New editorial draws attention to the need to understand the experience of anger among ex-Service members
Anger is the elephant in the room when it comes to understanding the mental health of Service members and ex-Service members. Such is the premise of a new editorial published in the Journal of Anxiety Disorders and authored by the Mental Health Research and Innovation Collaborative (MHRIC), a working group of military and veteran mental health experts across the Five–Eyes countries (UK, USA, Canada, Australia and New Zealand).
This editorial (“Problematic anger in military and veteran populations with and without PTSD: The elephant in the room”) focuses on two points right from the outset. First, problematic anger is not just an optional feature of posttraumatic stress disorder (PTSD) but is an issue in its own right. Second, despite its disruptive impact, little direct attention in clinical practice, research and veteran policies focuses on problematic anger.
The editorial draws attention to a number of important findings that have emerged from recent research on problematic anger:
- Problematic anger is common: almost one in three military veterans report problematic anger in the initial years following separation from the military.
- Problematic anger predicts difficulty in life adjustment after leaving the military: Problematic anger not only contributes to psychological distress in veterans but also contributes to difficulties with their adjustment to post-service life, including subsequent financial problems, employment and housing instability, and relationship breakdown.
- Problematic anger is associated with high-risk behaviours: Problematic anger is associated with significant risk in terms of suicidality and aggression and violence.
- Problematic anger is independent of other mental health problems: This research makes clear that problematic anger is associated with high-risk outcomes even after factoring in other mental health problems such as PTSD and depression. In other words, problematic anger can drive negative outcomes over and above the influence of PTSD and depression on the lives of service members and veterans.
After addressing the prevalence of problematic anger and the evidence regarding its link to post-service adjustment, the Editorial then outlines new strategies that can address problematic anger in both clinical treatment and other veteran service contexts. The Editorial also highlights the need for direct intervention in problematic anger. Given consistent evidence demonstrating that problematic anger reduces the effectiveness of PTSD treatment, it is important to develop approaches that directly tackle the issue of problematic anger. These strategies include:
- Brief and free screening tool to identify problematic anger: Recent research has developed and validated a 5-question screener for Problematic Anger called the Dimensions of Anger Reactions Scale 5 (or the “DAR-5”). This brief, free and simple screener for problematic anger can easily be used in clinical and other service contexts and in research.
- Interventions for problematic anger in veterans: There is a small evidence base for effective clinical interventions that address problematic anger, and these new treatments have been recently adapted for military veterans. This research has also explored promising technology-based interventions. If these interventions are effective, they can increase the reach of anger-focused interventions considerably.
The editorial concludes with a series of recommendations to be considered:
- Adding a brief measure of anger such as the DAR-5 in every relevant military and veteran study and screening opportunity.
- Emphasising non-clinical interventions (e.g., the role of leaders and peers).
- Ensuring military and veteran patients receiving evidence-based care are first screened for problematic anger to match their needs to effective treatment.
- Training clinicians to build skills and confidence in providing evidence-based treatments for problematic anger to serving and veteran military personnel.
- Focusing on the period of transition out of military service as an opportunity to address the deleterious effects of problematic anger on veteran adjustment.
- Offering information to recognize problematic anger and intervene, including self-management, emerging digital options, and evidence-based professional support.
Thank you to Professor David Forbes and Dr Amy B. Adler for writing this spotlight article of their important and timely editorial about anger and ex-Service personnel.
