ORIGINAL ARTICLE
Can Anger Be Helpful?
Soldier Perceptions of the Utility of Anger
Amy B. Adler, PhD,* Daniel F. Brossart, PhD,*† and Robin L. Toblin, PhD, MPH*
Abstract: Studies have found that soldiers returning from combat deployment
report elevated levels of anger and aggression. The present study examined the
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perception that anger was helpful in performing occupationally related duties
and whether this perception was associated with mental health problems, somatic
symptoms, and functioning. Soldiers (N = 627) completed a survey 4 months af-
ter their deployment to Afghanistan and again 3 months later. When examining
anger over time, findings revealed four groups of different latent classes: low sta-
ble (resilient), high stable (chronic), decreasing over time (improved), and in-
creasing over time (delayed problems). For two of the groups (chronic and
delayed problems), perceiving anger as helpful was closely related to anger reac-
tions. Perceiving anger as helpful was also associated with worse mental health
symptoms. Further work in understanding how to mitigate this positive percep-
tion of anger in prevention initiatives may be useful in addressing anger reactions.
Key Words: Anger reactions, aggression, military, mental health,
latent class analysis
(J Nerv Ment Dis 2017;205: 692–698)
E xposure to deployment-related stressors has been linked to numer-
ous transition difficulties (Adler et al., 2011) including mental
health problems such as posttraumatic stress disorder (PTSD) and de-
pression (Hoge et al., 2004), physical health problems (Jakupcak
et al., 2008), difficulties with functioning (Wright et al., 2013), and an-
ger and aggression (e.g., Elbogen et al., 2010; Heesink et al., 2015;
MacManus et al., 2015). In the military context, anger reactions may
be particularly important because of their association with unethical
conduct during deployment (Wilk et al., 2013), risky behaviors and un-
healthy habits after deployment (Adler et al., 2011), and greater symp-
tom severity overall (Forbes et al., 2003; Gonzalez et al., 2016). Anger
also does not seem to decrease over the course of the postdeployment
period (Bliese et al., 2007; Heesink et al., 2015; Reijnen et al., 2015),
and trait anger may even contribute to the risk of developing PTSD in
soldiers exposed to high levels of combat (Wilk et al., 2015).
Besides the link to deployment, anger reactions in military sam-
ples have also been associated with relationship problems (Novaco et al.,
2012), intent to harm others (Gonzalez et al., 2016), and violence
(MacManus et al., 2013). Moreover, there are indications that serious
problems with anger, such as intermittent explosive disorder, are
associated with risk for suicide (Kessler et al., 2014). Anger reactions
are also associated with being less likely to respond to evidence-
based treatments for PTSD (Lloyd et al., 2014).
*Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Re-
search, Silver Spring, Maryland; and †Department of Educational Psychology,
Texas A&M, College Station, Texas.
Send reprint requests to Amy B. Adler, PhD, Center for Military Psychiatry and
Neuroscience, Walter Reed Army Institute of Research, 503 Robert Grant Avenue,
Silver Spring, MD 20910. E‐mail: amy.b.adler.civ@mail.mil.
Written work prepared by employees of the Federal Government as part of their official
duties is, under the U.S. Copyright Act, a “work of the United States Government”
for which copyright protection under Title 17 of the United States Code is not
available. As such, copyright does not extend to the contributions of employees
of the Federal Government.
ISSN: 0022-3018/17/20509–0692
DOI: 10.1097/NMD.0000000000000712
692 www.jonmd.com The Journal of Nervous and Mental Disease • Volume 205, Number 9, September 2017
Given the potential negative impact of anger reactions on health
and adjustment, it is important to understand the role that anger reac-
tions play in the military occupational context. As Castro and Adler
(2011) have documented, there are unique characteristics associated
with emotional expression in the military. In the case of PTSD, for ex-
ample, whereas numbing may be a diagnostic focus, anger and aggres-
sion are key components of combat-related PTSD. Such reactions also
may be compounded by the acceptance of anger in the larger military
culture. Consistent with this perspective, one qualitative study found
that when soldiers were asked about their peritraumatic response to a
combat-related event, the most frequent response was that they reacted
based on occupational training, and the second most frequent response
was that they responded with anger (Adler et al., 2008). These angry re-
sponses typically reflected a drive to payback or punish others and
seemed to energize the soldiers responding to a combat-related event.
