11.5 years (2.66%) <Table 1>.
Variables Category N(%) M(SD)
Age(year) ≦30
31-40 41<
16(17.6) 29(31.8)
46(50.6) 40.2(11.07)
Sex Male
Female 32(35.2)
59(64.8)
Marital Status Married
Single 63(69.2)
28(30.8)
<Table 1> General Characteristics of Subjects
3.2 The Level of Aggression, Depression, Anxiety, and Stress
The average level of aggression, depression, anxiety, and stress was 74.5 (19.14), 9.7 (5.66), 9 (5.48), and 10.8 (465) <Table 2>.
M(SD) Min-Max
Physical 20.4(6.95) 11-44
Verbal 12.6(3.75) 6-24
Anger 19.5(5.54) 8-32
Hostility 21.8(6.91) 8-38
Depression 9.7(5.66) 1-21
Anxiety 9(5.48) 1-20
Stress 10.8(4.65) 1-21
<Table 2> Aggression, Depression, Anxiety, Stress of Subjects
3.3 Correlation among the depression, anxiety, stress, and aggression
Aggression had a positive correlation with depression (r = .62, p<.001), anxiety (r = .62, p<.001), and stress (r = .62, p<.001), indicating that as depression, anxiety, and stress increase, aggression increases.
Depression also had a significant positive correlation with anxiety (r = .75, p<.001) and stress (r = .81, p<.001), and anxiety also had a positive correlation with stress (r = .82, p<.001) <Table 3>.
1 (p)r
2 (p)r
3 (p)r
4 (p)r
5 (p)r
6 (p)r
Physical1 1 Verbal2 .51
(.001) 1 Anger3. .67
(.001) .50 (.001) 1 Hostility4 .62
(.001) .42 (.001) .63
(.001) 1 Depression5 .48
(.001) .30 (.007) .65
(.001) .58 (.001) 1 Anxiety6 .34
(.002) .26 (.018) .64
(.001) .57 (.001) .75
(.001) 1 Stress7 .39
(.001) .32 (.004) .73
(.001) .60 (.001) .81
(.001) .82 (.001)
<Table 3> Correlation among Variables
3.4 Predictor of aggression
To identify explanation power of factors affecting aggression, a multiple regression analysis was conducted with aggression as independent variable and depression, anxiety, and stress that are a general variable as dependent variable. The Durbin–Watson statistic that shows autocorrelation of error produced 1.8, relatively close to 2, indicating no problem with respect to independence and autocorrelation of error terms. As the correlation between independent variables was .57-.94, the tolerance limit was .30-.32, indicating both of them were above 0.1, and variance inflation factors was 3.0 - 3.2, indicating none of them were over 10, there was no problem in regard to multicollinearity between independent variables.
Depression showed a significant factor affecting aggression, and the explanation power of it was 42.3%
<Table 4>.
Variables β t p Adj.R2 F(p)
Depression .30 1.95 .05
.423 18.33
(<.001)
Anxiety .09 0.60 .55
Stress .29 1.65 .10
<Table 4> Predictors of Aggression
4. Discussion
This research aims to verify the effect of depression, anxiety, and stress on aggression.
Results derived from this research showed that depression is highly correlated with aggression. This is consistent with the findings of Kim & Kang [15] and Jung [16] that as depression is higher, aggression is higher.
Most people supp.ress or evade expressing anger as they consider it as immature although they have desire to express anger as their idea about anger is negative.
If they do not properly express anger induced instead of expressing it, it can be replaced by negative emotion and behavior. Whereas when they project their thought that they cannot control anger themselves, this can cause depression inside; when they project their emotion to others impulsively, this can cause aggression [17-19]. Hence, anger targeted to themselves is developed into the same mechanism as that of aggression, a form of outwardly expressed depression and anger. This indicates depression has a positive correlation with aggression.
Results derived from this research are consistent with Cho et al. [20]'s research results in that aggression had a significant correlation with depression, anxiety, and stress.
Stress causes depression and anxiety, and this insecure emotion can be expressed as aggression.
Therefore, stress has a positive correlation with depression and anxiety.
Depression is related to irrational thinking such as desire for acknowledgement, excessively high self-expectation, frustration response, over anxiety, powerlessness, and perfectionism, while the factor of frustration response, perfectionism, problem avoidance, over anxiety, and emotional irresponsibility are significantly correlated to both anxiety and depression [21,22]. As stated above, anxiety and depression are highly correlated with one another, and notwithstanding a slight difference, cognitive
similarities exist between them [23].
What to consider on such process is cognitive system of patients with depression. Cognitive vulnerability resulting from cognitive error of patients with depression is called schema, suggesting a frame of cognition that an individual systemizes his own experience by selectively accepting and interpreting his/her surrounding stimulus [24].
The cause of cognitive vulnerability is stress. This is caused by cognitive vulnerability such as a tendency of considering himself or herself as vulnerable, and judging the world as dangerous by being excessively over-protected on surrounding risk factors from worried parents, or is formed through severely shocking incidents [25].
Results derived from the research of Choi & Kim [26] drew a meaningful relationship between depression, anxiety and aggression, and that a factor affecting depression and anxiety was stress.
Aggression of patients with depression, an outwardly expressed form of depression and anxiety caused by stress, may serve as an alternative to protect themselves from dangerous external environment.
In the research of Park et al. [27], depression, anxiety, and stress had a significant correlation between them, suggesting a possibility of mental disorder of affective disorder such as aggression for consistent increase in depression, anxiety, and stress.
Stress causes not only physical disease but also negative emotion such as anxiety and depression, and unless this does not stabilize insecure emotion effectively, irrational behavior such as aggression as ineffective countermeasure can be caused.
These results derived from the research showed that depression, anxiety, and stress had a significant correlation with aggression, and notably depression was a factor affecting aggression. Namely, aggression is correlated with psychological factor. Hence, a prerequisite is psychological program to help reducing aggression relieving depression, anxiety, and stress of depressed adults.
5. Conclusion
This research was conducted to contribute to emotional stability of depressed adults, and provide basic data that help treating them by grasping the level of depression, anxiety, and stress affecting stress. A questionnaire survey was conducted for 91 depressed adults, and SPSS 21.1 was used to analyze collected data. Results derived from this research concluded that aggression had a significant correlation with depression (r=.62, p=.000), anxiety (r=.62, p=.000), and stress (r=.62, p=.000), and depression is a significant factor affecting aggression, whose explanation power was 42.3%.
Based on the results stated above, the suggestions are as follows.
1. Research is required on more variables affecting aggression of depressed adults.
2. Comparative research is required on aggressive character of depressed adults and other mental disorders.
3. Repeated research is required on aggression of depression patients.
4. Repeated studies are needed for various age groups.
5. Intervention program of aggression is required based on systematic survey data appropriate for various cultural backgrounds of depressed adults.
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김 영 희(Young-Hee Kim) [정회원]
▪1999년 2월 : 충남대학교 간호학 과 (간호학박사)
▪2005년 3월 ～ 현재 : 대전과학기 술대학교 간호학과 교수
▪관심분야 : 여성건강, 건강증진
▪E-Mail : [email protected]
권 명 진(Myoungjin Kwon) [정회원]
▪2008년 8월 : 충남대학교 간호학 과 (간호학박사)
▪2010년 3월 ～ 2014년 2월 : 혜천 대학교 간호학과 교수
▪2014년 3월 ～ 현재 : 대전대학교 간호학과 교수
▪관심분야 : 정서, 노인, 만성질환, 정신질환
▪E-Mail : [email protected]
