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Cowlishaw S, Freijah I, Kartal D, Sbisa A, Mulligan A, Notarianni M, Couineau AL, Forbes D, O’Donnell M, Phelps A, Iverson KM, Heber A, O’Dwyer C, Smith P, Hosseiny F. Intimate Partner Violence (IPV) in Military and Veteran Populations: A Systematic Review of Population-Based Surveys and Population Screening Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148853. [PMID: 35886702 PMCID: PMC9316917 DOI: 10.3390/ijerph19148853] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/23/2022]
Abstract
Intimate partner violence (IPV) may be a major concern in military and veteran populations, and the aims of this systematic review were to (1) provide best available estimates of overall prevalence based on studies that are most representative of relevant populations, and (2) contextualise these via examination of IPV types, impacts, and context. An electronic search of PsycINFO, CINHAL, PubMed, and the Cochrane Library databases identified studies utilising population-based designs or population screening strategies to estimate prevalence of IPV perpetration or victimisation reported by active duty (AD) military personnel or veterans. Random effects meta-analyses were used for quantitative analyses and were supplemented by narrative syntheses of heterogeneous data. Thirty-one studies involving 172,790 participants were included in meta-analyses. These indicated around 13% of all AD personnel and veterans reported any recent IPV perpetration, and around 21% reported any recent victimisation. There were higher rates of IPV perpetration in studies of veterans and health service settings, but no discernible differences were found according to gender, era of service, or country of origin. Psychological IPV was the most common form identified, while there were few studies of IPV impacts, or coercive and controlling behaviours. The findings demonstrate that IPV perpetration and victimisation occur commonly among AD personnel and veterans and highlight a strong need for responses across military and veteran-specific settings. However, there are gaps in understanding of impacts and context for IPV, including coercive and controlling behaviours, which are priority considerations for future research and policy.
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Affiliation(s)
- Sean Cowlishaw
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
- Correspondence:
| | - Isabella Freijah
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Dzenana Kartal
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Alyssa Sbisa
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Ashlee Mulligan
- Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - MaryAnn Notarianni
- Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - Anne-Laure Couineau
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - David Forbes
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Meaghan O’Donnell
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Andrea Phelps
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Katherine M. Iverson
- Women’s Health Sciences Division, National Center for PTSD, Veterans Affairs Boston Healthcare System, 150 South Huntington Street, Boston, MA 02130, USA;
- Department of Psychiatry, Boston University School of Medicine, 72 E Concord Street, Boston, MA 02118, USA
| | - Alexandra Heber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON L8N 3K7, Canada;
- Veterans Affairs Canada, Charlottetown, PE C1A 8M9, Canada
| | - Carol O’Dwyer
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry Street, Carlton, VIC 3053, Australia; (I.F.); (D.K.); (A.S.); (A.-L.C.); (D.F.); (M.O.); (A.P.); (C.O.)
| | - Patrick Smith
- Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
| | - Fardous Hosseiny
- Atlas Institute for Veterans and Families, Royal Ottawa Mental Health Centre, 1145 Carling Avenue, Ottawa, ON K1Z 7K4, Canada; (A.M.); (M.N.); (P.S.); (F.H.)
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Logan MW, McNeeley S, Morgan MA. The Effects of Traumatic Brain Injury and Post-Traumatic Stress Disorder on Prison Adjustment and Recidivism among Military Veterans: Evidence from Minnesota. Psychiatr Q 2021; 92:1147-1158. [PMID: 33587259 DOI: 10.1007/s11126-021-09883-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 01/31/2023]
Abstract
The prevalence of, and link between, mental health disorders-such as traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD)-and antisocial behavior is well-documented among the military veteran population. Studies also show that TBI and PTSD account for variation in prison-based and re-entry outcomes. Despite this body of research, comparatively fewer studies have explicitly focused on how these factors affect prison adjustment for inmates with prior military experience. We used administrative data provided by the Minnesota Department of Corrections (MnDOC) and employed a series of survival analyses to examine how prior diagnoses of TBI and PTSD (among other risk factors) influence metrics of institutional adjustment and recidivism among a sample of military veterans. Our results indicate that the effects of TBI, PTSD, and other indicators of criminogenic risk are relevant when examining the experiences of justice-involved military veterans-especially with respect recidivism-based outcomes. The implications of our results are discussed and directions for future research are given.
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Affiliation(s)
- Matthew William Logan
- School of Criminal Justice and Criminology, Texas State University, San Marcos, TX, USA.
| | - Susan McNeeley
- Minnesota Department of Corrections, Saint Paul, MN, USA
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Holliday SB, Sreenivasan S, Elbogen E, Thornton D, McGuire J. Factors associated with repeat sexual offending among U.S. military veterans compared to civilians. INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH 2021; 21:120-132. [PMID: 35845180 PMCID: PMC9285666 DOI: 10.1080/14999013.2021.1943569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although veterans have lower incarceration rates than civilians, large national surveys find higher rates of incarceration for sexual offenses among veterans compared to non-veterans. However, little is known about the factors associated with repeat sexual offending among veterans. This study examines characteristics of veterans who committed sexual offenses and how they differ from civilians with those offenses. It also examined if the factors that differ between veterans and civilians who have a history of repeat sexual offenses and those who do not. Based on previous research related to risk in veterans, we expected there may be veteran-specific risk factors. This study used the Survey of Inmates in State and Federal Correctional Facilities. Predictors were identified through a review of the literature regarding sexual offense risk assessment and justice-involved veterans. Risk factors were examined using logistic regression analysis. In a multivariate logistic regression, there were significant interactions between veteran status and age, race, and education in the prediction of repeat offense status. Prior incarceration for a non-sexual offense was also associated with repeat offense status. Findings suggests that civilian risk factors are relevant to veteran risk assessment, an important finding that can help inform intervention and risk management with veterans.
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Affiliation(s)
| | | | - Eric Elbogen
- Durham VA Medical Center, Duke University School of Medicine
| | | | - Jim McGuire
- Justice Programs, Veterans Health Administration
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Worthen M, Rathod SD, Cohen G, Sampson L, Ursano R, Gifford R, Fullerton C, Galea S, Ahern J. Risk and Protective Factors for Difficulty Controlling Violent Behavior in National Guard and Reserve Service Members. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:1049-1067. [PMID: 29294977 DOI: 10.1177/0886260517737552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Violent behavior is an important problem for military service members and veterans. A representative cohort of U.S. Reserve and National Guard personnel (N = 1,293) were interviewed to assess self-reported problems controlling violent behavior, deployment traumas, posttraumatic stress disorder (PTSD), alcohol abuse, and social support. Poisson regression models were used to estimate the associations of violent behavior with risk and protective factors. Problems controlling violent behavior were uncommon among male (3.3%) and female (1.7%) service members. Adjusted prevalence ratios (aPR) showed associations between violent behavior and deployment traumas (aPR = 1.67, 95% confidence interval [CI] = [1.34, 2.08]), PTSD (aPR = 9.95, 95% CI = [5.09, 19.48]), and PTSD symptom severity (aPR for each additional PTSD symptom = 1.07, 95% CI = [1.06, 1.09]). Social support was associated with lower prevalence of violent behavior (aPR = 0.62, 95% CI = [0.52, 0.76]). The association between violent behavior and alcohol abuse was not statistically significant (aPR = 1.94, 95% CI = [0.92, 4.09]). Results were consistent when the population was restricted to personnel who had deployed to a war zone. Problems controlling violent behavior were less common in this cohort than has been documented in other studies. Associations of violent behavior with risk and protective factors are consistent with prior research.
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Affiliation(s)
| | | | - Gregory Cohen
- Columbia University Mailman School of Public Health, New York, NY, USA
- Boston University School of Public Health, MA, USA
| | | | - Robert Ursano
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Robert Gifford
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Carol Fullerton
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Sandro Galea
- Boston University School of Public Health, MA, USA
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Kwan J, Sparrow K, Facer-Irwin E, Thandi G, Fear N, MacManus D. Prevalence of intimate partner violence perpetration among military populations: A systematic review and meta-analysis. AGGRESSION AND VIOLENT BEHAVIOR 2020; 53:101419. [PMID: 32714067 PMCID: PMC7375166 DOI: 10.1016/j.avb.2020.101419] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 01/28/2020] [Accepted: 04/03/2020] [Indexed: 05/25/2023]
Abstract
Intimate partner violence (IPV) is a global health issue that impacts both civilian and military populations. Factors associated with military service may result in increased risk of IPV perpetration among Veterans and Active Duty military personnel. Six bibliographic databases were searched to identify studies that estimated the prevalence of IPV perpetration among military populations by sociodemographic and military characteristics. Where possible, random effect meta-analyses were conducted to determine pooled prevalence estimates. 42 studies were eligible for inclusion in this systematic review. 28 of these studies met the requirements for inclusion in subsequent meta-analyses. Among studies that measured past-year physical IPV perpetration, the pooled prevalence was higher among men compared to women (26% and 20% respectively). Among Veterans, there were consistently higher prevalences compared to Active Duty samples. Similarly, higher prevalences were found among studies in general military settings compared to clinical settings. Further research that considers the impact of the act(s) of IPV perpetration on the victims is needed. This, along with the use of a consistent measurement tools across studies will help to develop a stronger evidence base to inform prevention and management programs for all types of IPV perpetration among military personnel.
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Affiliation(s)
- J. Kwan
- Psychological Medicine Department, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK
| | - K. Sparrow
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
| | - E. Facer-Irwin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
| | - G. Thandi
- Psychological Medicine Department, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK
| | - N.T. Fear
- Psychological Medicine Department, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK
| | - D. MacManus
- Psychological Medicine Department, King's College London, Weston Education Centre, 10 Cutcombe Road, SE5 9RJ London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
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Rosellini AJ, Stein MB, Benedek DM, Bliese PD, Chiu WT, Hwang I, Monahan J, Nock MK, Sampson NA, Street AE, Zaslavsky AM, Ursano RJ, Kessler RC. Predeployment predictors of psychiatric disorder-symptoms and interpersonal violence during combat deployment. Depress Anxiety 2018; 35:1073-1080. [PMID: 30102442 PMCID: PMC6212319 DOI: 10.1002/da.22807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Preventing suicides, mental disorders, and noncombat-related interpersonal violence during deployment are priorities of the US Army. We used predeployment survey and administrative data to develop actuarial models to identify soldiers at high risk of these outcomes during combat deployment. METHODS The models were developed in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Pre-Post Deployment Study, a panel study of soldiers deployed to Afghanistan in 2012-2013. Soldiers completed self-administered questionnaires before deployment and one (T1), three (T2), and nine months (T3) after deployment, and consented to administrative data linkage. Seven during-deployment outcomes were operationalized using the postdeployment surveys. Two overlapping samples were used because some outcomes were assessed at T1 (n = 7,048) and others at T2-T3 (n = 7,081). Ensemble machine learning was used to develop a model for each outcome from 273 predeployment predictors, which were compared to simple logistic regression models. RESULTS The relative improvement in area under the receiver operating characteristic curve (AUC) obtained by machine learning compared to the logistic models ranged from 1.11 (major depression) to 1.83 (suicidality).The best-performing machine learning models were for major depression (AUC = 0.88), suicidality (0.86), and generalized anxiety disorder (0.85). Roughly 40% of these outcomes occurred among the 5% of soldiers with highest predicted risk. CONCLUSIONS Actuarial models could be used to identify high risk soldiers either for exclusion from deployment or preventive interventions. However, the ultimate value of this approach depends on the associated costs, competing risks (e.g. stigma), and the effectiveness to-be-determined interventions.
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Affiliation(s)
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, CA, USA,VA San Diego Healthcare System, San Diego, CA, USA
| | - David M. Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Paul D. Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - John Monahan
- School of Law, University of Virginia, Charlottesville, VA, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Amy E. Street
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA,Corresponding author: Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA USA 02115; 617-432-3587 (voice); 617-432-3588 (fax);
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7
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Van Voorhees EE, Wagner HR, Beckham JC, Bradford DW, Neal LC, Penk WE, Elbogen EB. Effects of social support and resilient coping on violent behavior in military veterans. Psychol Serv 2018; 15:181-190. [PMID: 29723020 DOI: 10.1037/ser0000187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Violence toward others has been identified as a serious postdeployment adjustment problem in a subset of Iraq- and Afghanistan-era veterans. In the current study, we examined the intricate links between posttraumatic stress disorder (PTSD), commonly cited psychosocial risk and protective factors, and violent behavior using a national randomly selected longitudinal sample of Iraq- and Afghanistan-era United States veterans. A total of 1,090 veterans from the 50 United States and all United States military branches completed 2 waves of self-report survey-data collection 1 year apart (retention rate = 79%). History of severe violent behavior at Wave 1 was the most substantial predictor of subsequent violence. In bivariate analyses, high correlations were observed among risk and protective factors, and between risk and protective factors and severe violence at both time points. In multivariate analyses, baseline violence (OR = 12.43, p < .001), baseline alcohol misuse (OR = 1.06, p < .05), increases in PTSD symptoms between Waves 1 and 2 (OR = 1.01, p < .05), and decreases in social support between Waves 1 and 2 (OR = .83, p < .05) were associated with increased risk for violence at Wave 2. Our findings suggest that rather than focusing specifically on PTSD symptoms, alcohol use, resilience, or social support in isolation, it may be more useful to consider how these risk and protective factors work in combination to convey how military personnel and veterans are managing the transition from wartime military service to civilian life, and at what point it might be most effective to intervene. (PsycINFO Database Record
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Affiliation(s)
- Elizabeth E Van Voorhees
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - H Ryan Wagner
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Jean C Beckham
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Daniel W Bradford
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Lydia C Neal
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
| | - Walter E Penk
- Psychiatry and Behavioral Sciences, Texas A&M College of Medicine
| | - Eric B Elbogen
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center
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Blonigen DM, Cucciare MA, Timko C, Smith JS, Harnish A, Kemp L, Rosenthal J, Smelson D. Study protocol: a hybrid effectiveness-implementation trial of Moral Reconation Therapy in the US Veterans Health Administration. BMC Health Serv Res 2018. [PMID: 29514649 PMCID: PMC5842602 DOI: 10.1186/s12913-018-2967-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2024] Open
Abstract
Background Moral Reconation Therapy (MRT) is a cognitive-behavioral intervention aimed at reducing risk for criminal recidivism by restructuring antisocial attitudes and cognitions (i.e., “criminogenic thinking”). MRT has empirical support for reducing risk for criminal recidivism among civilian offenders. Recently, a version of MRT was developed for military veterans; however, no randomized controlled trials (RCT) have been conducted with the veteran-specific protocol, and the effectiveness and implementation potential of MRT outside of correctional settings has not been established. Methods Using a Hybrid Type 1 RCT design, this study will test the effectiveness of MRT to reduce risk for criminal recidivism and improve health-related outcomes among justice-involved veterans entering mental health residential treatment at three US Veterans Health Administration (VHA) Medical Centers. Upon admission to the treatment program, justice-involved veterans will complete a baseline assessment, be randomized to usual care (UC) or UC + MRT, and be followed 6 and 12 months post-baseline. A process evaluation will also be conducted to identify barriers and facilitators to implementation of MRT in residential treatment. Discussion The primary aim of this study is to evaluate the effectiveness of MRT with justice-involved veterans. If MRT proves effective in this trial, the findings can provide large healthcare systems that serve veterans with an evidence-based intervention for addressing criminogenic thinking among justice-involved adults, as well as guidance on how to facilitate future implementation of MRT in non-correctional settings. Trial registration This trial is funded by the VA Health Services Research & Development Program (IIR 14–081) and is registered with ClinicalTrials.gov (ID: NCT02524171).
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Affiliation(s)
- Daniel M Blonigen
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA. .,Palo Alto University, Palo Alto, CA, USA. .,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Michael A Cucciare
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jennifer S Smith
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Autumn Harnish
- Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA
| | - Lakiesha Kemp
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, AR, USA
| | - Joel Rosenthal
- Veterans Justice Programs, Veterans Health Administration, Washington DC, USA
| | - David Smelson
- Center for Health Care Organization and Implementation Research, Bedford VA Medical Center, Bedford, MA, USA.,University of Massachusetts Medical School, Worcester, MA, USA
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10
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Hourani LL, Williams J, Lattimore PK, Trudeau JV, Van Dorn RA. Psychological Model of Military Aggressive Behavior: Findings From Population-Based Surveys. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Laurel L. Hourani
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
| | - Jason Williams
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
| | - Pamela K. Lattimore
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
| | - James V. Trudeau
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
| | - Richard A. Van Dorn
- Social Policy, Health & Economics Research, RTI International, Durham, North Carolina
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11
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Rosellini AJ, Monahan J, Street AE, Petukhova MV, Sampson NA, Benedek DM, Bliese P, Stein MB, Ursano RJ, Kessler RC. Predicting Sexual Assault Perpetration in the U.S. Army Using Administrative Data. Am J Prev Med 2017; 53:661-669. [PMID: 28818420 PMCID: PMC5683072 DOI: 10.1016/j.amepre.2017.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 06/01/2017] [Accepted: 06/23/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Department of Defense uses a universal prevention framework for sexual assault prevention, with each branch implementing its own branch-wide programs. Intensive interventions exist, but would be cost effective only if targeted at high-risk personnel. This study developed actuarial models to identify male U.S. Army soldiers at high risk of administratively recorded sexual assault perpetration. METHODS This study investigated administratively recorded sexual assault perpetration among the 821,807 male Army soldiers serving 2004-2009. Administrative data were also used to operationalize the predictors. Penalized discrete-time (person-month) survival analysis (conducted in 2016) was used to select the smallest possible number of stable predictors to maximize number of sexual assaults among the 5% of soldiers with highest predicted risk of perpetration (top-ventile concentration of risk). Separate models were developed for assaults against non-family and intra-family adults and minors. RESULTS There were 4,640 male soldiers found to be perpetrators against non-family adults, 1,384 against non-family minors, 380 against intra-family adults, and 335 against intra-family minors. Top-ventile concentration of risk was 16.2%-20.2% predicting perpetration against non-family adults and minors and 34.2%-65.1% against intra-family adults and minors. Final predictors consisted largely of measures of prior crime involvement and the presence and treatment of mental disorders. CONCLUSIONS Administrative data can be used to develop actuarial models that identify a high proportion of sexual assault perpetrators. If a system is developed to consolidate administrative predictors routinely, then predictions could be generated periodically to identify those in need of preventive intervention. Whether this would be cost effective, though, would depend on intervention costs, effectiveness, and competing risks.
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Affiliation(s)
- Anthony J Rosellini
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts; Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - John Monahan
- School of Law, University of Virginia, Charlottesville, Virginia
| | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Maria V Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - David M Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Paul Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, South Carolina
| | - Murray B Stein
- Departments of Psychiatry and Family Medicine and Public Health, University of California San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
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12
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Rosellini AJ, Stein MB, Benedek DM, Bliese PD, Chiu WT, Hwang I, Monahan J, Nock MK, Petukhova MV, Sampson NA, Street AE, Zaslavsky AM, Ursano RJ, Kessler RC. Using self-report surveys at the beginning of service to develop multi-outcome risk models for new soldiers in the U.S. Army. Psychol Med 2017; 47:2275-2287. [PMID: 28374665 PMCID: PMC5679702 DOI: 10.1017/s003329171700071x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The U.S. Army uses universal preventives interventions for several negative outcomes (e.g. suicide, violence, sexual assault) with especially high risks in the early years of service. More intensive interventions exist, but would be cost-effective only if targeted at high-risk soldiers. We report results of efforts to develop models for such targeting from self-report surveys administered at the beginning of Army service. METHODS 21 832 new soldiers completed a self-administered questionnaire (SAQ) in 2011-2012 and consented to link administrative data to SAQ responses. Penalized regression models were developed for 12 administratively-recorded outcomes occurring by December 2013: suicide attempt, mental hospitalization, positive drug test, traumatic brain injury (TBI), other severe injury, several types of violence perpetration and victimization, demotion, and attrition. RESULTS The best-performing models were for TBI (AUC = 0.80), major physical violence perpetration (AUC = 0.78), sexual assault perpetration (AUC = 0.78), and suicide attempt (AUC = 0.74). Although predicted risk scores were significantly correlated across outcomes, prediction was not improved by including risk scores for other outcomes in models. Of particular note: 40.5% of suicide attempts occurred among the 10% of new soldiers with highest predicted risk, 57.2% of male sexual assault perpetrations among the 15% with highest predicted risk, and 35.5% of female sexual assault victimizations among the 10% with highest predicted risk. CONCLUSIONS Data collected at the beginning of service in self-report surveys could be used to develop risk models that define small proportions of new soldiers accounting for high proportions of negative outcomes over the first few years of service.
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Affiliation(s)
- Anthony J. Rosellini
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - David M. Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Paul D. Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, South Carolina, USA
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John Monahan
- School of Law, University of Virginia, Charlottesville, VA, USA
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy E. Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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13
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Heinz AJ, Cohen NL, Holleran L, Alvarez JA, Bonn-Miller MO. Firearm Ownership Among Military Veterans With PTSD: A Profile of Demographic and Psychosocial Correlates. Mil Med 2017; 181:1207-1211. [PMID: 27753553 DOI: 10.7205/milmed-d-15-00552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Post-traumatic stress disorder (PTSD), a condition that disproportionately affects military veterans, is associated with heightened rates of aggression and suicide. Although experience with firearms is common among this population, virtually nothing is known regarding who is more likely to own a firearm and whether firearm ownership is differentially associated with psychological and behavioral risk factors among veterans with PTSD. Of 465 veterans (79% male) entering PTSD treatment, 28% owned a firearm (median number of firearms among owners = 3, range = 1-40). Firearm owners reported higher income were less likely to be unemployed, and were more likely to be male, Caucasian, married, and living in permanent housing. Ownership was associated with higher combat exposure and driving aggression, yet lower rates of childhood and military sexual trauma, suicidal ideation, and incarceration. Ownership was not associated with previous suicide attempt, arrest history, number of traumas experienced, PTSD symptoms, or depression. Together, among a sample of treatment-seeking military veterans with PTSD, those who owned a firearm appeared to demonstrate greater stability across a number of domains of functioning. Importantly though, routine firearm safety discussions (e.g., accessibility restrictions; violence risk assessments) and bolstering of anger management skills remain critical when working with this high-risk population.
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Affiliation(s)
- Adrienne J Heinz
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
| | - Nicole L Cohen
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
| | - Lori Holleran
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304
| | - Jennifer A Alvarez
- VA Palo Alto Health Care System, 3801 Miranda Avenue, Menlo Park, CA 94304
| | - Marcel O Bonn-Miller
- National Center for PTSD, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025
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14
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Elbogen EB, Wagner HR, Kimbrel NA, Brancu M, Naylor J, Graziano R, Crawford E. Risk factors for concurrent suicidal ideation and violent impulses in military veterans. Psychol Assess 2017. [PMID: 28627921 DOI: 10.1037/pas0000490] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Suicide and violence are significant problems in a subset of Iraq/Afghanistan-era veterans. This study investigates how posttraumatic stress disorder (PTSD) and resilience in veterans are associated with suicidal ideation and violent impulses while controlling for known covariates of both adverse outcomes. Structured clinical interviews were conducted of N = 2,543 Iraq/Afghanistan-era U.S. veterans. Compared with veterans denying suicidal ideation or violent impulses (n = 1,927), veterans endorsing both (n = 171) were more likely to meet diagnostic criteria for PTSD, report childhood abuse, combat exposure, physical pain symptoms, and drug misuse, and less likely to endorse self-direction/life purpose. Veterans reporting concurrent suicidal ideation and violent impulses had higher odds of misusing drugs and reporting pain symptoms relative to veterans reporting suicidal ideation only (n = 186) and had lower odds of endorsing self-direction/life purpose compared with veterans reporting violent impulses only (n = 259). The findings underscore the importance of examining drug abuse, physical pain symptoms, and self-direction/life purpose, as well as PTSD and history of trauma, in the context of clinical assessment and empirical research aimed at optimizing risk management of suicide and violence in military veterans. (PsycINFO Database Record
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Affiliation(s)
- Eric B Elbogen
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - H Ryan Wagner
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Nathan A Kimbrel
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Mira Brancu
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Jennifer Naylor
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
| | - Robert Graziano
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Eric Crawford
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center
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15
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Watkins LE, Sippel LM, Pietrzak RH, Hoff R, Harpaz-Rotem I. Co-occurring aggression and suicide attempt among veterans entering residential treatment for PTSD: The role of PTSD symptom clusters and alcohol misuse. J Psychiatr Res 2017; 87:8-14. [PMID: 27984702 DOI: 10.1016/j.jpsychires.2016.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/31/2016] [Accepted: 12/08/2016] [Indexed: 11/16/2022]
Abstract
Aggression and suicidality are two serious public health concerns among U.S. veterans that can co-occur and share many overlapping risk factors. The current study aims to elucidate the contribution of posttraumatic stress disorder (PTSD) symptom clusters defined by a five-factor model and alcohol misuse in predicting aggression and suicide attempts among veterans entering residential treatment for PTSD. Participants were 2570 U.S. veterans across 35 Veterans Health Administration sites. Multinomial logistic regression models were used to identify correlates of aggression only (n = 1471; 57.2%), suicide attempts only (n = 41; 1.6%), co-occurring aggression and suicide attempts (n = 202; 7.9%), and neither behavior (n = 856; 33.3%) over the past four months. When compared to veterans endorsing neither behavior, greater PTSD re-experiencing symptoms were related to suicide attempts (odds ratio [OR] = 1.58, 95% confidence interval [CI] = 1.09-2.30), aggression (OR = 1.13, 95% CI = 1.02-1.26), and co-occurring aggression and suicide (OR = 1.38, 95% CI = 1.13-1.68), and higher PTSD dysphoric arousal symptoms and alcohol misuse symptoms were related to aggression (OR = 1.54, 95% CI = 1.38-1.71; OR = 1.30, 95% CI = 1.18-1.44, respectively) and co-occurring aggression and suicide (OR = 1.66, 95% CI = 1.35-2.04; OR = 1.50, 95% CI = 1.28-1.75, respectively). Our findings suggest that assessment of PTSD symptom clusters and alcohol misuse can potentially help to identify veterans who endorse suicide attempts, aggression, or both concurrently. These results have important implications for risk assessment and treatment planning with U.S. veterans seeking care for PTSD.
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Affiliation(s)
- Laura E Watkins
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Lauren M Sippel
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Robert H Pietrzak
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Rani Hoff
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Northeast Program Evaluation Center, VA Connecticut Healthcare System, West Haven, CT, USA
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16
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Calhoun PS, Van Voorhees EE, Elbogen EB, Dedert EA, Clancy CP, Hair LP, Hertzberg M, Beckham JC, Kimbrel NA. Nonsuicidal self-injury and interpersonal violence in U.S. veterans seeking help for posttraumatic stress disorder. Psychiatry Res 2017; 247:250-256. [PMID: 27930966 PMCID: PMC5191947 DOI: 10.1016/j.psychres.2016.11.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/17/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
Nonsuicidal self-injury (NSSI) has been defined as deliberately damaging one's body tissue without conscious suicidal intent. NSSI is a robust predictor of suicidal ideation and attempts in adults. While NSSI has been associated with other-directed violence in adolescent populations, the link between NSSI and interpersonal violence in adults is less clear. The current study examined the cross-sectional relationship between NSSI and past-year interpersonal violence among 729 help-seeking veterans with posttraumatic stress disorder (PTSD). Veterans who reported a recent history of engaging in cutting, hitting, or burning themselves were significantly more likely to report making violent threats and engaging in violent acts, including the use of a knife or gun, in the past year than veterans without NSSI. NSSI was uniquely associated with interpersonal violence after controlling for a variety of dispositional, historical, contextual, and clinical risk factors for violence, including age, race, socio-economic status, marital status, employment status, combat exposure, alcohol misuse, depression, PTSD symptom severity, and reported difficulty controlling violence. These findings suggest that clinicians working with veterans with PTSD should review NSSI history when conducting a risk assessment of violence.
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Affiliation(s)
- Patrick S Calhoun
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Center for Health Services Research in Primary Care, Durham VA Medical Center, NC, USA.
| | - Elizabeth E Van Voorhees
- Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Eric B Elbogen
- Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Eric A Dedert
- Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Lauren P Hair
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA; Center for Health Services Research in Primary Care, Durham VA Medical Center, NC, USA
| | - Michael Hertzberg
- Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jean C Beckham
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Nathan A Kimbrel
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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17
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Rosellini AJ, Monahan J, Street AE, Hill ED, Petukhova M, Reis BY, Sampson NA, Benedek DM, Bliese P, Stein MB, Ursano RJ, Kessler RC. Using administrative data to identify U.S. Army soldiers at high-risk of perpetrating minor violent crimes. J Psychiatr Res 2017; 84:128-136. [PMID: 27741501 PMCID: PMC5125854 DOI: 10.1016/j.jpsychires.2016.09.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/03/2016] [Accepted: 09/29/2016] [Indexed: 12/01/2022]
Abstract
Growing concerns exist about violent crimes perpetrated by U.S. military personnel. Although interventions exist to reduce violent crimes in high-risk populations, optimal implementation requires evidence-based targeting. The goal of the current study was to use machine learning methods (stepwise and penalized regression; random forests) to develop models to predict minor violent crime perpetration among U.S. Army soldiers. Predictors were abstracted from administrative data available for all 975,057 soldiers in the U.S. Army 2004-2009, among whom 25,966 men and 2728 women committed a first founded minor violent crime (simple assault, blackmail-extortion-intimidation, rioting, harassment). Temporally prior administrative records measuring socio-demographic, Army career, criminal justice, medical/pharmacy, and contextual variables were used to build separate male and female prediction models that were then tested in an independent 2011-2013 sample. Final model predictors included young age, low education, early career stage, prior crime involvement, and outpatient treatment for diverse emotional and substance use problems. Area under the receiver operating characteristic curve was 0.79 (for men and women) in the 2004-2009 training sample and 0.74-0.82 (men-women) in the 2011-2013 test sample. 30.5-28.9% (men-women) of all administratively-recorded crimes in 2004-2009 were committed by the 5% of soldiers having highest predicted risk, with similar proportions (28.5-29.0%) when the 2004-2009 coefficients were applied to the 2011-2013 test sample. These results suggest that it may be possible to target soldiers at high-risk of violence perpetration for preventive interventions, although final decisions about such interventions would require weighing predicted effectiveness against intervention costs and competing risks.
