Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

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...

Video
Mar 28, 2024

Headaches and TBI: A Journey of Treatment Over Time

Headaches and TBI: A Journey of Treatment Over Time

Dr. Joanne Gold, a pharmacist and neuroscience clinician with TBICoE, and experts from the National Museum of Health and Medicine discuss the treatment of headaches, past and present. Their conversation explores the museum's collections related to TBI and headache treatment, discusses ways to improve headache treatment, and highlights relevant TBICoE ...

Video
Jan 31, 2024

Be a Brain Warrior: Protect. Treat. Optimize.

Be a Brain Warrior: Protect. Treat. Optimize.

The Traumatic Brain Injury Center of Excellence is championing the theme 'Be a Brain Warrior: Protect, Treat, Optimize' during Brain Injury Awareness Month. The theme showcases the idea that service members, veterans, healthcare providers, caregivers, family members, and advocates can be warriors for brain health. Visit health.mil/BIAMonth to learn more.

Video
Jan 29, 2024

TBI Testimonials: Roxana Delgado & Victor Medina

TBI Testimonials: Roxana Delgado & Victor Medina

While he was deployed, retired Army Sgt. 1st Class Victor Medina was in a vehicle that was hit by an explosive device. He sustained a traumatic brain injury (TBI) that severely impaired some of his physical functions and ability to speak. Medina’s wife, Roxana Delgado, continued her pursuit of a Ph.D. in health sciences and became his caregiver. As ...

Video
Jan 29, 2024

TBI Testimonials: Dalton Mask

TBI Testimonials: Dalton Mask

Dalton was on his way to his biggest challenge in his military career: Army Ranger School. He had been training for several months, running 20 miles per week, and working out three times a day. As he was setting up a TV in his room, he had a seizure and fell, hitting his head on the side of his bed — resulting in a concussion, or a mild traumatic ...

Video
Jan 29, 2024

TBI Testimonials: Micah Norgard

TBI Testimonials: Micah Norgard

U.S. Marine Corps veteran Micah Norgard spent 12 years as an infantryman, serving in a variety of roles and locations. But his biggest battle was in recognizing the cumulative effects of 21 potentially concussive event exposures and multiple undiagnosed traumatic brain injuries. In this video, Norgard discusses how after he left the military, he ...

Video
Jan 29, 2024

TBI Testimonials: Beth King

TBI Testimonials: Beth King

Army veteran Beth King was on a routine mission when her helicopter was struck by an RPG, ultimately resulting in a traumatic brain injury (TBI). In this video, Beth shares the impact of her TBI and how she discovered her new passion along the way. Visit health.mil/brainhealth to learn about resources to prevent, recognize and recover from brain ...

Video
Jan 24, 2024

From Patient to Provider: One Sailor's Brain Health Journey

From Patient to Provider: One Sailor's Brain Health Journey

Timothy Bleigh clearly recalls when the bomb went off. The Mine-Resistant Ambush Protected (MRAP) tactical vehicle he was in with five Marines flipped several times through the air before it landed partly on its roof. He was near the end of his first tour in Afghanistan, assigned to a Marine personal security detachment, when the improvised explosive ...

Video
Jan 19, 2024

Who is TBICoE?

Who is TBICoE?

The U.S. Congress established TBICoE in 1992 in response to the need to treat service members with TBI from the first Gulf War. TBICoE assists military medical providers in delivering effective and reliable care, crucial for combat readiness. Learn more about their history, mission, and the critical importance they place on protecting, treating, and ...

Video
Jan 19, 2024

What Steps Should A Military Leader Take After A Potentially Concussive Event?

What Steps Should A Military Leader Take After A Potentially Concussive Event?

Military leadership has a responsibility to promote warfighter brain health among service members. That means prompt reporting of potentially concussive events and ensuring service members with TBI get medical attention. This video covers the steps leaders should take after a potential concussion.

Video
Jan 19, 2024

What Happens To The Brain After A TBI?

What Happens To The Brian After A TBI?

What Happens to the Brain After a TBI? This video explores the effects of concussion on a warfighter's brain, commonly caused by falls, sports, or car accidents. It emphasizes the importance of prevention through protective measures like helmets, seatbelts, and safe training practices, which are essential for maintaining brain health.

Video
Nov 6, 2023

The Warfighter Brain Health for Leaders Training Video

The Warfighter Brain Health for Leaders Training Video

The Warfighter Brain Health for Leaders Training video is an essential resource for enhancing the Department of Defense's Warfighter Brain Health Initiative. It empowers military leaders with strategies for preventing, protecting against, and managing brain injuries. Additionally, the video enhances leaders' abilities to assess and recognize symptoms ...

Skip subpage navigation
Refine your search
Last Updated: September 28, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery