Angry recruits may be prone to suicide, mental illness, study reveals

David Heitz

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Soldiers who are angry when they enter the military are more likely to develop mental health problems after enlistment and even suicidal ideation, according to a new study.

The study appears in JAMA Psychiatry. “Anger is experienced by all humans to varying degrees, including in situations where it may be adaptive,” the study explains. “However, excessive anger can be pathological, and extreme cases can indicate psychiatric illness. Intermittent explosive disorder (IED), characterized by repeated outbursts of verbal or physical aggression (anger attacks), affects approximately 4 percent to 7 percent of the U.S. population in their lifetimes.

“In military populations, it is even more common, with 11.4 percent of active duty Army personnel meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for past 30-day IED. Notably, several studies have found associations between IED and subsequent suicidal ideation and attempts in soldiers.”

Anger attacks lead to depression, anxiety, suicide

Diana Smith, Alejandro Meruelo and Laura Cambell-Sills undertook the study. “In a cohort study of 38,507 new soldiers, a pre-enlistment history of impairing anger attacks (i.e., attacks causing life interference) was significantly associated with post-enlistment onset of major depression, generalized anxiety disorder (GAD), panic disorder, and suicidal ideation,” the authors report. “These associations were partly explained by psychiatric comorbidity; however, impairing anger attacks were independently associated with new onset of GAD and suicidal ideation.”

The research can inform new interventions for angry recruits. “These findings suggest that detection of impairing anger attacks could aid in assessing elevated risk of developing anxiety disorders, depression, and suicidality after enlistment,” the authors explained. “The findings of this study suggest that a pre-enlistment history of impairing anger attacks may be associated with elevated risk of developing generalized anxiety disorder, major depressive disorder, and suicidality after enlistment. Detection of impairing anger attacks could aid in assessing psychiatric risk in new soldiers.”

Explosive disorder pervasive in basic training

The study found that 15 percent of recruits display intermittent explosive disorder during basic training, according to the New Soldiers Survey.

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study (NSS) surveyed soldiers entering basic training from April 2011 to November 2012.

How much anger is too much anger? “The NSS survey evaluated anger attacks, described as episodes ‘when all of a sudden you lost control and either broke or smashed something worth more than a few dollars, hit or tried to hurt someone, or threatened someone.’

“Episodes were counted as anger attacks only if respondents reported difficulty controlling the aggressive impulse, experiencing attacks in situations where most people would not get angry, or high frequency of attacks more than 10 lifetime attacks) and that attacks had occurred when they were not using alcohol or drugs.”

The study's authors stressed the toxicity of anger. “Anger is experienced by all humans to varying degrees, including in situations where it may be adaptive,” the study explains. “However, excessive anger can be pathological, and extreme cases can indicate psychiatric illness. Intermittent explosive disorder (IED), characterized by repeated outbursts of verbal or physical aggression (anger attacks), affects approximately 4 percent to 7 percent of the U.S. population in their lifetimes.

“In military populations, it is even more common, with 11.4 percent of active duty Army personnel meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for past 30-day IED. Notably, several studies have found associations between IED and subsequent suicidal ideation and attempts in soldiers.”

Anger attacks lead to depression, anxiety, suicide

Diana Smith, Alejandro Meruelo and Laura Cambell-Sills undertook the study. “In a cohort study of 38,507 new soldiers, a pre-enlistment history of impairing anger attacks (i.e., attacks causing life interference) was significantly associated with post-enlistment onset of major depression, generalized anxiety disorder (GAD), panic disorder, and suicidal ideation,” the authors report. “These associations were partly explained by psychiatric comorbidity; however, impairing anger attacks were independently associated with new onset of GAD and suicidal ideation.”

The research can inform new interventions for angry recruits. “These findings suggest that detection of impairing anger attacks could aid in assessing elevated risk of developing anxiety disorders, depression, and suicidality after enlistment,” the authors explained. “The findings of this study suggest that a pre-enlistment history of impairing anger attacks may be associated with elevated risk of developing generalized anxiety disorder, major depressive disorder, and suicidality after enlistment. Detection of impairing anger attacks could aid in assessing psychiatric risk in new soldiers.”

Explosive disorder pervasive in basic training

The study found that 15 percent of recruits display intermittent explosive disorder during basic training, according to the New Soldiers Survey.

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study (NSS) surveyed soldiers entering basic training from April 2011 to November 2012.

How much anger is too much anger? “The NSS survey evaluated anger attacks, described as episodes ‘when all of a sudden you lost control and either broke or smashed something worth more than a few dollars, hit or tried to hurt someone, or threatened someone.’

“Episodes were counted as anger attacks only if respondents reported difficulty controlling the aggressive impulse, experiencing attacks in situations where most people would not get angry, or high frequency of attacks more than 10 lifetime attacks) and that attacks had occurred when they were not using alcohol or drugs.”

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I have been in the news business more than 30 years, spending much of my career at some of the best local newspapers in the country. Today, I report on Denver City Hall, homelessness and other topics for NewsBreak, much like I did in my twenties covering Newport Beach, Calif. for the Daily Pilot. I consider myself a lucky guy to still be doing what I love after so many years.

Denver, CO
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