781 Insomnia is Associated with Anger Expression in an Army Population

Introduction Emotion-regulation and sleep-related difficulties are intertwined. Most research has focused on the impact of poor sleep on internalizing symptoms (e.g. depression, anxiety) but a few studies have found a that increased insomnia is associated with more externalizing symptoms (e.g. anger). This relationship may be particularly salient for military personnel, for whom poor sleep is endemic. It is important that this relationship be further investigated in order to understand the issues that Army servicemembers face. Methods Data were acquired from the All Army Study of the Army Study to Assess Risk and Resilience in Servicemembers (STARRS; N=21,449; 18–61 years old; 86.5% male). Participants completed the Brief Insomnia Questionnaire, an 11-item irritability and anger-related questionnaire and a 10-item questionnaire on anger attacks. Pearson correlations were used to examine the relationship between insomnia symptoms and emotional and behavioral components of anger, while controlling for depressive symptom severity. Results Insomnia severity in the past 30 days was significantly correlated with both emotional and behavioral expressions of anger (all p<0.001, r = .2 to .4). Overall insomnia severity and early morning awakenings (EMA) had the strongest relationships. These relationships were still significant after controlling for depression severity. Conclusion In a nationally-representative sample of Army servicemembers, insomnia severity, particularly EMA, was associated with higher levels of irritability and anger (outbursts and anger attacks) over and above the effects of depression. These findings highlight the importance of treating insomnia in order to regulate anger expression within a military population. Support (if any) This publication is based on public use data from Army STARRS (Inter-university Consortium for Political and Social Research, University of Michigan-http://doi.org/10.3886/ICPSR35197-v1), funded by U.S. NIMH-U01MH087981.

The Price of Playing Through Pain: The Link Between Physical and Behavioral Health in Former NFL Athletes

Over the past decade, media outlets have drawn attention to some of the health consequences of playing in the National Football League (NFL), including how wear-and-tear and injuries accumulated during athletes’ playing years can affect their physical, emotional, and behavioral health after retirement from professional sports. Through a secondary analysis of a cross-sectional telephone survey of former NFL athletes, this study estimated logistic regression models to assess the relationship between several forms of physical pain and anger attacks, controlling for binge drinking, signs of depression, functional limitations, NFL career duration, religious service attendance, and demographic characteristics (age, marital status, race, education, income, and wealth). The analytic sample included 1030 former NFL players. Neck pain, lower back pain, headaches/migraines, and the number of sites of pain were positively and significantly related to anger attacks. There was no significant association between joint pain and anger attacks. NFL career duration was negatively associated with anger attacks, as was religious service attendance. Future research should focus on factors that protect against affective aggression in former professional athletes and how protective factors can be adapted to the broader population.

Anger attacks are associated with persistently elevated irritability in MDD: findings from the EMBARC study

Background This report tests the association of self-reported symptoms of irritability with overt behavior of anger attacks (uncharacteristic sudden bouts of anger that are disproportionate to situation and associated with autonomic activation). Methods Participants of the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care study who completed Massachusetts General Hospital Anger Attacks questionnaire were included (n = 293). At each visit, the 17-item Hamilton Depression Rating Scale and the 16-item Concise Associated Symptom Tracking scale were used to measure depression, anxiety, and irritability. In those with anger attacks present v. those without anger attacks, separate t tests and mixed model analyses compared afore-mentioned symptoms at baseline and changes with treatment respectively. As anger attacks may occur without aggressive behaviors, analyses were repeated based only on the presence of aggressive behaviors. Results At baseline, those with anger attacks (n = 109) v. those without anger attacks (n = 184) had similar levels of depression but higher levels of irritability [effect size (d) = 0.80] and anxiety (d = 0.32). With acute-phase treatment, participants with anger attacks experienced a greater reduction in irritability (p < 0.001) but not in depression (p = 0.813) or anxiety (p = 0.771) as compared to those without anger attacks. Yet, irritability levels at week-8 were higher in those with anger attacks (d = 0.32) than those without anger attacks. Similar results were found in participants with aggressive behaviors. Conclusions The presence of anger attacks in outpatients with major depressive disorder may identify a sub-group of patients with persistently elevated irritability.

Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality

Aims Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment. Methods IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment. Results The lifetime prevalence of IED in all countries was 0.8% (s.e.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy property and hurt people’), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterised by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults. Conclusions The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterises the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.