Association of Problematic Anger With Long-term Adjustment Following the Military-to-Civilian Transition

Adler, Amy B.; LeardMann, Cynthia A.; Villalobos, Javier Aguilar; Jacobson, Isabel G.; Forbes, David; Belding, Jenn; Boparai, Satbir; Carey, Felicia R.; Castañeda, Sheila F.; Geronimo-Hara, Toni Rose; Kolaja, Claire A.; Magallon, Sandra; Rivera, Anna C.; Rull, Rudolph P.; Seay, Julia S.; Sharifian, Neika; Sheppard, Beverly; Trone, Daniel W.; Walstrom, Jennifer L.; Wooten, Nikki R.; Zhu, Katie

doi:10.1001/jamanetworkopen.2022.23236

Cited by 15 publications

(7 citation statements)

References 44 publications

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“…Furthermore, navigating a new civilian life can involve economic challenges and workrelated struggle. Previous work has shown signi cant associations between problematic anger and economic dysfunction(Adler et al, 2022), thus the increased economic instability associated with changing career may partially account for the increased levels of anger among veterans in our study.…”

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confidence: 54%

“…The relationship between military personnel entering the civilian world and the phenomenon of problematic anger is, however, relatively unexplored. In an exception, one study found signi cant associations between problematic anger during the transition and emotional, relational, and nancial functioning approximately 5 years later (Adler et al, 2022). Such ndings suggest the importance of considering the military-tocivilian transition in modeling risk of problematic anger.…”

Section: Introductionmentioning

confidence: 99%

“…Even so, academic research on problematic anger among combat veterans is relatively nascent, resulting in anger being labelled the "neglected emotion" (Forbes et al, 2022(Forbes et al, / 2023). To address this gap, calls have been made to assess the scope of problematic anger in military populations and explore its potential associations to other areas of concern in such cohorts, particularly shame and guilt (Metcalf et al, 2023), chronic pain (McDermott et al, 2017), and the military-to-civilian transition (Adler et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

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Problematic Anger among Military Personnel after Combat Deployment: Prevalence and Risk Factors

Nordstrand,

Anyan,

Bøe

et al. 2024

Preprint

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Background: Problematic anger, characterized by excessive frequency, intensity, and duration of anger which cause substantial emotional distress and functional interference, poses a marked challenge in military populations. Despite its importance, research on this topic is limited. This study contributes to the literature by exploring problematic anger in a large sample of Norwegian military personnel who served in NATO missions in Afghanistan. Methods: All Norwegian military personnel who deployed to Afghanistan between 2001 and 2020 were sent a link to a cross-sectional web-based survey by the Joint Medical Services of the Norwegian Armed Forces in 2020. A total of 6205 individuals (response rate: 67.7%) participated. The cross-sectional survey assessed problematic anger, mental and physical health, war zone stressor exposure, and quality of life. Results: Overall, 8.4% of participants reported problematic anger. Mental health disorders, deployment-related shame and guilt, chronic pain, and challenges with the military-to-civilian transition were independently associated with problematic anger. Both staying in service and maintaining a part-time connection with the military as a reservist mitigated the risk of problematic anger after deployment, compared to complete separation from military service. Conclusion: Findings demonstrate a sizeable prevalence of problematic anger among veterans of combat deployments. Given the associations between problematic anger and mental health disorders, chronic pain, and transition challenges, interventions designed to mitigate problematic anger need to be multi-faceted, including the possibility of maintaining an ongoing connection to military service. By reducing the risk of problematic anger, occupational, interpersonal and health outcomes may be improved for service members. Future research should examine the impact of problematic anger on adjustment over time, prevention strategies, and problematic anger in other high-risk occupations.

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confidence: 54%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Problematic Anger among Military Personnel after Combat Deployment: Prevalence and Risk Factors

Nordstrand,

Anyan,

Bøe

et al. 2024

Preprint

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“…Not only is problematic anger prevalent, it is associated with difficulties across psychosocial and economic domains. In studies of US military personnel, problematic anger has been associated with worse psychological health and challenges with personal relationships, parenting, financial well-being, employment, and housing, even after adjusting for co-occurring mental health problems . In addition, studies of Australian military personnel have identified that problematic anger from point of recruitment has a negative impact on mental health trajectories .…”