The Positive Role of Anger
Despite being generally regarded as a negative emotion associ-
ated with increased risk of mental health problems, anger can, in fact,
be adaptive. If anger is aligned with a task, then anger may be useful:
emotional resources may end up being directed toward a goal, and an-
ger may help performance (e.g., Lazarus, 2000). In contrast, if anger
is misaligned, then anger may interfere with performance. As Barsade
and Gibson (2007) suggest, there are opportunities for negative emo-
tions such as anger to have an important and positive role given the right
occupational context.
Likewise, anger may be useful for leaders to resolve problems. In
a qualitative study of workers in the construction industry, for example,
Lindebaum and Fielden (2011) found that project managers enacted an-
ger to ensure progress. Anger can also be used to restore equity or en-
sure fair treatment (van Doorn and Zeelenberg, 2014) and prompt
individuals to protest an unfair situation (Tagar et al., 2011). Studies
have also shown a positive link between anger and the tendency to ex-
press anger outward rather than suppress it and individual physical per-
formance (Davis et al., 2010).
Given that anger can be associated with benefits, it may be that
individuals in an occupational context like the military see anger as a
positive emotion. This positive perception introduces a potential layer
of complexity that would need to be understood to develop interven-
tions designed to reduce the deleterious effects of anger in this context.
The Present Study
Using a military sample, the first goal of the present study was to
characterize the perception of anger as helpful in performing occupationally
related duties. The goal was to identify the degree to which military person-
nel perceived anger as a useful tool for furthering performance and how that
perception shifted over the course of the period after a combat deployment.
The postdeployment period is known to be a dynamic time with potential
for increasing difficulties (e.g., Adler et al., 2011; Bliese et al., 2007).
The second goal of our study was to determine the degree to
which the perception of anger as helpful varied between subgroups of
soldiers based on their change in well-being over time. Specifically,
we examined mental health, somatic symptoms, and functioning
The Journal of Nervous and Mental Disease • Volume 205, Number 9, September 2017
because problems in each of these domains have been associated with
serving on a combat deployment (e.g., Hoge et al., 2004; Jakupcak
et al., 2008; Wright et al., 2013). This analysis was designed to identify
whether there is a health-related cost associated with viewing anger as
helpful even if soldiers believe there is a short-term benefit in job per-
formance. Such a health-related cost is important to consider because
persistently believing in the benefits of anger may inure individuals to
attempts to help them regulate their emotions. This perception may also
reinforce anger reactions that, in turn, increase relationship conflict and
detachment from others. Individuals who maintain a belief that anger is
adaptive may be at even greater risk for health-related problems and
functional impairment.
Finally, the third goal of the study was to examine potential cor-
relates of these subgroups to develop a more specific profile. We com-
pared the different subgroups in terms of combat experiences and
health-related behaviors (alcohol and sleep problems) given the link be-
tween these variables and postdeployment difficulties (e.g., Adler et al.,
2009; Sundin et al., 2014; Wright et al., 2011a).
METHODS
Participants and Procedure
Study participants were active-duty US soldiers in a brigade
combat team who had returned from a 12-month combat deployment
to Afghanistan 4 months earlier. Participants gave informed consent be-
fore enrollment, and 1110 of the 1322 soldiers briefed on the study
consented to participate (83.9%). The recruitment briefing, conducted
without senior leadership present, occurred in platoon-sized groups
(i.e., 30–40 soldiers) in classrooms on the installation. Initial (time 1)
and follow-up (time 2) survey administrations were also conducted
in platoon-sized groups and in installation classrooms. Time 2 oc-
curred 3 months after the initial survey.
Because of the nature of brigade combat teams, the sample was
all male, with the majority of the sample ranging in age from 20 to
24 years old (68%). In terms of education, most were high school grad-
uates (62%) or had some college or an associate's degree (32%). The
majority had only been in the military for 2 years (73%), and 83% were
of junior enlisted rank (E1–E4).
At follow-up, soldiers were surveyed again (N = 627 or 56% of the
original sample). This attrition rate is consistent with previous studies
(Adler et al., 2009, 2011) and reflects the procedure of tracking units rather
than individuals over time to preserve anonymity. Individuals may have
been unavailable at follow-up due to competing training or duty require-
ments and normal personnel rotation. This study was approved by an in-
stitutional review board at the Walter Reed Army Institute of Research.
Measures
Demographics
Demographic variables, asked in the initial survey, included sex,
age category, educational background, years in the military, and rank.
Perceptions of Anger as Helpful
One item, developed for the present study, assessed perceptions of
anger as helpful with the following statement, “Does anger help you in any
way to perform your duties now (such as: helps you focus, helps motivate
you)?” was rated on a 5-point scale (1 = not at all; 2 = rarely; 3 = some-
times; 4 = often; 5 = very often). This item was assessed at times 1 and 2.
