Anger is a normal human emotion that manifests in a spectrum of expression from frustration and irritability to fury and rage (1). Most of the time anger serves as an adaptive and appropriate expression of emotion. However anger can be considered problematic when it occurs with a level of frequency, intensity, or duration that causes significant distress, actively interferes with interpersonal relationships and functioning, and is associated with aggressive behaviours towards others.
Anger is also a common response to potentially traumatic events such as natural disasters (2) and war (3). It has been found to be implicated in the development and maintenance of PTSD, a significant co-morbidity associated with post-traumatic stress disorder (PTSD) beyond the PTSD items themselves that overlap with anger such as irritability (4), a risk factor for aggression and violence (5) and in the attenuation of PTSD treatment responsivity (6). However, despite the ubiquitous nature of anger in trauma exposed populations and trauma survivors seeking treatment for PTSD, it is rarely assessed. This is partly due to the less prominent representation of problematic anger in the clinical and research literature compared to anxiety and depression, but also the historic limitations to the availability of brief and robust measurement tools.
The State Trait Anger Expression Inventory-2 (STAXI 2) is considered the gold standard for assessing anger. However, a significant limitation to the STAXI-2 is that it is lengthy and hence does not easily lend itself to inclusion in brief survey assessment or treatment outcome batteries. In this context, there has been considerable interest in the development, utility, testing and translation of the Dimension of anger reactions 5 (DAR-5) scale (7). The DAR-5 is a brief 5 item measure that assesses the frequency, duration and intensity of anger, aggression orientation, and its interference with social relationship and general functioning and has demonstrated strong psychometric properties (7, 8). The measure is used widely internationally in military and veteran populations (9), disaster population studies (10), and community groups (11). One limitation has been its lack of availability in other languages. To begin to redress this, the measure was recently translated, tested and published in French (12).
Syria is a country that has been experiencing ongoing military conflict since 2011 and with refugees from this conflict escaping in their millions across the world particularly to Turkey, Jordan and across Europe. Given the considerable trauma exposure load experienced by the population, both still residing in Syria and as refugee across the world , it is of critical importance that anger be included as part of assessments for this population. This psychological distress increased further for Syrians in multiple countries due to COVID-19 as PTSD symptoms and mental disorder prevalence grew larger (13).
In view of the brevity, utility, psychometric robustness and increasingly wide-scale use of the DAR-5 (7), this study sought to develop an Arabic version of this measure, translating and testing it with a large community sample across Syria.