The present study documents that more than one in six responders to the 2016 Millennium Cohort Study survey reported levels of problematic anger, providing an unprecedented examination of the scope of problematic anger in a robust sample of service members and veterans. Further, correlates of anger that can impede mental health, relationships, and functioning were identified. In addition to supporting previous work that has found factors such as male gender, younger age, childhood trauma to be associated with anger, this study identified that lower education levels and financial problems, and military-specific factors significantly associated with higher odds for problematic anger, including serving on active duty, deployment with high levels of combat experience, and separation from military service. Importantly, these relationships remained significant after adjusting for baseline mental health disorders, including PTSD and MDD, suggesting that problematic anger appears to be more than simply an expression of PTSD and MDD. Instead, problematic anger appears to manifest in individuals with a constellation of variables reflecting personal background, aspects of the military experience, current circumstances, particularly financial concerns and mental health problems.
Developing interventions that target problematic anger in the military is critical given its high prevalence, distinction from other mental disorders, role in impeding effective PTSD treatment, and impact on vocational and interpersonal functioning. Results also suggest that directly targeting problematic anger may reduce the risk for interpersonal aggression and family violence, given research indicating that elevations on the DAR5 conferred at 13 fold risk of aggression (30) and further reinforced here in the finding that over one in 10 respondents endorsed that when they get angry at someone, they wanted “to hit or clobber the person”. That financial concerns also doubled the risk of reporting problematic anger paints a picture of a constellation, of financial stress, anger and aggression. Direct targeting of anger also potentially opens the gateway to improved outcomes in co-occurring conditions such as military-related PTSD. Although there has been little empirical attention paid to the development and testing of direct interventions for problematic anger in military populations, approaches to the management and treatment of problematic anger in military populations have been recently developed and pilot tested in both the US (31) and Australia (32). Implementing these kinds of specific interventions may also help mitigate the poorer treatment outcomes found with military veterans with PTSD relative to their civilian counterparts (33).
As noted, there were an array of significant predictors of problematic anger over time. Perhaps one benefit of having so many predictors is that there is a multitude of potential points for targeting interventions, from programs for lower intensity expressions of anger to clinical treatment for pathological responses. Such interventions should be developed for military-specific application given the unique occupational context in which service members operate which can potentially exacerbate anger, including being trained to maintain vigilance to threat, and to consider confrontational strategies in the face of threat (32). Furthermore such adaptation can be particularly beneficial since service members are more likely to engage in an intervention they regard as tailored for their needs (34).
Early intervention strategies could also be inserted into nontraditional contexts such as preparing financial counselors to reinforce military-specific anger management techniques with service members bothered by financial problems (34). Early interventions could also include training counselors who focus on the pivotal process of transitioning from military to veteran status in targeted anger management. Such initiatives like the US Army’s Soldier for Life-Transition Assistance Program could integrate these techniques into their formal courses. Early interventions could also be adapted for military leaders, given the importance of leaders in establishing unit culture and influencing soldier health and wellbeing (35). Results also highlight potential candidates for screening efforts and mental health treatments that are adapted to target anger as a primary goal.
The findings of the present study also point to another area of potential intervention, currently untapped in the conceptualization of anger responses and intervention. Specifically, findings indicate that individual endorsement of posttraumatic growth and self-mastery concepts are associated with reduced odds of problematic anger years later. These attitudes reflect the ability to use coping skills (36) that place challenges into perspective and that reflect the importance of finding meaning in one’s life and work. Skills related to these concepts could be strengthened in service members directly through training (36, 37), and indirectly through institutional messaging about the importance of meaning and self-mastery, and through leaders who set an example and reinforce these attitudes. By supporting these kinds of adaptive skills and perceptions, studies could examine whether the risk of problematic anger years later may be lowered.
While the present study examines factors associated with problematic anger over a 3–4 year follow-up period using a large sample, there are limitations. These data are correlational and there was no measure of DAR-5 on the baseline (2013) survey, which prevented the analysis of modeling the emergence of problematic anger. In addition, self-reported survey data may be subject to recall and reporting biases. Finally, while the Millennium Cohort Study includes participants from all branches of service, active and Reserve components, and veterans, it may not necessarily be representative of the entire U.S. military or those who deploy. However, investigations of the Millennium Cohort Study have not demonstrated systematic sampling bias (38, 39).
Results from this prospective study underscore the relatively high prevalence of problematic anger in a large military sample and the markers of risk and resilience that can potentially influence problematic anger over a period of time. By reducing the risk of problematic anger, individuals and organizations like the military may be able to benefit in terms of improved employee health, relationships with family, friends and coworkers, occupational functioning and reduced risks for aggression and violence.