Anger Reactions
The four-item measure of anger reactions, which has been the
standard measure used in large-scale studies with soldiers
(e.g., Cabrera et al., 2010; Cabrera et al., 2016; Killgore et al.,
2008; Thomas et al., 2010; Wilk et al., 2013, 2015), asked soldiers
Can Anger Be Helpful?
to rate their frequency of experience in the past month on a 5-point
scale (1 = never; 2 = one time; 3 = two times; 4 = three or four times;
5 = five or more times). The items, which are behaviorally anchored and
have face validity for soldiers, are as follows: “get angry at someone and
yell or shout at them,” “get angry at someone and kick or smash something,
slam the door, punch the wall, etc.,” “threaten someone with physical vio-
lence,” and “get into a fight with someone and hit the person.” These items
were based on existing measures of anger, aggression, and hostility (Kulka
et al., 1990; Spector and Jex, 1998; Spielberger, 1999). Previous work by
Wilk et al. (2015) has found two items from the trait anger scale
(Spielberger et al., 1983) correlated 0.51 with these four items. In a sepa-
rate, unpublished analysis of different survey data with 2036 soldiers, the
four-item scale correlated 0.68 (p < 0.001) with the Dimensions of An-
ger Reactions-5 (Forbes et al., 2004). Internal consistency on the initial
and follow-up survey was 0.72 and 0.78, respectively.
Deployment Experiences
A 34-item list of combat-related events such as “being attacked
or ambushed” and “handling human remains” was measured at time 1
and adapted from Hoge et al. (2004) and Adler et al. (2009). Items were
rated on a 4-point scale (never, one time, two to four times, five or more
times). Responses denoting any level of exposure to the event were
summed to create a total score ranging from 0 to 34. Coefficient alpha
was not estimated for the scale because the combat exposure items are
formative rather than reflective measures.
Mental Health
PTSD symptoms were measured at 4 months after redeployment
and 3 months later using the 17-item PTSD Checklist (PCL; Weathers
et al., 1993). This version has been used in other major postdeployment
studies (e.g., Adler et al., 2009; Hoge et al., 2004) and has been vali-
dated with military samples (Bliese et al., 2008; Riviere et al., 2011).
Items are rated on a 5-point Likert scale (not at all to extremely). Sam-
ple items included “repeated, disturbing memories, thoughts, or images
of the stressful experience” and “feeling distant or cut-off from other
people.” Internal consistency on the initial and follow-up survey was
0.94 and 0.95, respectively.
Depression symptoms were measured on the initial and
follow-up survey using the nine-item Patient Health Questionnaire
for Depression (PHQ-9; Spitzer et al., 1999), scored on a 4-point
scale (not at all to nearly every day). The PHQ-9 has been validated
in primary care samples (Spitzer et al., 1999) and used in postdeployment
studies (Adler et al., 2009). Sample items included “little interest or
pleasure in doing things” and “feeling down, depressed, or hopeless.”
Internal consistency on the initial and follow-up survey was 0.86 and
0.88, respectively.
Somatic Symptoms
Somatic symptoms were measured using 12 items from the Pa-
tient Health Questionnaire (PHQ-15; Kroenke et al., 2002). Symptoms
were rated in terms of the past 4 weeks using a three-item response scale
(1 = not bothered at all to 3 = bothered a lot). The PHQ-15 is typically
scored with two items that are shared with the PHQ-9 (i.e., feeling tired
or having low energy and trouble falling asleep, staying asleep, or
sleeping too much). To avoid using these same items on two scales,
the two items were only scored for the PHQ-9. The item regarding men-
strual problems was also omitted given that the sample only included
men. Thus, analyses were conducted on the 12 remaining items, such
as “stomach pain” and “back pain.” Internal consistency on the initial
and follow-up survey was 0.77 and 0.76, respectively.
Functional Impairment
The Walter Reed Functional Impairment Scale (WRFIS; Herrell
et al., 2014) is a 14-item measure used to assess functioning in an
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Adler et al. The Journal of Nervous and Mental Disease • Volume 205, Number 9, September 2017
occupational context like the military. Items are scored using five response
options (1 = no difficulty at all to 5 = extreme difficulty). Sample items in-
cluded rating “the accuracy of your work” and “your ability to multitask.”
Internal consistency was 0.92 on both the initial and follow-up survey.
Health-Related Behaviors
Alcohol problems were measured using the three-item Alcohol
Use Disorders Identification Test–Consumption scale (AUDIT-C; Bush
et al., 1998). These items were a) “How often do you have a drink contain-
ing alcohol?” b) “How many drinks containing alcohol do you have on a
day when you are drinking?” and c) “How often do you have six or more
drinks on one occasion?” Internal consistency on the initial and follow-up
survey was 0.88 and 0.90, respectively. Sleep problems were measured
with four items adapted from the Insomnia Severity Index (Bastien
et al., 2001), which has been used in other studies with soldiers
(Adler et al., 2009; Wright et al., 2011b). The items included difficulty
falling or staying asleep (1 = none to 5 = very severe), sleep satisfaction
(1 = very satisfied to 5 = very dissatisfied), and the degree to which
sleep interfered with functioning (1 = not at all to 5 = very much). In-
ternal consistency on the initial and follow-up survey was 0.92 and
0.91, respectively.
Analytic Strategy
First, we calculated the frequency of soldiers' perception of anger
as helpful, and then examined relationships between mental health mea-
sures and possible differences in rank and years of service. For the main
analysis, we selected a statistical method that could do three things:
a) account for intraindividual changes in soldiers' perceptions of anger
as helpful, b) examine how anger may be related to other mental health
problems over time, and c) examine interindividual differences in po-
tential groups of soldiers that were similar in how they perceived anger
and the symptoms they were experiencing. Latent transition analysis al-
lows examination of potential latent groups based on the distributional
properties of the variables under investigation and allows individuals to
change from one group or status to another over time. Adapting the ap-
proach taken by Lanza et al. (2010), when discussing the “latent clas-
ses” produced by the latent transition analysis, we used the term
“group” instead of “class” to highlight the fact that individuals may
change membership in class over time. The variables used to deter-
mine latent class at each time point and in the subsequent latent tran-
sition analysis consisted of the perceptions of anger as helpful, the
PHQ-9, the PCL, the anger reactions scale, somatic symptoms, and
the WRFIS. Mplus version 7.4 was used to test these models (Muthén
and Muthén, 1998–2015).
Using a common strategy, we first determined the optimal num-
ber of latent classes appropriate at each time point by running a number
of latent profile models, while varying the number of latent classes and
then examining the resulting model fit indices such as Akaike's Infor-
mation Criterion (AIC), Bayesian Information Criterion (BIC), Lo-
Mendell-Rubin Adjusted Likelihood Ratio Test (LMRT; Lo et al.,
2001), and the sample size-adjusted Bayesian information criteria
(SABIC; Schwarz, 1978). Then, the latent transition model was ana-
lyzed using the number of classes determined in the earlier step. Finally,
we examined the relationship across latent groups on one variable asso-
ciated with increased risk (combat experiences) and two health-related
behaviors (drinking problems and sleep problems) associated with poor
adjustment to determine whether these variables could be used to clarify
differences across latent groups over time.
RESULTS
Descriptive Statistics
In terms of the single item regarding perception of anger as help-
ful, at time 1, 39.4% of participants surveyed endorsed “not at all,”
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10.9% endorsed “rarely,” 27.8% endorsed “sometimes,” 13.4% en-
dorsed “often,” and 7.1% endorsed “very often.” At time 2, the ratings
were 45.8%, 17.8%, 29.3%, 4.0%, and 3.0%, respectively. Thus, at time
1, nearly half of the soldiers (48.3%) felt that anger was at least some-
times helpful; this proportion dropped at time 2 to 36.3%.
As with previously published studies, mental health symptoms
correlated with one another. For example, at time 1, PTSD scores were
correlated with depression symptoms (r = 0.79, p < 0.01) and with an-
ger reactions (r = 0.50, p < 0.01); similarly, depression symptoms were
correlated with anger reactions (r = 0.46, p < 0.01). Likewise, some de-
mographic differences in symptom reporting were significant. For ex-
ample, analyses of variance (ANOVAs) run on years of military
service in terms of PTSD and depression symptoms revealed that those
with 4 to 6 years of service reported more PTSD and depression symp-
toms than those with less (1–3 years) or more (7–10, 11+) years of ser-
vice (F [3, 621] = 4.62, p < 0.01; F [3, 621] = 4.22, p < 0.01,
respectively). In terms of rank, non-commissioned officers (NCOs;
E5–E9) reported more PTSD and depression symptoms than those at
junior or officer ranks (F[2, 618] = 4.02, p < 0.02; F[2, 618] = 3.56,
p < 0.03, respectively). However, in terms of anger reactions, there were
no significant differences for rank or years of service.
