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Original research| Volume 101, ISSUE 1, P81-88, January 2020

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Posttraumatic Stress Disorder Symptoms Contribute to Staff Perceived Irritability, Anger, and Aggression After TBI in a Longitudinal Veteran Cohort: A VA TBI Model Systems Study

Published:September 09, 2019DOI:https://doi.org/10.1016/j.apmr.2019.07.018

      Abstract

      Objective

      To examine the relationship between staff perceived irritability, anger, and aggression and posttraumatic stress disorder (PTSD) in veterans with traumatic brain injury (TBI) of all severity levels.

      Design

      Longitudinal cohort design.

      Setting

      Veterans Affairs Polytrauma Transitional Rehabilitation Programs.

      Participants

      Veterans and service members with TBI of all severity levels enrolled in the Veterans Affairs Polytrauma Rehabilitation Centers’ Traumatic Brain Injury Model System national database (N=240).

      Interventions

      Not applicable.

      Main Outcome Measure

      Univariable and multivariable logistic regression modeling was used to examine the association between irritability, anger, and aggression and potential risk factors, including PTSD symptoms. Irritability, anger, and aggression was measured as a single construct using an item from the Mayo-Portland Adaptability Inventory-4 that was rated by program staff at admission and discharge from the inpatient rehabilitation program. PTSD symptoms were assessed using the PTSD Checklist–Civilian Version.

      Results

      PTSD symptoms uniquely predicted program staff-rated irritability, anger, and aggression at discharge even after controlling for severity of TBI, age, male sex, education, and annual earnings. The model explained 19% of the variance in irritability, anger, and aggression.

      Conclusions

      When TBI severity and PTSD symptoms were considered simultaneously in a sample of veterans, only PTSD symptoms predicted staff-rated irritability, anger, and aggression. Given the negative outcomes linked with irritability, anger, and aggression, veterans may benefit from assessment and treatment of PTSD symptoms within rehabilitation settings.

      Keywords

      List of abbreviations:

      MPAI-4 (Mayo-Portland Adaptability Inventory-4), PCL-C (PTSD Checklist–Civilian Version), PTRP (Polytrauma Transitional Rehabilitation Program), PTSD (posttraumatic stress disorder), TBI (traumatic brain injury), TBIMS (TBI Model Systems), VA (Veterans Affairs)
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      References