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Affiliation(s)
| | - John Monahan
- School of Law, University of Virginia, Charlottesville, VA, USA
| | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Eric D Hill
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ben Y Reis
- Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - David M Benedek
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Paul Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, SC, USA
| | - Murray B Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, MD, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
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18
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Timko C, Flatley B, Tjemsland A, McGuire J, Clark S, Blue-Howells J, Blonigen D, Rosenthal J, Finlay A. A Longitudinal Examination of Veterans Treatment Courts' Characteristics and Eligibility Criteria. JUSTICE RESEARCH AND POLICY : JOURNAL OF THE JUSTICE RESEARCH AND STATISTICS ASSOCIATION : JRP 2016; 17:123-136. [PMID: 30034296 PMCID: PMC6051754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although the number of Veterans Treatment Courts (VTCs) has been growing at a rapid rate, thus far, VTC components have not been standardized, due in part to a lack of empirical evidence on the extent to which components vary across VTCs nationwide and change over time. This study analyzed data collected by the Department of Veterans Affairs' Veterans Justice Program, on VTCs in 2012 (n = 173 Courts), 2013 (n = 266), and 2014 (n = 351), to describe Court characteristics, participant eligibility criteria, and Courts' mentoring component. Despite growth in VTC numbers, the survey found consistency over time in these aspects of VTCs. Regarding characteristics, the majority of Courts had jurisdiction at the county level. Across survey years, the range of means was 22-24 for veteran participant census, 10-14 for number of months spent in the Court for misdemeanors, and 18-19 for number of months spent in the Court for felonies. Eligibility requirements suggested openness to veterans of different backgrounds and status. Less than two thirds of Courts had the mentoring component; Courts with the mentoring component had a higher participant census and a longer duration of participants' time under Court supervision than Courts without this component. Existing mentoring programs were organized mainly by volunteers. VTCs' adherence to policies supportive of veterans may benefit from having paid mentor coordinators in order to further ensure this hallmark of VTCs.
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Affiliation(s)
- Christine Timko
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Bessie Flatley
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, Philadelphia, PA, USA
- Department of Veterans Affairs, Veterans Justice Programs, Lexington, KY, USA
| | - Amanda Tjemsland
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
| | - Jim McGuire
- Department of Veterans Affairs, Veterans Justice Programs, Greater Los Angeles Health Care System–West LA Campus, Los Angeles, CA, USA
| | - Sean Clark
- Department of Veterans Affairs, Veterans Justice Programs, Lexington, KY, USA
| | | | - Daniel Blonigen
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Palo Alto University, Clinical Psychology Program, Palo Alto, CA, USA
| | - Joel Rosenthal
- Department of Veterans Affairs, Veterans Justice Programs, Menlo Park, CA, USA
| | - Andrea Finlay
- Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA
- Department of Veterans Affairs, National Center on Homelessness Among Veterans, Philadelphia, PA, USA
- Division of General Medical Disciplines, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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19
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Backhaus A, Gholizadeh S, Godfrey KM, Pittman J, Afari N. The many wounds of war: The association of service-related and clinical characteristics with problems with the law in Iraq and Afghanistan veterans. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:205-213. [PMID: 27863701 DOI: 10.1016/j.ijlp.2016.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Previous research has demonstrated that veterans with posttraumatic stress disorder (PTSD) are at higher risk for aggression, hostility, and anger, potentially leading to problems with the law or disciplinary action while in the military. There have been calls for increased consideration of the unique aspects of the judicial system in legal matters with veterans involved. The bulk of the research so far has considered the link between PTSD, traumatic brain injury (TBI), and combat exposure, but little is known about the potential role of chronic pain and Military Sexual Trauma (MST) in a veteran's experience of anger, aggression, and discipline while in the military and legal concerns. The present study used retrospective cross-sectional health screening data in a sample of 1250 Iraq and Afghanistan veterans to examine the associations of demographic, service-related, and clinical characteristics with self-reported legal problems. A total of 440 veterans (34.6%) endorsed having experienced some type of problems with the law. Independent logistic regression analyses demonstrated that those who screened positive for PTSD, MST, TBI, and clinical levels of pain were more likely to report legal problems; only the associations with positive PTSD (p=0.001) and MST (p=0.007) screens remained significant in multivariate regression analyses. The findings underscore the need for a thorough psychological evaluation when veterans are involved in the legal system with a special emphasis on factors prevalent to Iraq and Afghanistan veterans.
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Affiliation(s)
- Autumn Backhaus
- VA San Diego Healthcare System, San Diego, CA, United States; Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States.
| | - Shadi Gholizadeh
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States.
| | - Kathryn M Godfrey
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, United States; VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States.
| | - James Pittman
- VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States; La Jolla Outpatient Mental Health Services, VA San Diego Healthcare System, San Diego, CA, United States.
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA, United States; VA Center of Excellence for Stress and Mental Health, San Diego, CA, United States; University of California, San Diego, La Jolla, CA, United States.
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20
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Fanning JR, Lee R, Coccaro EF. Comorbid intermittent explosive disorder and posttraumatic stress disorder: Clinical correlates and relationship to suicidal behavior. Compr Psychiatry 2016; 70:125-33. [PMID: 27624432 PMCID: PMC5024714 DOI: 10.1016/j.comppsych.2016.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with both aggressive and suicidal behavior. Recent research suggests that the diagnosis of intermittent explosive disorder (IED), an impulse-control disorder characterized by repeated impulsive aggressive behavior, may help to identify individuals at risk for attempting suicide. Given the relationship between anger and PTSD, there is likely to be an increased prevalence of IED among individuals with PTSD; however, little is known about the overlap in these two disorders, including how individuals with comorbid IED and PTSD may differ from those with either disorder alone. The purpose of this study is to examine the clinical correlates of comorbid IED and PTSD and the contribution of these two disorders (among others) to lifetime suicide attempt and characteristics of suicidal behavior. METHOD In a large sample of community research volunteers (N=1460), we compared individuals with PTSD, IED, and comorbid PTSD and IED on measures of current mood, trait aggression, and trait impulsivity. We also examined the contributions of PTSD, IED, and other syndromal and personality disorders to the prediction of lifetime aggression and lifetime suicide attempt, and their relationship to characteristics of suicide attempts, including level of intent, use of violent versus non-violent means, and the medical seriousness of the attempt. RESULTS Comorbid PTSD and IED was associated with significantly elevated levels of depression, anxiety, anger, aggression, and impulsivity, as well as with high rates of comorbidity with other psychiatric disorders. IED (β=.56, p<.001), but not PTSD, significantly and uniquely predicted lifetime aggressive behavior. Both IED and PTSD were associated with lifetime suicide attempt in multivariate analysis (ORs: 1.6 and 1.6, ps<.05). The results show that IED, when comorbid with PTSD, identifies a subgroup of individuals with particularly high levels of aggressive behavior and a high rate of suicide attempt (41.4% in this sample). CONCLUSION These findings add support to the notion that the diagnosis of IED may aid in identifying individuals at risk for aggressive and suicidal behavior.
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21
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Smith-Marek EN, Cafferky B, Dominguez MM, Spencer C, Van K, Stith SM, Oliver MA. Military/Civilian Risk Markers for Physical Intimate Partner Violence: A Meta-Analysis. VIOLENCE AND VICTIMS 2016; 31:787-818. [PMID: 27523801 DOI: 10.1891/0886-6708.vv-d-15-00032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This meta-analysis compared risk markers for perpetration of physical intimate partner violence (IPV) among military and civilian males. We also examined strength of risk markers among male and female service members. In total, 36 military studies and 334 civilian studies, which reported 883 effect sizes, were included in the analyses. Results revealed more similarities than differences in risk markers for IPV among military and civilian males and among military males and females. Of the risk markers examined, relationship satisfaction and alcohol problems were significantly stronger risk markers for IPV among civilian males compared to military males. Perpetrating emotional abuse was a significantly stronger risk marker for IPV perpetration among military females compared to military males. Recommendations for IPV prevention and intervention are discussed.