Latent Profile Analysis
We began by determining the appropriate number of latent clas-
ses at both time points (based on how helpful anger is in performing
one's duties, the PHQ-9, the PCL, the anger reactions scale, somatic
symptoms, and the WRFIS) by comparing latent profile models with
two to four classes. Latent profile analysis is a cross-sectional method
“used to estimate membership in unobserved groups” (Newsom,
2015, p. 264). Table 1 provides the results of the latent profile analysis
at time 1 and time 2. Lower AIC, BIC, and SABIC (Schwarz, 1978)
values and higher entropy values indicate better model fit. The LMRT
(Lo et al., 2001) compares the model being tested to a model with one
less class; a statistically significant result indicates that the model being
tested fits better than the model with one less class. A nonsignificant
result suggests that a model with one less class is a better explanation
of the data.
Evaluating multiple indicators of fit is necessary because not all
fit indicators will suggest a model with the same number of classes as
the best fitting model. For example, in Table 1 the AIC, BIC, and
SABIC all suggest a four-class model at time one. However, entropy
values are highest for two and three classes, and the LMRT results sug-
gest a three-class model. Overall, a case can be made for three classes at
time 1 given the higher entropy value and the LMRT results. The same
type of discrepancy can be seen for time 2. AIC suggests four classes,
whereas the BIC and SABIC suggest that three classes will give the best
fit. Entropy was highest for two classes, and the LMRT suggests that
only two classes are needed. Simulation studies show that methods
(e.g., LMRT) that compare two models differing by one class may be
preferable to solely examining fit indices (AIC, BIC, SABIC; Lo
et al., 2001). Overall, it seems that a case can be made for two classes
at time 2 due to a higher entropy value and the LMRT results. In addi-
tion to examining fit values, one final criterion for determining the
number of classes is that the final model selected should be informative
and interpretable as demonstrated in other studies (e.g., McBride et al.,
2014; Rodgers et al., 2014). When the three-class solution was graphed
at time 2, the additional third class accounted for individuals who fell
between those who scored low and those who scored high across all
the variables. Thus, the conceptual and explanatory power gained by
using a three-class model instead of a two-class model seemed to
be minimal.
To summarize, the latent profile analysis was conducted at both
time points (time 1 and time 2) to determine how many classes to pro-
duce in the latent transition analysis, which allows for the identification
of classes at both time points and changes in class over time. Based on
The Journal of Nervous and Mental Disease • Volume 205, Number 9, September 2017 Can Anger Be Helpful?

Latent Group by Combat Experiences, Drinking and

TABLE 1. Latent Profile Analysis of Anger Reactions and Health
Scores of US Soldiers at 4 and 7 Months Postdeployment (N = 627) Sleep Problems Over Time
Further exploration of the latent class patterns involved a series
2 Classes 3 Classes 4 Classes of ANOVAs to see if they could shed light on the differences between
those in each group. In terms of combat experiences, there was a statis-
Time 1 tically significant difference among the groups: F(64, 626) = 2.25,
AIC 18,923 18,256 18,047 p < 0.001. Examination of the group means revealed that those with
BIC 19,034 18,425 18,273 the lowest scores for combat experiences were in the resilient group
SABIC 18,955 18,304 18,112 (mean = 48.16, SD = 13.19), and those with the highest scores of combat
Entropy 0.90 0.90 0.85 experiences were in the chronic group (mean = 58.5, SD = 13.94); those
Lo, Mendell, Rubin 2 vs. 1 3 vs. 2 4 vs. 3 participants with the most combat experiences were doing the worst at
Value = 2327 Value = 685 Value = 221 times 1 and 2. Interestingly, the delayed problems group had fewer com-
p < 0.01 p = 0.04 p = 0.39 bat experiences (mean = 51.74, SD = 12.51) than the improved class
n for each class C1 = 334 C1 = 248 C1 = 129 (mean = 54.04, SD = 12.35), suggesting that other kinds of life stressors
may have accounted for this decline.
