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Published Online: 25 April 2019

Anger and Depression in Middle-Aged Men: Implications for a Clinical Diagnosis of Chronic Traumatic Encephalopathy

Publication: The Journal of Neuropsychiatry and Clinical Neurosciences

Abstract

Objective:

In recent years, it has been proposed that problems with anger control and depression define clinical features of chronic traumatic encephalopathy (CTE). The authors examined anger problems and depression in middle-aged men from the general population and related those findings to the proposed clinical criteria for CTE.

Methods:

A sample of 166 community-dwelling men ages 40–60 was extracted from the normative database of the National Institutes of Health Toolbox. All participants denied prior head injury or traumatic brain injury (TBI). Participants completed scales assessing anger, hostility, aggression, anxiety, and depression.

Results:

In response to the item “I felt angry,” 21.1% of men reported “sometimes,” and 4.8% reported “often.” When asked “If I am provoked enough I may hit another person,” 11.4% endorsed the statement as true. There were moderate correlations between anger and anxiety (Spearman’s ρ=0.61) and between depression and affective anger (ρ=0.51), hostility (ρ=0.56), and perceived hostility (ρ=0.35). Participants were dichotomized into a possible depression group (N=49) and a no-depression group (N=117) on the basis of the question “I feel depressed,” specific to the past 7 days. The possible depression group reported higher anxiety (p<0.001, Cohen’s d=1.51), anger (p<0.001, Cohen’s d=0.96), and hostility (p<0.001, Cohen’s d=0.95).

Conclusions:

Some degree of anger and aggression are reported by a sizable minority of middle-aged men in the general population with no known history of TBI. Anger and hostility are correlated with depression and anxiety, indicating that all tend to co-occur. The base rates and comorbidity of affective dysregulation in men in the general population is important to consider when conceptualizing CTE phenotypes.

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Information & Authors

Information

Published In

Go to The Journal of Neuropsychiatry and Clinical Neurosciences
Go to The Journal of Neuropsychiatry and Clinical Neurosciences
The Journal of Neuropsychiatry and Clinical Neurosciences
Pages: 328 - 336
PubMed: 31018811

History

Received: 21 November 2018
Revision received: 3 January 2019
Revision received: 6 January 2019
Accepted: 6 January 2019
Published online: 25 April 2019
Published in print: Fall 2019

Keywords

  1. Mood Disorders (Neuropsychiatric Aspects)
  2. Neuropathology

Authors

Details

Grant L. Iverson, Ph.D. [email protected]
From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Mass. (Iverson, Terry, Luz, Zafonte); Massachusetts General Hospital for Children Sports Concussion Program (Iverson, Terry, Zafonte); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Mass. (Iverson, Terry, Zafonte); the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. (Zafonte); the Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (McCrory); the Departments of Neurological Surgery, Orthopaedic Surgery and Rehabilitation, and Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); the Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); and the Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (Gardner).
Douglas P. Terry, Ph.D.
From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Mass. (Iverson, Terry, Luz, Zafonte); Massachusetts General Hospital for Children Sports Concussion Program (Iverson, Terry, Zafonte); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Mass. (Iverson, Terry, Zafonte); the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. (Zafonte); the Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (McCrory); the Departments of Neurological Surgery, Orthopaedic Surgery and Rehabilitation, and Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); the Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); and the Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (Gardner).
Matthew Luz, B.S.
From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Mass. (Iverson, Terry, Luz, Zafonte); Massachusetts General Hospital for Children Sports Concussion Program (Iverson, Terry, Zafonte); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Mass. (Iverson, Terry, Zafonte); the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. (Zafonte); the Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (McCrory); the Departments of Neurological Surgery, Orthopaedic Surgery and Rehabilitation, and Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); the Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); and the Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (Gardner).
Ross Zafonte, D.O.
From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Mass. (Iverson, Terry, Luz, Zafonte); Massachusetts General Hospital for Children Sports Concussion Program (Iverson, Terry, Zafonte); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Mass. (Iverson, Terry, Zafonte); the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. (Zafonte); the Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (McCrory); the Departments of Neurological Surgery, Orthopaedic Surgery and Rehabilitation, and Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); the Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); and the Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (Gardner).
Paul McCrory, M.B.B.S., Ph.D.
From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Mass. (Iverson, Terry, Luz, Zafonte); Massachusetts General Hospital for Children Sports Concussion Program (Iverson, Terry, Zafonte); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Mass. (Iverson, Terry, Zafonte); the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. (Zafonte); the Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (McCrory); the Departments of Neurological Surgery, Orthopaedic Surgery and Rehabilitation, and Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); the Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); and the Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (Gardner).
Gary S. Solomon, Ph.D.
From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Mass. (Iverson, Terry, Luz, Zafonte); Massachusetts General Hospital for Children Sports Concussion Program (Iverson, Terry, Zafonte); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Mass. (Iverson, Terry, Zafonte); the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. (Zafonte); the Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (McCrory); the Departments of Neurological Surgery, Orthopaedic Surgery and Rehabilitation, and Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); the Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); and the Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (Gardner).
Andrew J. Gardner, Ph.D.
From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Mass. (Iverson, Terry, Luz, Zafonte); Massachusetts General Hospital for Children Sports Concussion Program (Iverson, Terry, Zafonte); Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Mass. (Iverson, Terry, Zafonte); the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. (Zafonte); the Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia (McCrory); the Departments of Neurological Surgery, Orthopaedic Surgery and Rehabilitation, and Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); the Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tenn. (Solomon); and the Hunter New England Local Health District Sports Concussion Program and Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (Gardner).

Notes

Send correspondence to Dr. Iverson ([email protected]).

Funding Information

The authors report no financial relationships with commercial interests.

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