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22
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Blonigen DM, Bui L, Elbogen EB, Blodgett JC, Maisel NC, Midboe AM, Asch SM, McGuire JF, Timko C. Risk of Recidivism Among Justice-Involved Veterans. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/0887403414562602] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Empirical research on recidivism risk among justice-involved veterans (JIVs) is limited. Using the risk-need-responsivity model, we conducted a systematic review of research on risk factors for recidivism among JIVs to identify the gaps in this literature and provide recommendations for future research. Substance abuse and indicators of antisociality were consistently linked to justice involvement in veterans; however, the evidence for negative family/marital circumstances and lack of positive school/work involvement was mixed. Several known risk factors for reoffending among civilian offenders (i.e., antisocial cognitions and associates; lack of prosocial activities) were marked by little to no empirical studies among veterans. Posttraumatic stress and traumatic brain injury, particularly when combined with anger and irritability issues, may be veteran-specific risk factors for violent offending. The implications of these findings for policy and practice and challenges to implementing risk assessments with JIVs are discussed.
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Affiliation(s)
| | - Leena Bui
- VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Eric B. Elbogen
- Durham VA Medical Center, NC, USA
- University of North Carolina at Chapel Hill, USA
| | | | | | | | - Steven M. Asch
- VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, CA, USA
| | | | - Christine Timko
- VA Palo Alto Health Care System, Menlo Park, CA, USA
- Stanford University School of Medicine, CA, USA
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Sadeh N, Wolf EJ, Logue MW, Lusk J, Hayes JP, McGlinchey RE, Milberg WP, Stone A, Schichman SA, Miller MW. Polygenic Risk for Externalizing Psychopathology and Executive Dysfunction in Trauma-Exposed Veterans. Clin Psychol Sci 2016; 4:545-558. [PMID: 27453802 PMCID: PMC4951156 DOI: 10.1177/2167702615613310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The frequent co-occurrence of antisocial behavior and other disinhibited phenotypes reflects a highly heritable externalizing spectrum. We examined the molecular genetic basis of this spectrum by testing polygenic associations with psychopathology symptoms, impulsive traits, and cognitive functions in two samples of primarily military veterans (n =537, n =194). We also investigated whether polygenic risk for externalizing moderated the effects of trauma on these phenotypes. As hypothesized, polygenic risk positively predicted externalizing psychopathology and negatively predicted performance on inhibitory control tasks. Gene-by-environment effects were also evident, with trauma exposure predicting greater impulsivity and less working memory capacity, but only at high levels of genetic liability. As expected, polygenic risk was not associated with internalizing psychopathology or episodic memory performance. This is the first independent replication of the polygenic score as a measure of genetic predispositions for externalizing and provides preliminary evidence that executive dysfunction is a heritable vulnerability for externalizing psychopathology.
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Affiliation(s)
- Naomi Sadeh
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
| | - Erika J. Wolf
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
| | - Mark W. Logue
- Research Service, VA Boston Healthcare System, Boston, MA; Biomedical Genetics, Boston University School of Medicine, Boston, MA; Department of Biostatistics, Boston University School of Public Health
| | - Joanna Lusk
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System
| | - Jasmeet P. Hayes
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Educational and Clinical Center, VA Boston Healthcare System; Department of Psychiatry, Harvard Medical School
| | - William P. Milberg
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Educational and Clinical Center, VA Boston Healthcare System; Department of Psychiatry, Harvard Medical School
| | - Annjanette Stone
- Pharmacogenomics Analysis Laboratory, Research Service, Central Arkansas Veterans Healthcare System
| | - Steven A. Schichman
- Pharmacogenomics Analysis Laboratory, Research Service, Central Arkansas Veterans Healthcare System
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
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Dually Diagnosed Patients with Arrests for Violent and Nonviolent Offenses: Two-Year Treatment Outcomes. JOURNAL OF ADDICTION 2016; 2016:6793907. [PMID: 27119040 PMCID: PMC4826919 DOI: 10.1155/2016/6793907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/23/2016] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to examine the history of arrests among dually diagnosed patients entering treatment, compare groups with different histories on use of treatment and mutual-help groups and functioning, at intake to treatment and six-month, one-year, and two-year follow-ups, and examine correlates and predictors of legal functioning at the study endpoint. At treatment intake, 9.2% of patients had no arrest history, 56.3% had been arrested for nonviolent offenses only, and 34.5% had been arrested for violent offenses. At baseline, the violent group had used the most outpatient psychiatric treatment and reported poorer functioning (psychiatric, alcohol, drug, employment, and family/social). Both arrest groups had used more inpatient/residential treatment and had more mutual-help group participation than the no-arrest group. The arrest groups had higher likelihood of substance use disorder treatment or mutual-help group participation at follow-ups. Generally, all groups were comparable on functioning at follow-ups (with baseline functioning controlled). With baseline arrest status controlled, earlier predictors of more severe legal problems at the two-year follow-up were more severe psychological, family/social, and drug problems. Findings suggest that dually diagnosed patients with a history of arrests for violent offenses may achieve comparable treatment outcomes to those of patients with milder criminal histories.
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Tobón C, Aguirre-Acevedo DC, Velilla L, Duque J, Ramos CP, Pineda D. [Psychiatric, Cognitive and Emotional Profile in Ex-combatants of Illegal Armed Groups in Colombia]. REVISTA COLOMBIANA DE PSIQUIATRIA 2016; 45:28-36. [PMID: 26896402 DOI: 10.1016/j.rcp.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 06/01/2015] [Accepted: 07/23/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Exposure to armed conflict produces biological adaptations oriented to handle the highly stressful conditions in war environments. The special features of The Colombian armed create a special scenario to evaluate the human behavior. OBJECTIVE In this study, psychiatric, cognitive and emotional processing characteristics of a group of Colombian armed illegal forces of ex-combatants are described. METHODS Sixty-three ex combatants and 22 controls were assessed with WAIS (IQ), INECO frontal screening (executive functions), Interpersonal Reactivity Index (empathy), emotional features recognition and MINI (psychiatric profile). RESULTS When compared to the control group, ex-combatants showed higher frequency of antisocial personality disorder (P=.031) and behavioral dissocial disorder (P=.017). In cognitive profile, the ex-combatants showed a lower score in the executive function test (Me=18.50; RQ=4.00), control (Me=23.00; RQ=5.25), with a poor personal distress in emphatic profile (Me=10.00; RQ=5.00) compared to control group (Me=37.00; RQ=7.25). CONCLUSIONS We found differences in cognitive and psychiatric profile in ex-combatants in comparison with controls.
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Affiliation(s)
- Carlos Tobón
- Grupo de Neurociencias de Antioquia, Facultad de Medicina, Universidad de Antioquia UDEA, Medellín, Colombia; Grupo de Neuropsicología y Conducta, Facultad de Medicina, Universidad de Antioquia UDEA, Medellín, Colombia
| | | | - Lina Velilla
- Grupo de Neurociencias de Antioquia, Facultad de Medicina, Universidad de Antioquia UDEA, Medellín, Colombia
| | - Jon Duque
- Grupo de Neurociencias de Antioquia, Facultad de Medicina, Universidad de Antioquia UDEA, Medellín, Colombia; Grupo de Investigación en Bioinstrumentación en Ingeniería Clínica, Facultad de Ingeniería, Universidad de Antioquia UDEA, Medellín, Colombia
| | - Claudia Patricia Ramos
- Grupo de Neuropsicología y Conducta, Facultad de Medicina, Universidad de Antioquia UDEA, Medellín, Colombia
| | - David Pineda
- Grupo de Neurociencias de Antioquia, Facultad de Medicina, Universidad de Antioquia UDEA, Medellín, Colombia; Grupo de Neuropsicología y Conducta, Facultad de Medicina, Universidad de Antioquia UDEA, Medellín, Colombia.