C2 = 293 C2 = 155 C2 = 214
When examining drinking problems at the initial time period,
C3 = 224 C3 = 196 there were statistically significant differences between the latent class
C4 = 88 patterns, F(14,626) = 5.76, p < 0.001. Therefore we examined the
Time 2 drinking scores for each latent group and found that those in the resil-
AIC 19,664 18,977 18,968 ient group drank the least at time 1 (mean = 3.04; SD = 2.87) and even
BIC 19,775 19,146 19,194 slightly less at follow-up (mean = 2.81; SD = 2.85). Consistent with the
SABIC 19,696 19,025 19,032 latent class patterns, those in the improved group also reduced their
Entropy 0.94 0.89 0.848 drinking at follow-up (meanT1 = 3.97, SDT1 = 3.79; meanT2 = 2.72,
Lo, Mendell, Rubin 2 vs. 1 3 vs. 2 4 vs. 3 SDT2 = 2.84), whereas those in the delayed problems group increased
Value = 2452 Value = 705 Value = 35 their drinking (meanT1 = 3.95, SDT1 = 3.45; meanT2 = 4.26, SDT2 =
3.58). Finally, those in the chronic group reported the most drinking
p < 0.01 p = 0.49 p = 0.58
at both time points (meanT1 = 5.86, SDT1 = 3.99; meanT2 =
n for each class C1 = 275 C1 = 181 C1 = 8 5.22, SDT2 = 4.17).
C2 = 352 C2 = 277 C2 = 162 A similar pattern was found for sleep problems. At time 1, there
C3 = 169 C3 = 198 was a statistically significant difference among the latent class patterns,
C4 = 259 F(16, 626) = 24.37, p < 0.001. Examining the sleep problem scores for
each latent pattern showed a similar pattern to that of drinking. Those in
Note. AIC lower values indicate better model fit. BIC lower values indicate
better model fit. SABIC lower values indicate better model fit. Higher entropy
the resilient group reported the fewest problems with sleeping overall
values indicate better model fit. The Lo-Mendell-Rubin test compares models (meanT1 = 6.48, SDT1 = 2.44; meanT2 = 6.70, SDT2 = 2.62). Those in
with one less class. If statistically significant, it suggests that a model with more the improved group reported a reduction in sleep problems (meanT1 =
classes should be investigated, not that adding more classes will necessarily pro- 10.39, SDT1 = 4.04; meanT2 = 8.88, SDT2 = 3.30), those in the delayed
duce better fit. If nonsignificant, it suggests that a model with one less class is a problems group reported an increase in sleep problems (meanT1 = 9.15,
better explanation of one's data. SDT1 = 3.57; meanT2 = 10.96, SDT2 = 3.85), and those in the chronic
C1, C2, C3, and C4 indicate to which class an individual belongs: C1, class 1; group reported the greatest level of sleep problems (meanT1 = 13.10,
C2, class 2; C3, class 3; C4, class 4. SDT1 = 4.24; meanT2 = 13.17, SDT2 = 3.78), although the level stayed
the same across the two time points.

our results, the latent profile analysis suggested a different number of DISCUSSION
classes for both time 1 and time 2. We selected a parsimonious two- Overall, nearly half of the soldiers surveyed reported that anger
class model using latent transition analysis to allow for differences at was at least sometimes helpful to them in performing their occupational
both times while also accounting for potential changes in class member- duties. The perception of anger as helpful, however, was not randomly
ship over time.
It can be confusing to read about a two-class model and yet have
four groups in the latent transition analysis. Recall that the latent profile TABLE 2. Counts, Proportions, and Latent Transition Probabilities for
analysis only examined a single time point, whereas the latent transition the Latent Class Patterns of Anger Reactions and Health Scores of US
analysis looks at group membership over time. Thus, with only a two- Soldiers at 4 and 7 Months Postdeployment (N = 627)
class model, there are actually four groups based on whether one stays
in the same group or transitions into another group at time 2. Latent Class Number Proportion of Latent Transition
The number of participants in each latent group, the proportion Patterna in Class Sample in Class Probabilities
of the sample in each group, and the latent transition probabilities are
Resilient: low-low 208 0.33 0.63
presented in Table 2. The largest groups are those that do not transition
from one class to another across time but are stable at both time 1 and Delayed problems: 126 0.20 0.37
low-high
time 2. To better understand what these latent class patterns mean, the
group means are presented for each variable in Table 3. Those low on Improved: high-low 72 0.11 0.24
measures at both time periods were termed “resilient” (n = 208), and Chronic: high-high 221 0.35 0.76
those high on the measures at both time periods were described as Note. Proportion rounded to two decimals.
“chronic” (n = 221). Those low at time 1 and high at time 2 were termed a
Latent class pattern description followed by relative time 1 and time 2 scores
the “delayed problems” group (n = 126), and those scoring high at time (e.g., low or high).
1 and low at time 2 were regarded as “improved” (n = 72).

