Magnitude of Problematic Anger and its Predictors in the Millennium Cohort

Abstract

Background: Problematic anger is intense anger associated with elevated generalized distress and that interferes with functioning. It also confers a heightened risk for the development of mental health problems. In military personnel and veterans, previous studies examining problematic anger have been constrained by sample size, cross-sectional data, and measurement limitations. Methods: The current study used Millennium Cohort survey data (N = 90,266) from two time points (2013 and 2016 surveys) to assess the association of baseline demographics, military factors, mental health, positive perspective, and self-mastery, with subsequent problematic anger. Results: Overall, 17.3% of respondents reported problematic anger. In the fully adjusted logistic regression model, greater risk of problematic anger was predicted by certain demographic characteristics as well as childhood trauma and financial problems. Service members who were in the Army or Marines, active duty (vs. reserves/national guard), and previously deployed with high levels of combat had increased risk for problematic anger. Veterans were also more likely to report problematic anger than currently serving personnel. Mental health predictors included posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and comorbid PTSD/MDD. Higher levels of positive perspective and self-mastery were associated with decreased risk of problematic anger. Conclusion: Not only did 1 in 6 respondents report problematic anger, but risk factors were significant even after adjusting for PTSD and MDD, suggesting that problematic anger is more than an expression of these mental health problems. Results identify potential points of early intervention and clinical treatment for addressing problematic anger in the military and veteran context.

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

“…Major financial problems were assessed with 1 item. 4 Financial security was assessed with 1 item asking about the "financial condition of you and your family," categorized into 4 levels. Homelessness…”

“…was assessed with 1 item asking if participants had slept in a shelter, on streets, or in other nonresidential settings because of having no other place to stay. 4,29 Employment status was assessed with 1 item; responses included full-time, part-time, homemaker, retired, unemployed, looking for work, unemployed, not looking for work, unemployed, disabled, and student, 4 which were collapsed into 6 groups.…”

“…1 Problematic anger has the potential to impede adjustment across different domains including behavioral health, 2,3 social relationships, 1 and economic functioning. 4 More broadly, a recent study found problematic anger was associated with suicidal ideation and suicide attempts, after accounting for psychiatric risk factors. 5 At present, however, problematic anger remains largely understudied, unrecognized, and undertreated.…”

“…At least one cross-sectional study demonstrated a link between problematic anger and economic distress (eg, financial strain, unemployment, homelessness), over and above demographics, military characteristics, and mental health. 4 Given the study design, however, the degree to which problematic anger is a response or a contributor to difficult circumstances, or some combination of the two is unclear. 4 Clarifying the temporal sequence of this association is critical to identifying periods of risk and opportunities for intervention.…”

“…4 Given the study design, however, the degree to which problematic anger is a response or a contributor to difficult circumstances, or some combination of the two is unclear. 4 Clarifying the temporal sequence of this association is critical to identifying periods of risk and opportunities for intervention. Such intervention can leverage advances in addressing problematic anger and potentially mitigate a cascade of ensuing detrimental outcomes.…”