J. psychiat. Res., Vol. 30, No. 6, pp. 459 467. 1996 - ~ P e r - a m o n Copyright c: 1996 Elsevier Science Ltd. All rights reserved Printed in Great Britain 0022 3956,,'96 $15.00+0.00 PII: S0022-3956(96)00034-9 H O S T I L I T Y C H A N G E S F O L L O W I N G A N T I D E P R E S S A N T T R E A T M E N T : R E L A T I O N S H I P TO S T R E S S A N D N E G A T I V E T H I N K I N G MAURIZIO FAVA, KATHARINE DAV1DSON, JONATHAN E. ALPERT, ANDREW A. NIERENBERG, JOHN WORTHINGTON, RICHARD O'SULLIVAN and JERROLD F. ROSENBAUM Depression Research Program, Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston, MA, U.S.A. (Received 5 July 1995; ret,ised 17 June 1996: accepted 26 Julr 1996) Summary--It is unclear whether changes in hostility following treatment are primarily related to improvement in depressive symptoms or are also closely associated with reductions in negative thinking or perceived stress. We evaluated 94 outpatients with major depression before and after eight weeks of fluoxetine treatment by administering the Symptom Questionnaire (SQ) Hostility Scale, the Hamilton Rating Scale for Depression (HAM-D), the Cognitions Questionnaire (CQ) and the Perceived Stress Scale (PSS). We observed significant elevations in scores on these ques- tionnaires in depressed patients as compared to normal controls. Following treatment with fluox- etine, there was a statistically significant reduction in scores on all four questionnaires. We observed that changes in SQ Hostility were significantly positively related to changes in both depression severity and perceived stress, with these relationships remaining significant after adjusting for gender and baseline SQ Hostility. The relationship between SQ Hostility changes and reductions in negative thinking became significant only after adjusting for gender and baseline SQ hostility. Our results suggest thai the marked decrease in hostility following antidepressant treatment is related to a reduction in depressive symptoms, stress levels and negative thinking. Copyright !i 1996 Elsevier Science Ltd. Introduction Over the past few years, a number of studies have suggested an association be hostility and major depression. In particular, depressed patients have been observed to significantly more hostile and angry than normal subjects (Riley et al., 1989) and to r anger attacks much more frequently than normal controls (Fava et al., 1991b). Several possible contributing factors have been postulated to play an important role in media this relationship. For example, a study by Pilowsky & Spence (1975) indicated that dep patients' self-ratings of anger were positively, but none significantly, correlated with presence of nonendogenous features which suggests that excessive anger may be mor to occur in individuals who are highly sensitive to external events. On the other hand, et al., 1982b have reported a significant association between severity of depression hostility among depressed patients who had not reported losses, but not among depres Correspondence to: Dr M. Fava (Tel: + I 617 726 3488: Fax: + 1 617 726 7541). 459