PTSD/Depression Combination Increases Anger in Veterans

by U.S. Medicine

July 24, 2015

IRVINE, CA — Veterans with post-traumatic stress disorder (PTSD) are much more likely to have their tempers erupt if they also are depressed, according to a new study.

The study, led by researchers from the University of California Irvine, appeared in the journal Psychological Trauma: Theory Research, Practice and Policy.1

“Our study findings should draw attention to anger as a major treatment need when military servicemembers screen positive for PTSD or for depression and especially when they screen positive for both,” said lead author Raymond Novaco, PhD, professor of psychology and social behavior at the University of California, Irvine.

For the study, researchers reviewed behavioral health data on 2,077 U.S. troops — 1,823 men and 254 women — who were deployed to Iraq and Afghanistan and subsequently sought behavioral health services at a military facility. Participants were screened for PTSD and major depressive disorder before being placed in one of four groups:

  • PTSD-only
  • MDD-only
  • PTSD and MDD combined
  • Neither

Veterans then were assessed for anger and asked whether they said they were considering harming others.

Results indicate that anger and self-rated risk of harm were both significantly higher in the group with both PTSD and MDD compared to the other three groups. PTSD also was commonly paired with depression, with about 72%of those who screened positive for PTSD also screening positive for MDD.

Novaco suggested that anger has been given insufficient attention as a clinical problem among combat veterans and trauma populations in general, explaining, “PTSD and depression dominate the landscape, but these, of course, are formal psychiatric disorders. There is no diagnostic category for anger, nor do I think there should be, so anger slips from research attention.”

According to previous PTSD studies, anger can predict PTSD severity but also interfere with PTSD treatment. The recent report cited a 2010 study of more than 18,000 soldiers returning from Iraq, which found that about 40% had physical bursts of anger, more than 30% threatened someone with physical violence and greater than 15% engaged in a physical fight.

“Anger is a driver of violent behavior, but it is responsive to anger-focused psychological treatment,” said Novaco. He recommended that servicemembers presenting with PTSD, depression or, most importantly, both should receive treatment focusing on anger.

1 Gonzalez OI, Novaco RW, Reger MA, Gahm GA. Anger Intensification With Combat-Related PTSD and Depression Comorbidity. Psychol Trauma. 2015 May 11. [Epub ahead of print] PubMed PMID: 25961863.

Mental, Physical Health Visits Rise for Returning Troops’ Kids

BETHESDA, MD — Children whose military parents have recently returned from combat deployment increase their visits for mental healthcare, physical injury and child maltreatment consults, compared to children whose parents have not been deployed, according to a recent study.

The study, published recently in the Journal of the American Academy of Child and Adolescent Psychiatry, also notes that similar healthcare visits also were significantly higher for children of combat-injured parents.1

The study, led by researchers from the Uniformed Services University of the Health Sciences, used MHS data to analyze healthcare utilization patterns of 487,460 children aged 3-8. The research team assessed the rate of post-deployment mental health, injury and child maltreatment visits of children whose parents did not deploy, those whose parents deployed and returned uninjured, and children whose parents deployed and returned injured.

Of the participants, 58,479 (12%) had a parent deploy, and 5,405 (1%) had a parent injured during deployment. Relative to children whose parents did not deploy, children of deployed and combat-injured parents had additional visits for mental health diagnoses — incidence rate ratio 1.09 and 1.67, respectively. They also had more injuries — an incident rate ratio of 1.07 for deployed parents and 1.24 for injured parents — and more maltreatment — IRRs 1.21 and 2.30, respectively.

“Mental health problems, injuries and maltreatment after a parent’s return from deployment are amplified in children of combat-injured parents,” the authors conclude. “Increased preventive and intervention services are needed for young children as parents return from deployments. Child health and mental health providers are crucial to effective identification of these at-risk children to ensure effective care provision.”

1 Hisle-Gorman E, Harrington D, Nylund CM, Tercyak KP, Anthony BJ, Gorman GH. Impact of parents’ wartime military deployment and injury on young children’s safety and mental health. J Am Acad Child Adolesc Psychiatry. 2015 Apr;54(4):294-301. doi: 10.1016/j.jaac.2014.12.017. Epub 2015 Feb 2. PubMed PMID: 25791146.

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