Skip to main content

Military Health System

Test of Sitewide Banner

This is a test of the sitewide banner capability. In the case of an emergency, site visitors would be able to visit the news page for addition information.

The Language of Anger and Depression Among Patients with Concussions

Image of naval captain talking to another military person. Capt. Tracy Skipton, Naval Hospital Jacksonville's mental health director, talks to a sailor about good mental health. The hospital is expanding behavioral health services, with a new inpatient unit planned to open this summer. The inpatient unit augments a robust system of outpatient care at the hospital. Effective treatments and interventions are available for depression, situational stressors, and other health problems. (190529-AW702-002)(U.S. Navy photo by Jacob Sippel, Naval Hospital Jacksonville/Released).

To combat stigma and ensure appropriate care, behavioral health providers need to listen more attentively to service members with mild traumatic brain injuries, also known as concussions, when discussing their mental health, according to new research from the Defense and Veterans Brain Injury Center, a division of the Defense Health Agency Research and Development Directorate.

In the study, DVBIC and University of Washington researchers found soldiers often do not overtly express their feelings of depression, but the signs for mental health challenges are still there if providers "read the language" accurately for indications of illness. Psychological issues like depression and anger are common among service members who have experienced TBIs and combat trauma. However, the military culture has traditionally emphasized personal endurance when faced with adversity, which may account for soldiers' reluctance to characterize their emotional states using terms such as depression.

For the analysis, the researchers relied on recorded transcripts from a University of Washington-based study that tested whether telephone-based problem-solving interventions could improve the mental health symptoms of service members with combat-sustained TBI. In a clinical trial, the study population was divided into two groups. One group received 12 educational brochures in the mail with advice on how to manage common TBI issues and concerns; the other group received the same literature and a bi-weekly phone call from a counselor. All participants completed questionnaires to assess their mental health.

In the study published in the journal Military Psychology, the researchers focused on a subset of 25 participants who had participated in the recorded telephone intervention. Based on their responses to the questionnaires, these 25 service members appeared to fit the model of clinical depression. In the recorded transcripts, however, few used the word "depression" to describe their feelings. They claimed to be "frustrated" and had a "loss of control" in their lives.

Their frustration manifested through irritability and anger: "I feel like I am ready to snap . . . I'm angry, very angry, and I do not know why," said one respondent. Anger was also tied to an inability to function: "It's not that I don't want to work, it's just that with my concentration and focus and irritability and anger." Even when they had a diagnosis like PTSD, they were still frustrated and blamed themselves for difficulties maintaining relationships with friends and family; as another participant said, "I'm a bad apple that no one is going to want."

The fact these service members did not use the word "depression," or similar terms, is important in both treatment and policy development within the Military Health System.

"If you have people who are rating themselves as depressed but are not reporting that they are depressed, where is the mismatch and what are the implications for intervention?" said Wesley Cole, a neuropsychologist and the senior research director at DVBIC's Fort Bragg site when the study was conducted.

Because the subjects consistently reported anger and irritability, Cole suggested many of these service members might have been treated for anger management. Not only does this fail to address the root cause of their problem, but it also may contribute to the stigma associated with mental illness. Cole added, "If you send someone to anger management who doesn't really need it, then that contributes to the stigma because I am now getting treatment that does not fit what I am experiencing. I am more disenfranchised from the medical system."

These findings underscore that providers need to be sensitive to psychological conditions when treating TBI patients. Although TBI patients may focus on the physical attributes of their illnesses, providers should also consider mental health as a factor in recovery.

"It's not just what shows up on a CAT scan or an MRI; there are so many other things that can affect service members, and being aware of those other conditions, like mental health conditions, is fundamental," said Army veteran Maj. (Dr.) Daniel José Correa. As a TBI patient and a physician who specializes in neurology, Correa can see both sides as he recounts in the video from the A Head for the Future education initiative.

If providers become more sensitive to these issues, then they can direct patients to appropriate resources. DVBIC has produced a fact sheet on changes in behavior, personality, or mood following a concussion. It offers concrete steps when confronting these psychological changes—such as working on stress management and using the mobile application Mood Tracker designed by Connected Health to identify triggers. Additional resources on depression and anger are available through the Real Warriors Campaign, which encourages the military community to reach out for help when dealing with mental health concerns.

You also may be interested in...

Report
Sep 21, 2023

2023 Q1 DOD Worldwide Numbers for TBI

.PDF | 758.20 KB

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the first quarter of calendar year 2023. The data is also broken down by each branch of the ...

Report
Sep 21, 2023

2022 DOD Worldwide Numbers for TBI

.PDF | 845.65 KB

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the calendar year 2022. The data is also broken down by each branch of the armed services.

Report
Sep 21, 2023

2000-2023 Q1 DOD Worldwide Numbers for TBI

.PDF | 844.12 KB

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the first quarter of calendar year 2023. The data is also broken ...

Calendar Event
Sep 18, 2023

TBICoE Quarterly Education Series: Military Branch and Job-Specific Risk

Military job-specific risks such as blast exposure and jumps increase the chances of traumatic brain injuries throughout the armed forces. Join the Traumatic Brain Injury Center of Excellence as researchers and clinicians dive into the TBI risks across our military branches and explore what the health services are doing to prevent TBI and treat our ...

Publication
Sep 18, 2023

TBI: Military Branch Job-Specific Risk

.PDF | 510.89 KB

Military job-specific risks such as blast exposure and jumps increase the chances of traumatic brain injuries throughout the armed forces. Join the Traumatic Brain Injury Center of Excellence as researchers and clinicians dive into the TBI risks across our military branches and explore what the health services are doing to prevent TBI and treat our ...

Calendar Event
Sep 14, 2023

Application of Acute Concussion Care Pathway: MACE 2 & PRA Training

The Traumatic Brain Injury Center of Excellence is hosting a combined Military Acute Concussion Evaluation 2 and Progressive Return to Activity clinical recommendation virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office.

Publication
Sep 12, 2023

Application of Acute Concussion Care Pathway: MACE 2 and PRA Training Flier

.PDF | 650.72 KB

The Traumatic Brain Injury Center of Excellence is hosting a combined Military Acute Concussion Evaluation and Progressive Return to Activity clinical recommendation virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office.

Publication
Aug 29, 2023

Concussion Awareness Day Event Flier

.PDF | 1.39 MB

Every day should be Concussion Awareness Day! Learn how you can "Be a Brain Warrior" and protect your head from concussion, also known as a mild traumatic brain injury. Join TBICoE's online event and discover how YOU can prevent, recognize, and recover!

Technical Document
Jul 20, 2023

Infographic: What is the Acute Concussion Care Pathway?

.PDF | 714.95 KB

TBICoE developed this infographic as a quick reference tool that demonstrates application of the standardized acute concussion assessment and care process. By adhering to this established pathway of care for mild TBI, providers across the MHS can ensure a reduction in unwarranted variation and foster an integrated, standardized system of readiness and ...

Calendar Event
Jul 18, 2023

TBICoE's Anomalous Health Incident Acute Assessment Training

This virtual training, hosted by the Traumatic Brain Injury Center of Excellence, will introduce learners to Anomalous Health Incidents and review assessment and treatment strategies. Detailed guidance on how to complete a medical evaluation using Anomalous Health Incident Acute Assessment (DHA Form 244), will be provided.

Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery