Back to Top Skip to main content Skip to sub-navigation

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).

Recommended Content:

Traumatic Brain Injury | Posttraumatic Stress Disorder | Anger | Depression

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...

Caregiver Guide supports service members and veterans with TBI

Article
7/22/2021
Military family posing for a picture

Traumatic Brain Injury Center of Excellence’s 2021 Caregiver Guide provides specific tools to help caregivers manage TBI patient recovery.

Recommended Content:

Centers of Excellence | Traumatic Brain Injury | TBI Education and Training Events

2020 TBICoE Annual Report

Publication
7/9/2021

2020 Traumatic Brian Injury Center of Excellence (TBICoE) Annual Report.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury

Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans

Publication
7/7/2021

The 2021 "Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans" is a recovery support tool to assist caregivers of service members and veterans who have sustained a traumatic brain injury at any severity level.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Traumatic Brain Injury | Psychological Health Center of Excellence

Turn Post-traumatic Stress Into Post-traumatic Growth

Article
6/30/2021
PTSD Infographic

Myths and facts about post-traumatic stress (PTS) and post-traumatic growth (PTG).

Recommended Content:

Posttraumatic Stress Disorder | Total Force Fitness | Posttraumatic Stress Disorder

TBI Caregiver Support Forms

Form/Template
6/29/2021

This is a fillable and printer-friendly version of the forms available in the "Traumatic Brain Injury: A Guide for Caregivers of Service Members and Veterans."

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | Patient and Family Resources

Aphasia, Caused by Stroke or TBI, is Frustrating and Little Known

Article
6/29/2021
A doctor looking at brain scans

Aphasia is an incurable disease usually caused by stroke that affects all forms of communication.

Recommended Content:

Total Force Fitness | Heart Health | Centers of Excellence | Traumatic Brain Injury

PTSD: Seeking out mental health care is the first step to wellness

Article
6/28/2021
A picture of hands folded together

PTSD: What it is and treatments that can help

Recommended Content:

Posttraumatic Stress Disorder | Psychological Fitness | Posttraumatic Stress Disorder

NICoE Education Webinar Series: July Poster

Publication
6/25/2021

Service Members and TBI: The Not So Invisible Wound

Recommended Content:

Traumatic Brain Injury | TBI Education and Training Events | Centers of Excellence

PTSD: Help is Available

Video
6/24/2021
PTSD: Help is Available

PTSD can happen to anyone. The Military Health System can help you get diagnosed and provide you with evidence-based treatment so you can get your life back. If you're struggling with PTSD, reach out to your local military hospital or clinic and make an appointment today. Learn more at health.mil/ptsd.

Recommended Content:

Posttraumatic Stress Disorder | Psychological Fitness | Posttraumatic Stress Disorder

5 Tips to Manage Anger

Video
6/23/2021
5 Tips to Manage Anger

When dealing with the stresses of military life, anger can become frequent or intense. Use these tips to manage anger in a healthy way.

Recommended Content:

Psychological Fitness | Anger | Real Warriors Campaign

Depression: Know the Signs and Options for Care

Video
6/23/2021
Depression: Know the Signs and Options for Care

Depression is treatable and treatment works. Learn the signs and options for getting care.

Recommended Content:

Psychological Fitness | Depression | Real Warriors Campaign

4 Facts About PTSD

Video
6/23/2021
4 Facts About PTSD

Learn about PTSD symptoms, the benefits of seeking care and get connected to confidential, 24/7 resources.

Recommended Content:

Psychological Fitness | Posttraumatic Stress Disorder | Real Warriors Campaign

Coping with Flashbacks Between Appointments

Video
6/23/2021
Coping with Flashbacks Between Appointments

Flashbacks can sometimes occur during treatment for posttraumatic stress disorder. Follow these tips to help cope with flashbacks between appointments with a health care provider.

Recommended Content:

Psychological Fitness | Posttraumatic Stress Disorder | Real Warriors Campaign

NICoE Education Webinar Series: June Poster

Publication
6/23/2021

Combat-related Concussion: Understanding Trajectories of Long-term Clinical and Imaging Outcomes

Recommended Content:

Traumatic Brain Injury | TBI Education and Training Events

Managing Anger Infographic

Publication
6/23/2021

Learn six tips to effectively manage strong feelings of anger and find support resources.

Recommended Content:

Anger
<< < 1 2 3 4 5  ... > >> 
Showing results 61 - 75 Page 5 of 18
Refine your search
Last Updated: June 13, 2022

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.