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26
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Van Voorhees EE, Dennis PA, Neal LC, Hicks TA, Calhoun PS, Beckham JC, Elbogen EB. Posttraumatic Stress Disorder, Hostile Cognitions and Aggression in Iraq/Afghanistan Era Veterans. Psychiatry 2016; 79:70-84. [PMID: 27187514 PMCID: PMC4973515 DOI: 10.1080/00332747.2015.1123593] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Most veterans with posttraumatic stress disorder (PTSD) are not violent, yet research has demonstrated that there is a substantial minority who are at increased risk. This study tested hypotheses regarding hyperarousal symptoms and hostile cognitions (i.e., "hostility") as potential mechanisms of the association between PTSD and physical aggression in a longitudinal sample of Iraq/Afghanistan era veterans. METHOD The sample included U.S. veterans between the ages of 18 and 70 who served in the military after September 11, 2001. At baseline, 301 veterans were evaluated for PTSD and completed self-report measures of hostility. At six-month follow-up 275 veterans and their family members or friends reported on the veterans' physical aggression over the preceding interval. Regression models were used to evaluate relationships among PTSD status, hyperarousal cluster symptoms, and hostility at baseline, and physical aggression at six months. Bootstrapping was used to test for the mediation of baseline PTSD and six-month aggression by hostility. RESULTS PTSD significantly predicted physical aggression over six months, but hyperarousal cluster symptoms did not account for unique variance among the three clusters in the longitudinal model. Hostility partially mediated the association of PTSD at baseline and physical aggression at six months. CONCLUSIONS Hostility may be a mechanism of the association of PTSD and physical aggression in veterans, suggesting the potential utility of targeting hostile cognitions in therapy for anger and aggression in veterans with PTSD.
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Affiliation(s)
- Elizabeth E. Van Voorhees
- Durham Veterans Affairs Medical Center,VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Paul A. Dennis
- Durham Veterans Affairs Medical Center,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | - Terrell A. Hicks
- VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center
| | - Patrick S. Calhoun
- Durham Veterans Affairs Medical Center,VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Jean C. Beckham
- Durham Veterans Affairs Medical Center,VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Eric B. Elbogen
- Durham Veterans Affairs Medical Center,VISN 6 Mental Illness Research, Education and Clinical Center (MIRECC), Durham Veterans Affairs Medical Center,Department of Psychiatry, University of North Carolina School of Medicine
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Rosellini AJ, Monahan J, Street AE, Heeringa SG, Hill ED, Petukhova M, Reis BY, Sampson NA, Bliese P, Schoenbaum M, Stein MB, Ursano R, Kessler RC. Predicting non-familial major physical violent crime perpetration in the US Army from administrative data. Psychol Med 2016; 46:303-16. [PMID: 26436603 PMCID: PMC5111361 DOI: 10.1017/s0033291715001774] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although interventions exist to reduce violent crime, optimal implementation requires accurate targeting. We report the results of an attempt to develop an actuarial model using machine learning methods to predict future violent crimes among US Army soldiers. METHOD A consolidated administrative database for all 975 057 soldiers in the US Army in 2004-2009 was created in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Of these soldiers, 5771 committed a first founded major physical violent crime (murder-manslaughter, kidnapping, aggravated arson, aggravated assault, robbery) over that time period. Temporally prior administrative records measuring socio-demographic, Army career, criminal justice, medical/pharmacy, and contextual variables were used to build an actuarial model for these crimes separately among men and women using machine learning methods (cross-validated stepwise regression, random forests, penalized regressions). The model was then validated in an independent 2011-2013 sample. RESULTS Key predictors were indicators of disadvantaged social/socioeconomic status, early career stage, prior crime, and mental disorder treatment. Area under the receiver-operating characteristic curve was 0.80-0.82 in 2004-2009 and 0.77 in the 2011-2013 validation sample. Of all administratively recorded crimes, 36.2-33.1% (male-female) were committed by the 5% of soldiers having the highest predicted risk in 2004-2009 and an even higher proportion (50.5%) in the 2011-2013 validation sample. CONCLUSIONS Although these results suggest that the models could be used to target soldiers at high risk of violent crime perpetration for preventive interventions, final implementation decisions would require further validation and weighing of predicted effectiveness against intervention costs and competing risks.
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Affiliation(s)
- Anthony J. Rosellini
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John Monahan
- School of Law, University of Virginia, Charlottesville, Virginia, USA
| | - Amy E. Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Steven G. Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Eric D. Hill
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ben Y. Reis
- Predictive Medicine Group, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Bliese
- Darla Moore School of Business, University of South Carolina, Columbia, South Carolina, USA
| | - Michael Schoenbaum
- Office of Science Policy, Planning and Communications, National Institute of Mental Health, Bethesda, Maryland, USA
| | - Murray B. Stein
- Departments of Psychiatry and Family Medicine & Public Health, University of California San Diego, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
| | - Robert Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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28
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Worthen M, Rathod SD, Cohen G, Sampson L, Ursano R, Gifford R, Fullerton C, Galea S, Ahern J. Anger and Posttraumatic Stress Disorder Symptom Severity in a Trauma-Exposed Military Population: Differences by Trauma Context and Gender. J Trauma Stress 2015; 28:539-46. [PMID: 26580844 DOI: 10.1002/jts.22050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Studies have found a stronger association between anger and posttraumatic stress disorder (PTSD) severity in military populations than in nonmilitary populations. Two hypotheses have been proposed to explain this difference: Military populations are more prone to anger than nonmilitary populations, and traumas experienced on deployment create more anger than nondeployment traumas. To examine these hypotheses, we evaluated the association between anger and PTSD severity among never-deployed military service members with nondeployment traumas (n = 226) and deployed service members with deployment traumas (n = 594) using linear regression. We further examined these associations stratified by gender. Bivariate associations between anger and PTSD severity were similar for nondeployment and deployment events; however, gender modified this association. For men, the association for deployment events was stronger than for nondeployment events (β = .18, r = .53 vs. β = .16, r = .37, respectively), whereas the reverse was true for women (deployment: β = .20, r = .42 vs. nondeployment: β = .25, r = .65). Among men, findings supported the hypothesis that deployment traumas produce stronger associations between PTSD and anger and are inconsistent with hypothesized population differences. In women, however, there was not a clear fit with either hypothesis.
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Affiliation(s)
- Miranda Worthen
- Department of Health Science and Recreation, San Jose State University, San Jose, California, USA
| | - Sujit D Rathod
- Global Mental Health Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Gregory Cohen
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Laura Sampson
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Robert Ursano
- Department of Psychiatry, Uniformed Services University, School of Medicine, Bethesda, Maryland, USA
| | - Robert Gifford
- Department of Psychiatry, Uniformed Services University, School of Medicine, Bethesda, Maryland, USA
| | - Carol Fullerton
- Department of Psychiatry, Uniformed Services University, School of Medicine, Bethesda, Maryland, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jennifer Ahern
- Division of Epidemiology, University of California, Berkeley, Berkeley, California, USA
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Sadeh N, Spielberg JM, Miller MW, Milberg WP, Salat DH, Amick MM, Fortier CB, McGlinchey RE. Neurobiological indicators of disinhibition in posttraumatic stress disorder. Hum Brain Mapp 2015; 36:3076-86. [PMID: 25959594 PMCID: PMC4532949 DOI: 10.1002/hbm.22829] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/01/2015] [Accepted: 04/20/2015] [Indexed: 01/21/2023] Open
Abstract
Deficits in impulse control are increasingly recognized in association with posttraumatic stress disorder (PTSD). To our further understanding of the neurobiology of PTSD-related disinhibition, we examined alterations in brain morphology and network connectivity associated with response inhibition failures and PTSD severity. The sample consisted of 189 trauma-exposed Operation Enduring Freedom/Operation Iraqi Freedom veterans (89% male, ages 19-62) presenting with a range of current PTSD severity. Disinhibition was measured using commission errors on a Go/No-Go (GNG) task with emotional stimuli, and PTSD was assessed using a measure of current symptom severity. Whole-brain vertex-wise analyses of cortical thickness revealed two clusters associated with PTSD-related disinhibition (Monte Carlo cluster corrected P < 0.05). The first cluster included portions of right inferior and middle frontal gyri and frontal pole. The second cluster spanned portions of left medial orbital frontal, rostral anterior cingulate, and superior frontal gyrus. In both clusters, commission errors were associated with reduced cortical thickness at higher (but not lower) levels of PTSD symptoms. Resting-state functional magnetic resonance imaging analyses revealed alterations in the functional connectivity of the right frontal cluster. Together, study findings suggest that reductions in cortical thickness in regions involved in flexible decision-making, emotion regulation, and response inhibition contribute to impulse control deficits in PTSD. Furthermore, aberrant coupling between frontal regions and networks involved in selective attention, memory/learning, and response preparation suggest disruptions in functional connectivity may also play a role.
