Anger problems and posttraumatic stress disorder in male and female National Guard and Reserve Service members

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Abstract

Anger is a common problem among veterans and has been associated with posttraumatic stress disorder (PTSD). This study aimed to improve understanding of how anger and PTSD co-occur by examining gender differences and differences by whether the triggering traumatic event is deployment-related vs. civilian-related in current service members. A representative cohort of Reserve and National Guard service personnel (n = 1293) were interviewed to assess for deployment- or civilian-related traumas, PTSD, and anger. The prevalence of self-reported anger problems was estimated among male (n = 1036) and female (n = 257) service members. Log Poisson regression models with robust standard errors were used to estimate the associations of problems with anger with PTSD and PTSD symptom severity for men and women. Self-reported anger problems were common among male (53.0%) and female (51.3%) service members. Adjusted prevalence ratios (PR) showed associations between anger and PTSD connected to both civilian- and deployment-related traumas (PR were 1.77 (95% CI 1.52–2.05) and 1.85 (95% CI 1.62–2.12), respectively). PTSD symptom severity was also associated with anger. This study was cross-sectional and so a causal relationship between PTSD and anger cannot be established. Problems with anger are common among male and female current Guard and Reserve members. These findings suggest that anger treatment should be made available to current service members and that clinicians should assess anger problems irrespective of gender. Future research should examine the effectiveness of anger treatment protocols by gender.

Section snippets

Objectives of the study and background

Anger problems are common among military veterans, with population-based estimates of the prevalence of self-reported anger in post 9/11 veterans ranging between 44% and 57% (Pew Research Center, 2011, Sayer et al., 2010, Wheeler, 2007). In both military and civilian populations, anger problems have been associated with a number of negative consequences, including poor family functioning (Taft et al., 2008), negative workplace and school outcomes (Hershcovis et al., 2007, Thomas and Smith, 2004

Materials and methods

The U.S. Army Medical Command's Congressionally Directed Medical Research Programs Unit, the Human Research Protection Office at the U.S. Army Medical Research & Materiel Command, and the Institutional Review Boards at both the Uniformed Services University of the Health Sciences and Columbia University approved the study protocol. Verbal informed consent was obtained from all participants.

Results

The characteristics of this sample are presented in Table 1. Group differences in the prevalence of anger, civilian-related PTSD, and deployment-related PTSD were examined by demographic characteristics and gender. The prevalence of anger was similar among women and men (51.3% in women, 53.0% in men, p = 0.6). Civilian-related PTSD in the past year was documented among 3.0% of participants; deployment-related PTSD in the past year was documented among 3.4% of participants. Men had lower

Discussion

In a representative national sample of Reserve and National Guard soldiers, we found that half of all soldiers reported problems with anger within the past year. The prevalence of anger in this population is comparable to recent veteran populations (Pew Research Center, 2011, Sayer et al., 2010, Wheeler, 2007), suggesting problems with anger likely precede separation from the military. While no studies have examined the effectiveness of treatment for anger problems in current service members

Conclusion

These findings contribute valuable information about the prevalence of anger and the nature of the association between anger and PTSD in military service members. We established that anger is a common problem for current service members, in addition to veterans, and that anger is equally common among men and women in contrast to the perception that anger is a larger problem for men. We also found that the relations between anger and PTSD are similar for men and women, in contrast to previous

Role of funding source

This study was funded by the following federal grants. The opinions expressed in the manuscript are those of the authors and, therefore, do not necessarily reflect the views of the Department of Defense or the National Institutes of Health.

MH 082729/MH/ National Institute of Mental Health NIH U.S. Department of Health and Human Services/United States.

U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland 21702-5012: Award Number W81XWH-08-2-0650.

U.S. Army Medical Research and

Contributors

Drs. Ursano, Gifford, Fullerton, and Galea designed the study and wrote the protocol. Drs. Worthen and Ahern developed supplementary procedures for the protocol. Mr. Cohen and Ms. Sampson manage the study data and assisted in statistical analysis. Drs. Rathod, Worthen, and Ahern undertook statistical analyses. Dr. Worthen wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflicts of interest

None of the authors have any conflicts of interest to disclose.

Acknowledgments

This research was funded by Federal grants W81XWH-08-2-0204, W81XWH-08-2-0650, MH 082729. The opinions expressed in the manuscript are those of the authors and, therefore, do not necessarily reflect the views of the Department of Defense, the Uniformed Services University of the Health Sciences, or the Center for the Study of Traumatic Stress.

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