Effects of prior deployments and perceived resilience on anger trajectories of combat-deployed soldiers

Background Problematic anger is frequently reported by soldiers who have deployed to combat zones. However, evidence is lacking with respect to how anger changes over a deployment cycle, and which factors prospectively influence change in anger among combat-deployed soldiers. Methods Reports of problematic anger were obtained from 7298 US Army soldiers who deployed to Afghanistan in 2012. A series of mixed-effects growth models estimated linear trajectories of anger over a period of 1–2 months before deployment to 9 months post-deployment, and evaluated the effects of pre-deployment factors (prior deployments and perceived resilience) on average levels and growth of problematic anger. Results A model with random intercepts and slopes provided the best fit, indicating heterogeneity in soldiers' levels and trajectories of anger. First-time deployers reported the lowest anger overall, but the most growth in anger over time. Soldiers with multiple prior deployments displayed the highest anger overall, which remained relatively stable over time. Higher pre-deployment resilience was associated with lower reports of anger, but its protective effect diminished over time. First- and second-time deployers reporting low resilience displayed different anger trajectories (stable v. decreasing, respectively). Conclusions Change in anger from pre- to post-deployment varies based on pre-deployment factors. The observed differences in anger trajectories suggest that efforts to detect and reduce problematic anger should be tailored for first-time v. repeat deployers. Ongoing screening is needed even for soldiers reporting high resilience before deployment, as the protective effect of pre-deployment resilience on anger erodes over time.

Was a forced lockdown adequate for a country in conflict? A psychological perspective from the Syrian population

Background: Syria has suffered for nine years from a conflict that left over 11.1 million inhabitants in need of humanitarian assistance and over 80% in poverty. A ten-week-long full lockdown was enforced in Syria and successfully minimized the spread of COVID-19. This study aims to estimate the occurrence of mental health disorders after lockdown termination among the citizens of war-torn Syria. Methods: Online questionnaires, which included demographic and war-related questions, Dimensions of Anger Reactions 5 (DAR-5) and the Depression Anxiety Stress Scale-21 (DASS-21) were distributed to different social media groups. Results: This study recruited 1445 participants, of which 515 (35.6%) were males, the mean age was 24.8 ± 6.3 years, 38% had problematic anger, 64% had moderate to very severe depression, 42.9% had moderate to severe anxiety and 39.7% had moderate to severe stress. Increased living expenses, not being able to go out and a reduced ability to earn income and provide food were significantly associated with the psychological burden after the lockdown (p < 0.05). The association of war variables with mental disorders was weaker than the effect of the deteriorating economy. Other healthcare workers had more severe distress than doctors, who themselves were found to have less distress than the general population (p < 0.05). Anger scores were approximately equal, regardless of the type of work. Finally, shisha smoking was associated with worse mental health (p < 0.05). Conclusion: The psychological burden of the damaged economy surpassed the direct damage due to COVID-19 and the effect of years of conflict. Urgent interventions are required, as this burden may continue for years, if not for decades. A full lockdown in countries with fragile economies may delay the spread of the virus, but it will severely damage the economy, which will lead to a deterioration of the mental health of their citizens.

Post-traumatic stress disorder (PTSD), anger and mental health of school students in Syria after nine years of conflict: a large-scale school-based study

AimsThe Syrian crisis has entered its ninth year with many being affected by the war. This is the largest-scale study that aims to evaluate the psychological profile of secondary school students in Syria.MethodThis is a cross-sectional study in schools in Damascus, Syria. The surveys assessed working habits, smoking, war exposure, grades, socioeconomic status (SES), social support, health-related quality of life (HRQL), post-traumatic stress disorder (PTSD), problematic anger, and other parameters.ResultThis study included 1369 students of which 53% suffered from PTSD and 62% from problematic anger. Around 46% declared a fair or worse general health and 61% had moderate or severe mental health. Only 9.3% did not report exposure to any war-related variable. War exposure had an impact on PTSD, anger, and HRQL, but not on students' grades. Smoking, having consanguineous parents, and working did not have a clear association with grades or anger. Social support weakly reduced PTSD and anger scores. Interestingly, working was associatedwith lower PTSD scores but was associated with a worse physical component of HRQL.ConclusionThis is the largest study on school students in Syria that reports the psychological ramifications of war. Although the direct effects of war could not be precisely described, the high burden of PTSD and anger distress was a strong reflection of the chronic mental distress.

