Men who suppress their anger about unfair treatment at work are two to five times more likely to suffer a heart attack or die from heart disease than those who quickly vent their frustration, a Swedish study shows.

The results from the survey involving 2,755 men confirm previous findings from the Framingham Study in the US and show bottling up anger and frustration may harm the heart. Scientists have long speculated that anger or arousal that "boils under the surface" may cause physical reactions like high blood pressure and related ailments, the researchers said.

They enrolled healthy Swedish men with an average age of 41 in the study from 1992 through 1995, then tracked them for a decade to compare a range of work and health factors. The analysis found those who often relied on "covert coping," where they walked away or ignored unfair treatment, often paid the price in terms of their health. The results appear in the Journal of Epidemiology and Community Health.

"It's not good to go away and just leave the conflict if you feel you have been badly treated," Constanze Leineweber, lead researcher from the Stress Research Institute at Stockholm University, said yesterday in a telephone interview. "You have to act. It's better to say that you feel unfairly treated."

The risk of heart attack and death was double among men who reported holding in their feelings, developing physical symptoms such as headaches or stomach aches, or letting off steam once they got home, the study found. When they honed in on men who often walked away or let things pass without saying anything, the heart risks rose nearly five-fold, the researchers said.

They were unable to identify the best way to respond, getting similar rates of heart complications among men who said they yelled, protested their treatment directly, talked to the offender right away or addressed the problem after the situation had calmed down.

More rigorous studies are needed to determine if suppressed anger does increase heart risk, the researchers said. If the finding is confirmed, a more active approach to confronting unfair treatment may reduce rates of heart disease, the leading cause of death worldwide, they said.

"The best thing might be to not have any conflict," Leineweber said. "If you've been unfairly treated, it's not good to do covert coping."

However, anger and violent conflicts in the workplace has become a major problem for Corporate America. In a recent Gallup poll, two out of every ten employees confessed to being angry enough to "hurt" some co-worker in the last six months.

Workplace hostility can often be traced to attitudes that have little to do with the current employment situation in which workers find themselves.

Deep-seated feelings of hostility toward other people because of their gender, skin colour, sexual orientation, political beliefs, or other factors are often firmly in place long before the person begins working at your company.

Often, the small business owner faced with such an employee will have limited options available to deal with such problems; instead, he or she will concentrate efforts on making sure that those undesired attitudes do not disrupt the workplace.

Factors that cause workplace anger, on the other hand, can sometimes be addressed directly. While workplace anger sometimes can be traced back to prejudices that are at the root of deep-seated hostility, on many other occasions, work-oriented factors serve as the primary catalysts. Common causes of workplace anger include:

• General harassment, whether sexual or some other form.

• Favouritism of one employee over another.

• Rejection (whether arbitrary or for good reason) of a proposal or project in which employee has big emotional investment.

• Insensitivity by owners or managers.

• Criticisms of employees in front of staff or clients.

• Depersonalised workplace environment.

• Unfair (or tardy) performance appraisals or criticism.

• Lack of resources for the employee to meet his/her objectives.

• Inadequate training.

• Lack of teamwork.

• Withdrawal of earned benefits.

• Betrayal of trust extended to manager or owner.

• Unreasonable demands on employees.

• Does not keep promises.

• Lack of flexibility on part of owner or manager.

• Poor communication.

• Feedback is wholly or primarily negative in tone.

• Absentee leadership (such as instances wherein needed disciplinary action is absent).

• Micromanagerial environment in which staff decisionmaking opportunities are limited.

Of course, sometimes a distinction must be made between legitimate and illegitimate catalysts of workplace anger. For example, an employee may express great anger over a negative performance review even though the appraisal was conducted fairly and honestly.

Small business owners and managers cannot jettison basic principles of management simply to avoid making one of their employees angry.

Workplace anger is often sublimated by employees until they reach a point where they suddenly burst. This "bursting" point may manifest itself in a variety of ways. One employee may just yell at his manager, while another may impetuously decide to quit. Still others may resort to workplace violence or vandalism.

Small business owners and managers should acquaint themselves with the warning signs of hidden anger so that they can address the causes for that anger and hopefully head off an incident before it occurs. Other employees, meanwhile, may exhibit behavior that is more obviously troubling. Following are a range of behaviors that may signal a need for intervention:

• Sarcastic, irritable, or moody behaviour.

• Apathetic and/or inconsistent work performance.

• Prone to making direct or veiled threats.

• Aggressive and antisocial behaviour.

• Overreaction to company policies or performance appraisals.

• Touchy relationships with other workers.

• Obsessive involvement and/or emotional attachment to job.