Section: Introductionmentioning

confidence: 99%

Three-Item Dimensions of Anger Reactions Scale

Forbes,

LeardMann,

Lawrence-Wood

et al. 2024

JAMA Netw Open

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ImportanceProblematic anger is prevalent and associated with adjustment difficulties in military populations. To facilitate measurement of problematic anger, a very brief valid measure is needed.ObjectiveTo reduce the Dimensions of Anger Reactions 5-item (DAR-5) scale to a very brief measure.Design, Setting, and ParticipantsThis cross-sectional study used survey data collected between 2014 and 2016 in the Australian Transition and Well-Being Research Programme and US Millennium Cohort Study. Participants were service members who were actively serving or had transitioned out of the military (separated). Statistical analyses were performed from September 2021 to June 2023.Main Outcomes and MeasuresThe DAR-5 was reduced to the 3 experiential items: frequency, intensity, and duration (the DAR-3). Psychometrics for the DAR-3 and DAR-5 were compared in terms of standardized Cronbach α, positive screening result, mean, and SD. Analyses were stratified by Australian and US military service status cohorts (active duty and separated).ResultsA total of 71 010 participants were included from Australia and the US. Of 10 900 Australian participants (8145 active duty participants [74.7%]; 2755 separated participants [25.3%]), 5893 (55.2%) were aged 40 years or older and 8774 (80.5%) were male; of 60 110 US participants (24 706 active duty participants [41.1%]; 35 404 separated participants [58.9%]), 28 804 (47.9%) were aged 30 to 39 years and 43 475 (72.3%) were male. The DAR-3 demonstrated good internal consistency in the active duty (Australia: mean [SD] score, 4.97 [2.5]; α = 0.90; US: mean [SD] score, 5.04 [2.6]; α = 0.87) and separated (Australia: mean [SD] score, 6.53 [3.4]; α = 0.92; US: mean [SD] score, 6.05 [3.2]; α = 0.91) samples. The cutoff score of 8 or greater on the DAR-3 had optimal sensitivity and specificity across all samples. DAR-3 and DAR-5 were associated with posttraumatic stress disorder (PTSD), depression, aggression, and relationship conflict. While the scales did not significantly differ in their associations with PTSD, depression, and relationship conflict, the magnitude of association for aggression was significantly lower in US samples using the DAR-3 (eg, US active duty sample: DAR-5 OR, 9.96; 95% CI, 9.01-11.00; DAR-3 OR, 8.36; 95% CI, 7.58-9.22).Conclusions and RelevanceIn this cross-sectional study of a very brief measure of anger, each item contributed to the overall strength of the measure without losing psychometric strength compared with the DAR-5. The consistency of these findings across military and veteran samples in Australian and US populations demonstrated the psychometric robustness of the DAR-3.

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“…Anger is a basic human emotion that is experienced as a reaction to the unwanted or unexpected behavior of others and often occurs after traumatic experiences, frustrations, and stressful situations. Research suggests that military service and ex-service personnel commonly experience difficulties with anger and aggression (Adler et al, 2022; Adler et al, 2020; Rona et al, 2015; Turgoose and Murphy, 2018). In the United Kingdom (UK), prevalence estimates are approximately 29% for all types of physical aggression, 13% for violent behavior, and 10% for physical assault (MacManus et al, 2012; MacManus et al, 2015).…”

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confidence: 99%

Anger Among UK Ex-Service Military Personnel During the COVID-19 Pandemic

et al. 2023

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Military service and ex-service personnel commonly experience difficulties with anger. The COVID-19 pandemic had several negative consequences upon social, economic, and health factors that influence anger. This study aimed to explore 1) levels of anger in an ex-serving military cohort during the COVID-19 pandemic; 2) self-reported changes in anger compared with prepandemic levels; and 3) identify sociodemographic characteristics, military characteristics, COVID-19 experiences, and COVID-19 stressors associated with anger. UK ex-service personnel (n = 1499) completed the Dimensions of Anger Reactions 5-item measure within an existing cohort study. Overall, 14.4% reported significant difficulties with anger, and 24.8% reported their anger worsened during the pandemic. Anger was associated with factors such as financial difficulties, extra/new caring responsibilities, and COVID-19 bereavement. Endorsing more COVID-19 stressors was associated with higher odds of anger difficulties. This study highlights the impact of the pandemic on ex-service personnel, including a strain on family/social relationships and financial hardship, which affected anger.

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Association of Problematic Anger With Long-term Adjustment Following the Military-to-Civilian Transition

Cited by 15 publications

References 44 publications

Problematic Anger among Military Personnel after Combat Deployment: Prevalence and Risk Factors

Problematic Anger among Military Personnel after Combat Deployment: Prevalence and Risk Factors

Three-Item Dimensions of Anger Reactions Scale

Anger Among UK Ex-Service Military Personnel During the COVID-19 Pandemic

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