        • Hesdorffer D.C.
        • Rauch S.L.
        • Tamminga C.A.
        Long-term psychiatric outcomes following traumatic brain injury: a review of the literature.
        J Head Trauma Rehabil. 2009; 24: 452-459
        • Orth U.
        • Wieland E.
        Anger, hostility, and posttraumatic stress disorder in trauma-exposed adults: a meta-analysis.
        J Consult Clin Psychol. 2006; 74: 698-706
        • Kim E.
        Agitation, aggression, and disinhibition syndromes after traumatic brain injury.
        NeuroRehabiliation. 2002; 17: 297-310
        • Kelly G.
        • Parry A.
        Managing challenging behaviour of people with acquired brain injury in community settings: the first 7 years of a specialist clinical service.
        Brain Impair. 2008; 9: 293-304
        • Watson C.
        • Rutterford N.A.
        • Shortland D.
        • Williamson N.
        • Alderman N.
        Reduction of chronic aggressive behaviour 10 years after brain injury.
        Brain Inj. 2001; 15: 1003-1015
        • Winkler D.
        • Unsworth C.
        • Sloan S.
        Factors that lead to successful community integration following severe traumatic brain injury.
        J Head Trauma Rehabil. 2006; 21: 8-21
        • Lezak M.D.
        • Howieson D.B.
        • Loring D.W.
        • Fischer J.S.
        Neuropsychological assessment.
        Oxford University Press, New York2004
        • Brenner L.A.
        Neuropsychological and neuroimaging findings in traumatic brain injury and post-traumatic stress disorder.
        Dialogues Clin Neurosci. 2011; 13: 311-323
        • Koenigs M.
        • Grafman J.
        Posttraumatic stress disorder: the role of medial prefrontal cortex and amygdala.
        Neuroscientist. 2009; 15: 540-548
        • Grafman J.
        • Schwab K.
        • Warden D.
        • Pridgen A.
        • Brown H.R.
        • Salazar A.M.
        Frontal lobe injuries, violence, and aggression: a report of the Vietnam Head Injury Study.
        Neurology. 1996; 46: 1231-1238
        • Rao V.
        • Rosenberg P.
        • Bertrand M.
        • et al.
        Aggression after traumatic brain injury: prevalence and correlates.
        J Neuropsychiatry Clin Neurosci. 2009; 21: 420
        • Neumann D.
        • Malec J.F.
        • Hammond F.M.
        The relations of self-reported aggression to alexithymia, depression, and anxiety after traumatic brain injury.
        J Head Trauma Rehabil. 2017; 32: 205
        • Bailie J.M.
        • Cole W.R.
        • Ivins B.
        • et al.
        The experience, expression, and control of anger following traumatic brain injury in a military sample.
        J Head Trauma Rehabil. 2015; 30: 12-20
        • Walker W.C.
        • Stromberg K.A.
        • Marwitz J.H.
        • et al.
        Predicting long-term global outcome after traumatic brain injury: development of a practical prognostic tool using the Traumatic Brain Injury Model Systems National Database.
        J Neurotrauma. 2018; 35: 1587-1595
        • Corrigan J.D.
        • Horn S.D.
        • Barrett R.S.
        • et al.
        Effects of patient preinjury and injury characteristics on acute rehabilitation outcomes for traumatic brain injury.
        Arch Phys Med Rehab. 2015; 96: S209-S221
        • Baguley I.J.
        • Cooper J.
        • Felmingham K.
        Aggressive behavior following traumatic brain injury: how common is common?.
        J Head Trauma Rehabil. 2006; 21: 45-56
        • Roy D.
        • Vaishnavi S.
        • Han D.
        • Rao V.
        Correlates and prevalence of aggression at six months and one year after first-time traumatic brain injury.
        J Neuropsychiatry Clin Neurosci. 2017; 29: 334-342
        • Taft C.T.
        • Watkins L.E.
        • Stafford J.
        • Street A.E.
        • Monson C.M.
        Posttraumatic stress disorder and intimate relationship problems: a meta-analysis.
        J Consult Clin Psychol. 2011; 79: 22-33
        • Marshall A.D.
        • Panuzio J.
        • Taft C.T.
        Intimate partner violence among military veterans and active duty servicemen.
        Clin Psychol Rev. 2005; 25: 862-876
        • Elbogen E.B.
        • Johnson S.C.
        • Wagner H.R.
        • Sullivan C.
        • Taft C.T.
        • Beckham J.C.
        Violent behavior and post-traumatic stress disorder in US Iraq and Afghanistan veterans.
        Br J Psychiatry. 2014; 204: 368-375
        • Rueve M.E.
        • Welton R.S.
        Violence and mental illness.
        Psychiatry (Edgmont). 2008; 5: 34-48
        • Miles S.R.
        • Sharp C.
        • Tharp A.T.
        • et al.
