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...

PTSD Treatment Works While Challenges Like Stigma Remain a Concern

Article
7/21/2022
PTSD_725

Anyone who has been through a trauma—violent crime, sexual violence, natural disasters, mass shooting, or combat—can develop posttraumatic stress disorder.

Recommended Content:

Posttraumatic Stress Disorder | PTSD | Mental Health: Seeking Care with TRICARE

Interview with the SEAC: TBI from a Joint Perspective

Video
7/18/2022
Interview with the SEAC: TBI from a Joint Perspective

In this episode of Picking Your Brain, Traumatic Brain Injury Center of Excellence Branch Chief Capt. Scott Cota and clinical moderator Amanda Gano interview the Senior Enlisted Advisor to the Chairman of the Joint Chiefs of Staff (SEAC), Ramón Colón-López. The discussion covers the health impacts of TBI and blast-related concussion stemming from the demands of combat and training. The SEAC also addresses the importance of maintaining medical readiness through education and military leadership. Listen to more Picking Your Brain episodes at www.health.mil/TBIPodcasts, on DVIDS, or wherever you listen to podcasts.

Recommended Content:

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

Talking to Your Family and Friends About Your Depression

Publication
7/18/2022

Talking with your friends and family about your depression symptoms is not easy. Use this worksheet to help plan the discussion. 1. Decide who to talk to. List the family and friends that you will tell. Bold or underline the person you will tell first.

Recommended Content:

Psychological Health Center of Excellence | Psychological Fitness | Depression

Patient Self-Management for Depression

Publication
7/14/2022

You can do several things to help yourself feel better, even when you’re not at your best. Start by selecting one of the activities from this list. Remember to take it slowly and add new things as you begin to feel better. (Make copies of this worksheet, and review it weekly with your mental health provider or a trusted family member or friend to track your progress.)

Recommended Content:

Psychological Health Center of Excellence | Psychological Fitness | Depression

JBLM Army spouse combats PTSD with physical fitness

Article Around MHS
7/13/2022
Military personnel in physical training session

Stress and anxiety are a normal part of life, but anxiety disorders like PTSD, which affect 40 million adults, are the most common psychiatric illnesses in the U.S.

Recommended Content:

Physical Fitness | Psychological Fitness | Posttraumatic Stress Disorder

PTSD Awareness Month - PTSD Awareness

Infographic
6/1/2022
PTSD Awareness Month - PTSD Awareness

Unfortunately, experiencing trauma is not uncommon. If you’ve experienced trauma and notice symptoms of #PTSD, don’t hesitate to ask your primary care provider about possible treatment. #TreatmentWorks #PTSDAwarenessMonth www.health.mil/ptsd

Recommended Content:

June | Total Force Fitness | Psychological Fitness | Posttraumatic Stress Disorder

PTSD Awareness Month - Treatment Works

Infographic
6/1/2022
PTSD Awareness Month - Treatment Works

Experiencing #PTSD can make one feel hopeless. Fortunately, there are strategies and treatments that WORK to relieve PTSD symptoms. Don’t wait, seek help today. #PTSDAwarenessMonth www.health.mil/ptsd

Recommended Content:

June | Total Force Fitness | Psychological Fitness | Posttraumatic Stress Disorder

PTSD Awareness Month

Infographic
6/1/2022
PTSD Awareness Month

June is #PTSDAwarenessMonth Just because you cannot see a wound doesn’t mean it isn’t there. If you or someone you know is struggling with PTSD, seek help immediately. www.health.mil/ptsd

Recommended Content:

June | Psychological Fitness | Posttraumatic Stress Disorder

A Matter of Life or Death: Seeking Help and Overcoming

Article Around MHS
5/25/2022
Military personnel at computer

For Tech. Sgt. Jilayne Michelsen, a Command Post Control Operations Specialist, assigned to the Ohio National Guard’s 180th Fighter Wing, having the ability to ask her husband for help during her darkest hour, saved her life, her family and her military career.

Recommended Content:

Suicide Prevention | Depression

2000-2021 DOD Worldwide Numbers for TBI

Report
5/17/2022

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 fourth quarter of 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 | Traumatic Brain Injury

2021 DOD Worldwide Numbers for TBI

Report
5/17/2022

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 | Traumatic Brain Injury

Neuroimaging Following Mild TBI Clinical Recommendation

Publication
5/16/2022

This TBICoE clinical recommendation allows primary care managers to make an informed, evidenced-based decision regarding whether or not imaging is indicated following a concussion/mild TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Traumatic Brain Injury

2021 Traumatic Brain Injury Center of Excellence Annual Report

Publication
4/26/2022

The 2021 Traumatic Brain Injury Center of Excellence (TBICoE) Annual Report provides a look at accomplishments and activities from calendar year 2021.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury | TBI Educators | TBICoE Research | TBI Provider Resources

A History of the Combat Helmet and the Quest to Prevent Injuries

Article
4/25/2022
Lt. Gen. George S. Patton and Brig. Gen. Theodore Roosevelt Jr. are pictured here in 1943 wearing the standard M1 helmet, sometimes called the "steel pot." (Photo: 1st Infantry Division Courtesy Photo)

The combat helmet has evolved over time to improve protection against projectiles and shock waves to reduce the risk of fatal blows and traumatic brain injuries.

Recommended Content:

Traumatic Brain Injury | Our History | Injury Prevention

Concussion Care Pathway Streamlined for Better Results

Article
4/1/2022
Dr. Gregory Johnson, Tripler Concussion Clinic medical director, conducts a neurological exam on Army Spc. Andrew Karamatic, a combat medic, having him follow his finger with his eyes, at Tripler Army Medical Center, in Honolulu, Hawaii. Neurologic exams are part of the MACE 2 diagnostic tool to assess service members’ Acute Concussion Care Pathway. (Photo: Army Staff Sgt. Christopher Hubenthal, DMA Pacific – Hawaii Media Bureau)

The Defense Health Agency has developed a comprehensive clinical care program (Acute Concussion Care Pathway) to manage concussions based on the military medical community’s many years of experience with injured service members.

Recommended Content:

Traumatic Brain Injury
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 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.