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TABLE 3. Latent Class Pattern and Means on Anger Reactions and Health Scores at Time 1 and Time 2 of US Soldiers at 4 and 7 Months
Postdeployment (N = 627)

Latent Class Pattern Mean Scores

Resilient Delayed Problems Improved Chronic
Variable (Low-Low) (n = 208) (Low-High) (n = 126) (High-Low) (n = 72) (High-High) (n = 221)
Anger as helpful T1 1.35 1.43 1.61 2.02
Anger as helpful T2 1.69 1.93 1.81 2.40
PHQ-9 T1 0.98 2.82 4.24 8.60
PHQ-9 T2 0.87 5.31 1.87 9.47
PCL T1 20.52 24.53 28.59 41.20
PCL T2 19.33 29.40 22.04 41.53
Anger reactions T1 0.82 1.56 2.78 5.24
Anger reactions T2 0.95 2.98 1.12 6.08
PHQ-15 T1 13.35 14.55 15.68 17.80
PHQ-15 T2 13.34 15.41 13.93 17.22
WRFIS T1 14.84 16.13 18.89 24.34
WRFIS T2 14.96 21.10 15.86 27.83

distributed across the sample. Specifically, latent transition analysis
identified two at-risk groups of soldiers. We termed the first group of
at-risk soldiers “chronic.” The “chronic” group represented more than
a third of the sample (35%) and was likely to agree that anger helped
them fulfill their occupational role. This group also reported high levels
of anger reactions, mental health problems, somatic symptoms, and
functional impairment. This perception of anger as helpful persisted
roughly 3 months later as did their other symptoms. The other at-risk
group accounted for 20% of the sample and was characterized as “de-
layed problems.” Soldiers in this group initially reported moderately
low levels of perceptions of anger as helpful and lower scores for anger
reactions, mental health problems, somatic symptoms, and functional
impairment. Nonetheless, at follow-up, their symptoms increased as did
their perception of anger as helpful. The other two latent class patterns
consisted of those with low scores on both the initial survey and on the
follow-up survey (33%; “resilient”) or those whose symptoms and per-
ceptions of anger as helpful decreased over time (11%; “improved”).
These differences across groups can be characterized as mean-
ingful given the consistency with which the mean scores differed across
groups and the consistency with which the two shifting groups (the de-
layed and improved group) changed scores over time. The extent of the
group differences are seen most clearly by comparing the resilient and
chronic group; in general, individuals in the chronic group reported at
least double what was reported by the resilient group, and the chronic
group's mean PCL score was near the standard cutoff score of 50
(e.g., Hoge et al., 2004), a marker of clinical distress.
Taking all four latent groups into account, the perception of an-
ger as helpful was not associated with positive adjustment after deploy-
ment; rather the perception of anger as helpful was comorbid with
higher levels of overall anger reactions, mental health problems, so-
matic symptoms, and lower levels of functioning. Furthermore, sub-
groups characterized by the perception of anger as helpful and other
symptoms were also more likely to report alcohol and sleep problems.
Thus, although there have been previous indications that anger can be
useful in the right context (Barsade and Gibson, 2007), it seems in this
particular occupational context—the postdeployment phase—the per-
ception of anger as helpful is not associated with better health
or functioning.
In addition, although those in the chronic group reported the
highest levels of combat experiences as would be expected from previ-
ous research (e.g., Adler et al., 2009; Wilk et al., 2015), the delayed
problem group reported fewer combat experiences than the improved
group, suggesting the possibility this group may be negatively
responding to other life-related events.
The fact that perceiving anger as helpful is not associated with
positive mental health adjustment offers an important insight into how
anger may function to undermine individual well-being in the military
context. Individuals may mislead themselves and believe that anger is
of benefit rather than realize that anger may lead to a spiral of negative
health, compounded by unhealthy behaviors. Given previous evidence
that anger may be accepted in the military culture (e.g., Adler et al.,
2008; Castro and Adler, 2011), it may be that individuals who integrate
the belief that anger is helpful into their experience, without caveat, may
not manage their emotional response during the postdeployment phase
appropriately. Emphasizing the importance of emotion regulation may
forestall a negative spiral.
From another clinical vantage point, it may be worth determining
if anger is the soldier's “go to” emotion. If anger serves to energize and
get things done while also serving as one's primary emotion, it may be
easy for soldiers to default to this response as a way to navigate life cir-
cumstances. The downside is that the anger may obscure other impor-
tant emotions and may also disrupt relationships. Teaching soldiers
strategies to increase emotion regulation may aid in developing alter-
nate ways of interacting and interpreting events.
Limitations and Future Directions
There are several limitations to the present study. First, only one
item was used to assess the perception of anger as helpful. One item
does not represent a complex assessment of the construct, although
one-item questions can be useful in assessing some constructs, espe-
cially if it has good face validity (Wanous et al., 1997). Second, there
were no women in the sample and no soldiers from support units; thus,
the findings may not generalize to the way in which anger is perceived
by women or soldiers in support units. Third, this study relied on self-
report scales to measure clinical outcomes, although anonymous sur-
veys may result in more reporting than formal interviews (Warner
et al., 2011). Fourth, the measure of anger reactions used in the present
study is not a well-validated measure. Although frequently used in stud-
ies with service members, follow-on research should rely on more tra-
ditional measures of anger and aggression. Finally, there is no way to
assess directionality. That is, it is unclear the extent to which the percep-
tion of anger as helpful is a consequence of anger reactions and the ex-
tent to which it is a cause.

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The Journal of Nervous and Mental Disease • Volume 205, Number 9, September 2017
There are several additional implications for future research. The
results of this study are important in that each latent class identified sug-
gests a potentially different approach to treatment for mental health
problems after deployment. For example, it may be useful to consider
the service member's perception of anger in the context of treatment
planning. Given that over a third of the sample perceived anger as help-
ful initially and at follow-up, an additional study on these individuals is
merited to develop targeted methods of addressing their confluence of
mental health problems, somatic symptoms, and anger reactions. The
belief that anger is useful may result in the persistence of symptoms
and may benefit from being addressed directly in modules added to
evidence-based treatments. Another group that warrants further exami-
nation is the class of service members that was worse on a range of mea-
sures at follow-up. Several studies have identified this drop in adjustment
(e.g., Bliese et al., 2007; Bonanno et al., 2012). It may be that the belief
that anger is useful and other life stressors that occur after the deployment
fuel a downward spiral. Identifying what drives this drop in adjustment
would be useful for informing interventions to prevent such a decline. Fu-
ture research should also target the improved group to gain insight into
what leads to a decrease in symptoms and in a decrease in finding anger
helpful over time. In addition, follow-on work should examine the degree
to which these group-based characteristics predict episodes of violence,
identify other variables that may be contributing to aggression, and use
an expanded measure of the positive perception of anger and of anger
and aggression, including reports from unit or family members.
Research should also examine the degree to which the findings
replicate in women who are serving in the military. Although Worthen
et al. (2014) have found similarly high rates of anger between men and
women in a National Guard sample, other studies have documented
sex differences in anger (e.g., Martin et al., 2013). Thus, it is not clear
if there are sex differences in anger in the military occupational context.
It is also not clear whether the perception of anger as helpful is associ-
ated with more difficult adjustment in women as it is with men.
Furthermore, research should explore whether having a positive
perspective of anger may result in individuals being less receptive to
standardized attempts at anger management or early intervention. If this
is the case, then adjustments to existing interventions may need to be con-
sidered to address this misperception of anger's utility. Although anger
may be useful under some circumstances, holding this perception seems
to come at a significant cost. Such interventions should acknowledge the
positive role anger may have played during combat and specifically iden-
tify how these benefits may become detrimental after returning home.
Finally, future work should assess the larger role of anger in this
high-risk occupational context. Studies should address the degree to which
the positive perception of anger is unidimensional or present before join-
ing the military. In addition, future research should examine how anger
is perceived within teams and managed by small team leaders.
CONCLUSIONS
Perceiving anger as helpful is not associated with better mental
health adjustment and may be an indicator of risk. Considering how an-
ger is perceived has the potential to identify a range of potential points of
intervention for individuals working in a high-risk occupational context.
ACKNOWLEDGMENTS
The authors thank Charles W. Hoge, Richard Herrell, Jonathan
Metzler, Jennifer Auchterlonie, Laura Bean, Kristina Clarke-Walper,
Rachel Eckford, Paul Kim, Brian Kok, Carla Kreilein, Nadia Marroquin,
Julie Merrill, Randall Mills, Leonard Skipper, Michael Wood, and Kristin
Young for their research support. The views expressed in this article
are those of the authors and do not necessarily represent the official
policy or position of the US Army Medical Command or the Depart-
ment of Defense.
Can Anger Be Helpful?
DISCLOSURE
Funding was provided by the US Army's Military Operational
Medicine Research Program and was not part of a grant.
The authors declare no conflict of interest.
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