Direct and indirect relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans

Bhardwaj, Vinnu; Angkaw, Abigail C.; Franceschetti, Massimo; Rao, Ramesh R.; Baker, Dewleen G.

doi:10.1002/ab.21827

Cited by 11 publications

(6 citation statements)

References 48 publications

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“…Alternatively, it is possible that anger acted as a commonality between participants who felt they had been treated unjustly by their employers and as such became a bonding mechanism for group members. Finally, correlations between anger and PTSD symptoms (r = .16) were lower than in previous studies (Bhardwaj et al, 2018;Novaco et al, 2012) and lower than that reported in the meta-analysis of Orth and Wieland (2006). Thus, it is possible that some group participants were experiencing non-PTSD-related anger confined to other life domains, such as relationships and family, which may have not necessarily influenced their decision making about persisting with PTSD treatment.…”

Section: Discussioncontrasting

confidence: 63%

Anger and predictors of drop-out from PTSD treatment of veterans and first responders

Hinton

Steel

Hilbrink

et al. 2021

Behav. Cogn. Psychother.

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Background: Drop-out is an important barrier in treating post-traumatic stress disorder (PTSD) with consequences that negatively impact clients, clinicians and mental health services as a whole. Anger is a common experience in people with PTSD and is more prevalent in military veterans. To date, no research has examined if anger may predict drop-out in military veterans or first responders. Aims: The present study aimed to determine the variables that predict drop-out among individuals receiving residential treatment for PTSD. Method: Ninety-five military veterans and first responders completed pre-treatment measures of PTSD symptom severity, depression, anxiety, anger, and demographic variables. Logistic regression analyses were used to determine if these variables predicted drop-out from treatment or patterns of attendance. Results: Female gender was predictive of drop-out. However, when analysed by occupation female gender was predictive of drop-out among first responders and younger age was predictive of drop-out in military participants. Anger, depression, anxiety and PTSD symptom severity were not predictive of drop-out in any of the analyses. No variables were found to predict attendance patterns (consistent or inconsistent) or early versus late drop-out from the programme. Conclusion: These results suggest that although anger is a relevant issue for treating PTSD, other factors may be more pertinent to drop-out, particularly in this sample. In contrast with other findings, female gender was predictive of drop-out in this study. This may indicate that in this sample, there are unique characteristics and possible interacting variables that warrant exploration in future research.

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Section: Discussioncontrasting

confidence: 63%

Anger and predictors of drop-out from PTSD treatment of veterans and first responders

Hinton

Steel

Hilbrink

et al. 2021

Behav. Cogn. Psychother.

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“…Research has also demonstrated that depression and suicidality are related to aggression [ 61 - 63 ]. Other research has even related to aggression [ 64 , 65 ] or focused on predicting personality disorder through aggression [ 66 - 68 ]. All these findings tend to question whether aggression has impacts on global health in the general population [ 69 - 71 ], which could open the way for further studies.…”

Section: Discussionmentioning

confidence: 99%

Psychiatric and non-psychiatric population vulnerabilities in time of a crisis: the unsuspected aggression factor

Martin

Oltra²,

Monte

2023

BMC Psychiatry

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Objectives In March 2020, France faced a health crisis due to the COVID-19 outbreak that, like previous infectious disease crises, involved high psychological and emotional stress, a series of factors that influenced the ongoing mental health crisis. Methods We recruited 384 respondents to complete an online questionnaire during the second month of isolation: 176 psychotherapy recipients (68 were currently attending psychiatric care) and 208 healthy controls. We measured demographic characteristics, impulsivity, aggression, hopelessness, suicidal risk, and the global level of anxiety and depression in order to estimate potential discrepancies in clinical measures across these populations. Results Our results indicate that the group currently undergoing psychiatric care was prone to loneliness and social isolation. Regarding clinical and nonclinical population, there were differences in suicidal risk, depression, anxiety, and hopelessness but mainly in aggression. Regression analysis also demonstrated that aggression surprisingly influenced anxiety levels. Patients undergoing therapy compared with patients who were not displayed differences only in suicidal risk, anxiety, and hopelessness, with those undergoing therapy having higher scores. The outpatient group undergoing therapy had a significantly lower level of impulsivity. Moreover, the regression to predict anxiety and depression levels from correlated factors highlighted the potentially heightened role of aggression in predicting anxiety in the clinical group. Conclusion New research into stress reactions should assess other clinical signals, such as aggression, and examine preventive mental health interventions in times of crisis.

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“…In our subsample of veterans with a retrospective history of greater than minimal early life adversity, depression and anxiety symptoms were significantly associated with anger. Studies with post‐9/11 veterans have shown an indirect relationship between PTSD and anger through depressive symptoms (Angkaw et al, 2013; Bhardwaj et al, 2019), suggesting that although anger is a symptom of PTSD, depressive symptoms play an important role in anger. Notably, these studies relied on mediation methods that lacked control of confounders (Angkaw et al, 2013) or controlled only for basic demographics of age and gender (Bhardwaj et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Studies with post‐9/11 veterans have shown an indirect relationship between PTSD and anger through depressive symptoms (Angkaw et al, 2013; Bhardwaj et al, 2019), suggesting that although anger is a symptom of PTSD, depressive symptoms play an important role in anger. Notably, these studies relied on mediation methods that lacked control of confounders (Angkaw et al, 2013) or controlled only for basic demographics of age and gender (Bhardwaj et al, 2019). Although our sample size did not allow us to explore the differential impact of early life adversity type and timing on the relationships among depression and anxiety with current anger, our findings align with relevant recent studies.…”

Section: Discussionmentioning

confidence: 99%

Associations among clinical variables and anger differ by early life adversity among post‐9/11 veterans

Etchin

Corbo

Brown

et al. 2022

Clin Psychology and Psychoth

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Maladaptive anger and aggression are common in US military veterans and increase risk for impaired social relationships and functioning, justice-involvement and violence. Early life (before age 18) adversity predisposes veterans to later life psychopathology, though the link to increased later life anger is unclear. We analysed crosssectional data of 158 post-9/11 veterans from the Translational Research Center for Traumatic Brain Injury and Stress Disorders study with and without a history of early life adversity (ns = 109 and 49, respectively). We explored the relationship among major clinical variables and current veteran anger (Dimensions of Anger Reactions) and whether the associations with these variables differed among participants with and without a history of retrospective self-reported early life adversity (Childhood Trauma Questionnaire). In the overall sample, posttraumatic stress disorder (PTSD) and depression severities had the strongest associations with current veteran anger (βs = 0.261 and 0.263; p-values = 0.0022 and 0.0103, respectively). In the subsample without early life adversity, only PTSD severity was significantly associated with anger (β = 0.577, p = 0.0004). In the early life adversity subsample, this strong association weakened and was no longer significant (β = 0.168, p = 0.1007); instead, anxiety and depression severities showed moderate associations with anger (βs = 0.243 and 0.287, p-values = 0.0274 and 0.0130, respectively). Findings suggest that clinicians should screen veterans with history of early life adversity for depression and anxiety when anger is present.

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Direct and indirect relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans

Cited by 11 publications

References 48 publications

Anger and predictors of drop-out from PTSD treatment of veterans and first responders

Anger and predictors of drop-out from PTSD treatment of veterans and first responders

Psychiatric and non-psychiatric population vulnerabilities in time of a crisis: the unsuspected aggression factor

Associations among clinical variables and anger differ by early life adversity among post‐9/11 veterans

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