        Emotion dysregulation as an underlying mechanism of impulsive aggression: reviewing empirical data to inform treatments for veterans who perpetrate violence.
        Aggress Violent Behav. 2017; 34: 147-153
        • Lee T.W.
        • Xue S.W.
        Does emotion regulation engage the same neural circuit as working memory? A meta-analytical comparison between cognitive reappraisal of negative emotion and 2-back working memory task.
        PLoS One. 2018; 13e0203753
        • Miles S.R.
        • Thompson K.E.
        • Stanley M.
        • Kent T.A.
        Single session emotion regulation skills training to reduce aggression in combat veterans: a clinical innovation case study.
        Psychol Serv. 2016; 13: 170-177
        • Dursa E.
        • Reinhard M.
        • Barth S.
        • Schneiderman A.
        Prevalence of a positive screen for PTSD Among OEF/OIF and OEF/OIF-Era veterans in a large population-based cohort.
        J Trauma Street. 2014; 27: 542-549
        • Dohrenwend B.P.
        • Turner J.B.
        • Turse N.A.
        • Adams B.G.
        • Koenen K.C.
        • Marshall R.
        The psychological risks of Vietnam for U.S. veterans: a revision with new data and methods.
        Science. 2006; 313: 979-982
        • Bahraini N.H.
        • Breshears R.E.
        • Hernández T.D.
        • Schneider A.L.
        • Forster J.E.
        • Brenner L.A.
        Traumatic brain injury and posttraumatic stress disorder.
        Psychiatr Clin North Am. 2014; 37: 55-75
        • Bryant R.A.
        • Marosszeky J.E.
        • Crooks J.
        • Baguley I.J.
        • Gurka J.A.
        Posttraumatic stress disorder and psychosocial functioning after severe traumatic brain injury.
        J Nerv Ment Dis. 2001; 189: 109-113
        • Gallaway M.S.
        • Fink D.S.
        • Millikan A.M.
        • Bell M.R.
        Factors associated with physical aggression among US Army soldiers.
        Aggress Behav. 2012; 38: 357-367
        • Lamberty G.J.
        • Nakase-Richardson R.
        • Farrell-Carnahan L.
        • et al.
        Development of a traumatic brain injury model system within the department of veterans affairs polytrauma system of care.
        J Head Trauma Rehabil. 2014; 29: E1-E7
        • Duchnick J.J.
        • Ropacki S.
        • Yutsis M.
        • Petska K.
        • Pawlowski C.
        Polytrauma transitional rehabilitation programs: comprehensive rehabilitation for community integration after brain injury.
        Psychol Serv. 2015; 12: 313
        • Dillahunt-Aspillaga C.
        • Nakase-Richardson R.
        • Hart T.
        • et al.
        Predictors of employment outcomes in veterans with traumatic brain injury: a VA traumatic brain injury model systems study.
        J Head Trauma Rehabil. 2017; 32: 271-282
        • Weathers F.
        • Litz B.
        • Herman D.
        • Huska J.
        • Keane T.
        The PTSD Checklist (PCL): reliability, validity, and diagnostic utility.
        Paper presented at: Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TXOctober 1993
        • Blanchard E.B.
        • Jones-Alexander J.
        • Buckley T.C.
        • Forneris C.A.
        Psychometric properties of the PTSD Checklist (PCL).
        Behav Res Ther. 1996; 34: 669-673
        • Bellon K.
        • Malec J.
        • Kolakowsky-Hayner S.
        Mayo-Portland Adaptability Inventory-4.
        J Head Trauma Rehabil. 2012; 27: 314-316
        • Nagelkerke N.J.D.
        A note on a general definition of the coefficient of determination.
        Biometrika. 1991; 78: 691-692
        • Jakupcak M.
        • Conybeare D.
        • Phelps L.
        • et al.
        Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD.
        J Trauma Stress. 2007; 20: 945-954
      1. Tanielian T. Jaycox L.H. Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. RAND Corporation, Santa Monica2008
        • Shin L.M.
        • Rauch S.L.
        • Pitman R.K.
        Amygdala, medial prefrontal cortex, and hippocampal function in PTSD.
        Ann N Y Acad Sci. 2006; 1071: 67-79
        • Resick P.A.
        • Monson C.M.
        • Chard K.M.
        Cognitive processing therapy: veteran/military version.
        Department of Veterans Affairs, Washington (DC)2010
        • Foa E.B.
        • Hembree E.A.
        • Rothbaum B.O.
        Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences. Therapist guide.
        Oxford University Press, Oxford2007
        • Hundt N.E.
        • Mott J.M.
        • Miles S.R.
        • Arney J.
        • Cully J.A.
        • Stanley M.A.
        Veterans’ perspectives on initiating evidence-based psychotherapy for PTSD.
        Psychol Trauma. 2015; 7: 539-546