Skip to main content

Military Health System

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 Center of Excellence | 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...

DOD Begins Hiring Prevention Workforce

Article Around MHS
12/2/2022
Suicide in the Military is down, but suicide suicide prevention remains a dedicated DOD focus.

DOD is working to create the healthy climates necessary to address a range of problematic and harmful behaviors, including suicide. This will be accomplished, in part, with a new and dedicated focus.

Recommended Content:

Suicide Prevention Toolkit | Suicide Prevention | Depression | Psychological Fitness | Mental Health is Health Care

Healthy Sleep Following Concussion/mTBI Fact Sheet

Fact Sheet
11/16/2022

Getting restful sleep is one of the most important things you can do for your health, and it often takes thoughtful preparation during the day. This fact sheet offers service members and veterans who experience sleep disturbances after a concussion with healthy sleep tips that can likely improve sleep.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | TBI Provider Resources | Centers of Excellence

2022 (Q2) DOD Worldwide Numbers for TBI

Report
11/9/2022

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 through the second quarter. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Provider Resources | TBI Educators | TBICoE Research | Armed Forces Health Surveillance Division

2000-2022 Q2 DOD Worldwide Numbers for TBI

Report
11/9/2022

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 second quarter of 2022. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Provider Resources | TBI Educators | TBICoE Research | Armed Forces Health Surveillance Division

2021 DOD Worldwide Numbers for TBI

Report
11/9/2022

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 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | TBI Provider Resources | DOD TBI Worldwide Numbers

Groundbreaking Study on Trauma-related Sleep Disorder

Article
10/17/2022
Airman with elecronic trackers on his head seen in profile for a sleep disorder study on TSD.

Army researchers publish an important new study on Trauma-associated Sleep Disorder, or TSD.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Sleep

Top U.S. Military Enlisted Leader Shares Experience of Stigma Surrounding TBI

Article
9/30/2022
A man wearing headphones in front of his computer

Recovery after brain injury keeps warfighters mission-ready.

Recommended Content:

Traumatic Brain Injury Center of Excellence

On National Concussion Awareness Day, Learn the Truth about TBI

Article
9/16/2022
A mountain biker wearing a helmet bikes through hard terrain.

Separate the myths and truths around TBI

Recommended Content:

Traumatic Brain Injury Center of Excellence

Neuroendocrine Dysfunction Following Concussion/Mild TBI Provider Fact Sheet

Fact Sheet
9/14/2022

The Neuroendocrine Dysfunction Following Concussion/Mild TBI Provider Fact Sheet, developed by TBICoE, is a one page document that gives primary care managers (PCMs) an overview of neuroendocrine dysfunction (NED) that can occur after concussion, or mild TBI. It highlights conditions with overlapping symptoms, screening and treatment considerations, risk factors, and referral guidance for suspected NED.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources

Suicide Awareness Month Reminder: Seek Help for PTSD

Article
9/2/2022
Graphic of warfighters on patrol with the caption Not All Wounds are Visible .PTSD Awareness

Post-traumatic Stress Disorder is a real mental health issue. Be aware and seek help.

Recommended Content:

Suicide Prevention Toolkit | Posttraumatic Stress Disorder | Suicide Prevention | Psychological Fitness | In the Spotlight

Mental Health Office Helps AUAB Members Maintain Readiness

Article Around MHS
8/30/2022
Air Force Tech. Sgt. Melissa Leonardo smiles for photo

Comprehensive Airman Fitness is comprised of physical, social, spiritual and mental fitness. Being physically fit to fight and maintaining a war fighter spirit are crucial to completing the mission.

Recommended Content:

Health Readiness & Combat Support | Spiritual Fitness | Nutritional Fitness | Depression | Posttraumatic Stress Disorder | Anxiety | Stress | Mental Health: Seeking Care with TRICARE | Mental Health is Health Care

Suicide Prevention: One Mother's Story

Video
8/25/2022
Suicide Prevention: One Mother's Story

Virginia Cooper's son, Joshua Jaymes Wood, a veteran of the U.S. Marine Corps, was 30 years old when he took his life on November 7, 2021. This is her story.

Recommended Content:

Suicide Prevention Toolkit | Mental Health: Seeking Care with TRICARE | Suicide Prevention | Depression

Suicide Prevention: A Message from CSM Gragg

Video
8/25/2022
Suicide Prevention: A Message from CSM Gragg

A message from CSM Michael A. Gragg regarding suicide prevention and how to get help.

Recommended Content:

Suicide Prevention Toolkit | Depression | Suicide Prevention | Mental Health: Seeking Care with TRICARE

Fort Campbell SRU Pilot Program Explores Post-traumatic Growth

Article Around MHS
8/25/2022
Military personnel in classroom

The Fort Campbell Soldier Recovery Unit has begun a new pilot program for the Army Recovery Care Program, highlighting post-traumatic growth and positive growth through struggle.

Recommended Content:

Posttraumatic Stress Disorder | Stress | Anger | Mental Health: Seeking Care with TRICARE | Mental Health is Health Care

2022 (Q1) DOD Worldwide Numbers for TBI

Report
8/24/2022

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 2022.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | TBI Educators
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 20
Refine your search
Last Updated: September 01, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery