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

Shannon R. Miles, Lisa A. Brenner, Dawn Neumann, Flora M. Hammond, Susan Ropacki, Xinyu Tang, Blessen C. Eapen, Austin Smith, Risa Nakase-Richardson

Research output: Contribution to journalArticle


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.

Original languageEnglish (US)
Pages (from-to)81-88
Number of pages8
JournalArchives of physical medicine and rehabilitation
Issue number1
StatePublished - Jan 2020



  • Aggression
  • Anger
  • Brain injuries, traumatic
  • Rehabilitation
  • Stress disorders, post-traumatic
  • Veterans

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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