Women with congestive heart failure who repress their emotions, especially anger, are more likely than emotionally expressive women to experience symptoms of depression associated with knowledge about their disease, according to new research.

Coping styles of women in the study influenced how depressed or anxious they felt. The less they talked about or expressed their emotions, the more likely they were to have symptoms of depression and anxiety.

When Ohio State University researchers examined the influence of knowledge about their illness on the patients’ mental well-being, they found that some women with heart failure felt worse emotionally when they had more information about the disease. For those women - who tend to deny their emotions - less information is better. For them, certain types of knowledge can actually lower their emotional quality of life, according to the research.

The findings of this pilot study suggest that clinicians should consider patients’ individual coping styles when educating them about their illness, the researchers say. For example, women who cope by denying their emotions might become particularly distressed by information that provokes fear – such as learning about the increased risk of hospitalization as a consequence of not taking medication or exercising enough.

“We’re not saying knowledge is not a good thing,” said Charles Emery, professor of psychology at Ohio State and co-author of the study. “For patients who are greater in denial, knowledge seemed to be a negative factor. Whereas for people who either had difficulty expressing emotion or putting a label on their emotion, knowledge is still beneficial.”

Emery co-authored the study with Jamie Jackson, a former Ohio State graduate student who is now a postdoctoral fellow at Northwestern University. The study is published in a recent issue of the journal Heart & Lung.

The study involved 35 women diagnosed with at least stage C congestive heart failure as categorized by the American College of Cardiology, meaning they had structural heart damage, experienced symptoms that might include shortness of breath and swelling in the legs and abdomen, and were managing the disease with medication. Heart failure is a condition in which the heart muscle is weakened, resulting in reduced blood flow throughout the body.

The researchers asked the participants to complete a number of questionnaires to measure their coping styles, illness knowledge, emotional quality of life and physical quality of life.

Women’s coping styles were categorized in three ways: anger-in, or a tendency to withhold angry emotions; alexithymia, or difficulty identifying and describing feelings; and emotional expressivity, which could be either low or high.

Overall, the women reported elevated symptoms of depression and anxiety compared to national data on these symptoms in healthy adults.

Depressive symptoms – which can include loneliness, sadness, fear, sleep problems and an unshakable sense of the “blues” – as well as anxiety symptoms were associated with repression of anger, difficulty describing feelings and low emotional expressivity. Those with a higher level of emotional expression were less likely to report depressive symptoms.