The involvement of anger in the psychological adjustment of current war veterans, particularly in conjunction with combat-related posttraumatic stress disorder (PTSD), warrants greater research focus than it has received. The present study concerns a brief anger measure, Dimensions of Anger Reactions (DAR), intended for use in large sample studies and as a screening tool. The concurrent validity, discriminant validity, and incremental validity of the instrument were examined in conjunction with behavioral health data for 3,528 treatment-seeking soldiers who had been in combat in Iraq and Afghanistan. Criterion indices included multiple self-rated measures of psychological distress (including PTSD, depression, and anxiety), functional difficulties (relationships, daily activities, work problems, and substance use), and violence risk. Concurrent validity was established by strong correlations with single anger items on 4 other scales, and discriminant validity was found against anxiety and depression measures. Pertinent to the construct of anger, the DAR was significantly associated with psychosocial functional difficulties and with several indices of harm to self and to others. Hierarchical regression performed on a self/others harm index found incremental validity for the DAR, controlling for age, education, military component, officer rank, combat exposure, PTSD, and depression. The ability to efficiently assess anger in at-risk military populations can provide an indicator of many undesirable behavioral health outcomes.

These results provide preliminary evidence that multiple deployments to Iraq may be a risk factor for PTSD. However, these cross-sectional data require replication in a longitudinal study.

No abstract

Repeated combat deployments to Iraq and Afghanistan are resulting in increased rates of posttraumatic stress disorder (PTSD) among military personnel. Although exposure therapy is an effective treatment for this disorder, some personnel do not significantly respond to treatment, possibly due to poor activation of the trauma memory or a lack of emotional engagement during therapy. In addition, some service members do not seek mental healthcare due to treatment stigma. Researchers recently developed a virtual reality (VR) Iraq to attempt to improve activation of the traumatic memory during exposure therapy and to provide a treatment approach that may be more appealing to some service members, relative to traditional face-to-face talk therapy. Initial validation of the application requires an assessment of how well it represents the experiences of previously deployed service members. This study evaluated the realism of the VR Iraq application according to the subjective evaluation of 93 U.S. Army soldiers who returned from Iraq in the last year. Those screening negative for PTSD used and evaluated a VR tactical convoy and a VR dismounted patrol in a simulated Middle Eastern city. Results indicated that 86% of soldiers rated the overall realism of the VR convoy as ranging from adequate to excellent. Eighty-two percent of soldiers reported adequate-to-excellent overall realism of the city environment. Results provide evidence that the VR Iraq presents a realistic context in which VR exposure therapy can be conducted. However, clinical trials are needed to assess the efficacy of VR exposure therapy for Iraq veterans with PTSD.

The PDHRA MDD, PTSD, and alcohol abuse screens appear to be functioning well in accurately ruling out these diagnoses, consistent with a population-level screening program. Cross validation of the current results is indicated. Additional refinement may yield more sensitive screening measures within constraints imposed by the low base rates in a typically healthy population.