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Depression Intensifies Anger in Veterans with PTSD

The tendency for veterans with post-traumatic stress disorder to lash out in anger can be significantly amplified if they are also depressed, according to research led by Ray Novaco, UC Irvine professor of psychology & social behavior, and published this month by the American Psychological Association.

"Our findings should draw attention to anger as a major treatment need when military service members screen positive for PTSD or for depression – and especially when they screen positive for both," Novaco says. The study first appeared in the journal Psychological Trauma: Theory Research, Practice & Policy.

The researchers analyzed the behavioral health data of 2,077 U.S. soldiers (1,823 men and 254 women) who were deployed to Iraq and Afghanistan and subsequently sought behavioral health services at a large military installation. The participants were screened for PTSD and major depressive disorder and placed in one of four groups: PTSD only, MDD only, PTSD and MDD combined, or neither. Novaco's team also gauged the veterans' anger and noted whether they had said they were considering harming others.

Anger and self-rated risk of harm were both significantly higher in the group with both PTSD and major depression, which were found to frequently coexist. About 72% of those who screened positive for PTSD also screened positive for MDD.

"One reason we conducted this research is that anger has been given insufficient attention as a clinical problem among combat veterans and trauma populations in general," Novaco says. "PTSD and depression dominate the landscape, but these, of course, are formal psychiatric disorders. There is no diagnostic category for anger, nor do I think there should be, so anger slips from research attention."

Previous studies conducted with both military members and civilians who had experienced trauma have shown anger in the context of PTSD to be far more than a symptom; it can predict PTSD severity and interfere with PTSD treatment. A 2010 analysis of more than 18,000 soldiers returning from Iraq found that about 40% had had physical bursts of anger, at least 30% had threatened someone with physical violence, and more than 15% had gotten into a physical fight.

"Anger is a driver of violent behavior, but it is responsive to anger-focused psychological treatment," says Novaco, adding that this is one reason why soldiers presenting with PTSD, depression or, especially, both should receive appropriate care. Numerous studies have been published on the effectiveness of cognitive behavioral therapy for anger in combat veterans, he notes.

--Source: University of California, Irvine