Post-traumatic stress disorder (PTSD), anger and mental health of school students in Syria after nine years of conflict: a large-scale school-based study

Background The Syrian crisis has entered its ninth year with many being affected by the war. This is the largest-scale study that aims to evaluate the psychological profile of secondary school students in Syria. Methods This is a cross-sectional study in schools in Damascus, Syria. The surveys assessed working habits, smoking, war exposure, grades, socioeconomic status (SES), social support, health-related quality of life (HRQL), post-traumatic stress disorder (PTSD), problematic anger, and other parameters. Results This study included 1369 students of which 53% suffered from PTSD and 62% from problematic anger. Around 46% declared a fair or worse general health and 61% had moderate or severe mental health. Only 9.3% did not report exposure to any war-related variable. War exposure had an impact on PTSD, anger, and HRQL, but not on students' grades. Smoking, having consanguineous parents, and working did not have a clear association with grades or anger. Social support weakly reduced PTSD and anger scores. Interestingly, working was associatedwith lowerPTSD scores but was associated with a worse physical component of HRQL. Conclusion This is the largest study on school students in Syria that reports the psychological ramifications of war. Although the direct effects of war could not be precisely described, the high burden of PTSD and anger distress was a strong reflection of the chronic mental distress.

Assessment of problematic anger using an Arabic adaptation of the Dimensions of Anger Reactions Scale-5 (DAR-5)

Background:Anger is a normal human emotion that is a common response to potentially traumatic events and implicated in the development and maintenance of post-traumatic stress disorder (PTSD). Anger is also a risk factor for aggression and violence. With millions of Syrians having to flee and being refugees in other countries, anger was rarely assessed as there was no brief robust tool for anger in Arabic. Objective: To develop and test an Arabic version of the Dimensions of Anger Reactions 5 (DAR-5) scale, a five-question scale to screen for anger distress and problematic anger in adults and adolescentsMethod:DAR-5 was translated into Arabic, then back translated into English, and finally re-checked for accuracy. Participants were 1641 Syrian adults, (621 males and 1020 females) and 784 adolescents aged between 14-16 years old (355 male and 429 female). Only Arabic speaking participants were included. Measures included the DAR-5 Arabic version (DAR-5 A) for both samples the Depression Anxiety Stress Scale-21 (DASS 21) for adults and the Children Revised Impact of Events Scale – 8 (CRIES-8). Results:High levels of internal reliability were reported (Cronbach’s α of .86) and factor analysis found that DAR-5-A scores fit as a single-factor model. Problematic anger rates were 35.8% and 60.3% of adults and adolescents respectively across the population using the cut-off point for DAR-5-A of ≥12. This cut off score also differentiated between scores high versus low scores on anxiety, depression and stress. Conclusions:This study reinforces the importance of assessing for anger in these populations. The DAR-5A written in formal Arabic, is a critical measure that can be used as a brief measure to assess for this problematic anger in Syrians and other Arabic-speaking communities

Arabic adaptation of the Dimensions of Anger Reactions Scale-5 (DAR-5)

Background:Anger is a normal human emotion that is a common response to potentially traumatic events and implicated in the development and maintenance of post-traumatic stress disorder (PTSD). Anger is also a risk factor for aggression and violence. With millions of Syrians having to flee and being refugees in other countries, anger was rarely assessed as there was no brief robust tool for anger in Arabic. Objective: To develop and validate an Arabic version of the Dimensions of Anger Reactions 5 (DAR-5) scale, a five-question scale to screen for anger distress and problematic anger.Method:DAR-5 was translated into Arabic, then back translated into English, and finally re-checked for accuracy. Participants were 1641 Syrian adults, with 621 (37.8%) males and 1020 (62.2%) females. Only Arabic speaking participants were included. Questionnaires were distributed to online that contained demographic data, the DAR5 Arabic version and the Depression Anxiety Stress Scale-21 (DASS 21). Results:High levels of internal reliability were reported (Cronbach’s α of .86) and factor analysis found that DAR-5-A scores fit as a single-factor model. Problematic anger rates were 36.7% across the population using the cut-off point for DAR-5-A of ≥12. This cut off score also successfully differentiated between scores high versus low scores on anxiety, depression and stress. Conclusions:DAR-5-A is a reliable and valid tool for clinicians and researchers, written in formal Arabic that can be used as a brief measure to assess problematic anger in Syrians and other Arabic-speaking communities.