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Affiliation(s)
- Naomi Sadeh
- National Center for PTSD, Behavioral Science DivisionVA Boston Healthcare System, Boston, MA, USA
- Department of PsychiatryBoston University School of Medicine, Boston, MA, USA
| | - Jeffrey M. Spielberg
- Neuroimaging Research for Veterans CenterVA Boston Healthcare System, Boston, MA, USA
- Department of PsychiatryBoston University School of Medicine, Boston, MA, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science DivisionVA Boston Healthcare System, Boston, MA, USA
- Department of PsychiatryBoston University School of Medicine, Boston, MA, USA
| | - William P. Milberg
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Educational and Clinical CenterVA Boston Healthcare System, Boston, MA, USA
- Department of PsychiatryHarvard Medical School, Boston, MA, USA
| | - David H. Salat
- Neuroimaging Research for Veterans CenterVA Boston Healthcare System, Boston, MA, USA
- Department of Radiology, Martinos Center for Biomedical ImagingMassachusetts General Hospital, Boston, MA, USA
- Department of RadiologyHarvard Medical School, Boston, MA, USA
| | - Melissa M. Amick
- Department of PsychiatryBoston University School of Medicine, Boston, MA, USA
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Educational and Clinical CenterVA Boston Healthcare System, Boston, MA, USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Educational and Clinical CenterVA Boston Healthcare System, Boston, MA, USA
- Department of PsychiatryHarvard Medical School, Boston, MA, USA
| | - Regina E. McGlinchey
- Translational Research Center for TBI and Stress Disorders and Geriatric Research, Educational and Clinical CenterVA Boston Healthcare System, Boston, MA, USA
- Department of PsychiatryHarvard Medical School, Boston, MA, USA
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Abstract
The objective of this study is to identify and facilitate re-entry services for military veterans in the Criminal Justice System through the Incarcerated Veteran Outreach Program. Veterans are explored as a subgroup of the general inmate jail populations in southern Ohio based upon veteran's status, military discharges, service-related injuries, treatment needs, pre-release planning, and re-entry services. Veterans reported having psycho-social problems, diverse levels of criminality, criminogenic needs, and significant episodes of homelessness. A sample of 399 incarcerated veterans in state prison, county jails, and community corrections setting were identified and completed the psycho-social pre-release assessment. Their average age was 44.6; they were more likely to be White males, divorced, most honorably discharged, and were represented in the following eras: 34% Vietnam, 35% post-Vietnam, 26% Persian Gulf War, and 5% Operation Iraqi Freedom/Operation Enduring Freedom. The findings encourage the development of a re-entry outreach model and strategies to prevent episodes of criminal recidivism.
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Affiliation(s)
- Bradley J Schaffer
- a School of Social Work, Edinboro University , Edinboro , Pennsylvania , USA
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31
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Blodgett JC, Avoundjian T, Finlay AK, Rosenthal J, Asch SM, Maisel NC, Midboe AM. Prevalence of Mental Health Disorders Among Justice-Involved Veterans. Epidemiol Rev 2015; 37:163-76. [DOI: 10.1093/epirev/mxu003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Van Voorhees EE, Dennis PA, Elbogen EB, Clancy CP, Hertzberg MA, Beckham JC, Calhoun PS. Personality assessment inventory internalizing and externalizing structure in veterans with posttraumatic stress disorder: associations with aggression. Aggress Behav 2014; 40:582-92. [PMID: 25131806 DOI: 10.1002/ab.21554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 05/23/2014] [Accepted: 06/06/2014] [Indexed: 12/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with aggressive behavior in veterans, and difficulty controlling aggressive urges has been identified as a primary postdeployment readjustment concern. Yet only a fraction of veterans with PTSD commit violent acts. The goals of this study were to (1) examine the higher-order factor structure of Personality Assessment Inventory (PAI) scales in a sample of U.S. military veterans seeking treatment for PTSD; and (2) to evaluate the incremental validity of higher-order latent factors of the PAI over PTSD symptom severity in modeling aggression. The study sample included male U.S. Vietnam (n = 433) and Iraq/Afghanistan (n = 165) veterans who were seeking treatment for PTSD at an outpatient Veterans Affairs (VA) clinic. Measures included the Clinician Administered PTSD Scale, the PAI, and the Conflict Tactics Scale. The sample was randomly split into two equal subsamples (n's = 299) to allow for cross-validation of statistically derived factors. Parallel analysis, variable clustering analysis, and confirmatory factor analyses were used to evaluate the factor structure, and regression was used to examine the association of factor scores with self-reports of aggression over the past year. Three factors were identified: internalizing, externalizing, and substance abuse. Externalizing explained unique variance in aggression beyond PTSD symptom severity and demographic factors, while internalizing and substance abuse did not. Service era was unrelated to reports of aggression. The constructs of internalizing versus externalizing dimensions of PTSD may have utility in identifying characteristics of combat veterans in the greatest need of treatment to help manage aggressive urges.
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Affiliation(s)
- Elizabeth E. Van Voorhees
- VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center; Durham North Carolina
- Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Psychiatry and Behavioral Sciences; Duke University Medical Center; Durham North Carolina
| | - Paul A. Dennis
- Durham Veterans Affairs Medical Center; Durham North Carolina
| | - Eric B. Elbogen
- Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Psychiatry; University of North Carolina School of Medicine; Chapel Hill North Carolina
| | - Carolina P. Clancy
- Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Psychiatry and Behavioral Sciences; Duke University Medical Center; Durham North Carolina
| | - Michael A. Hertzberg
- Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Psychiatry and Behavioral Sciences; Duke University Medical Center; Durham North Carolina
| | - Jean C. Beckham
- VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center; Durham North Carolina
- Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Psychiatry and Behavioral Sciences; Duke University Medical Center; Durham North Carolina
| | - Patrick S. Calhoun
- VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center; Durham North Carolina
- Durham Veterans Affairs Medical Center; Durham North Carolina
- Department of Psychiatry and Behavioral Sciences; Duke University Medical Center; Durham North Carolina
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Elbogen EB, Cueva M, Wagner HR, Sreenivasan S, Brancu M, Beckham JC, Van Male L. Screening for violence risk in military veterans: predictive validity of a brief clinical tool. Am J Psychiatry 2014; 171:749-57. [PMID: 24832765 PMCID: PMC4142592 DOI: 10.1176/appi.ajp.2014.13101316] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Violence toward others is a serious problem among a subset of military veterans. The authors evaluated the predictive validity of a brief decision support tool to screen veterans for problems with violence and identify potential candidates for a comprehensive risk assessment. METHOD Data on risk factors at an initial wave and on violent behavior at 1-year follow-up were collected in two independent sampling frames: a national random-sample survey of 1,090 Iraq and Afghanistan veterans and in-depth assessments of 197 dyads of veterans and collateral informants. Risk factors (lacking money for basic needs, combat experience, alcohol misuse, history of violence and arrests, and anger associated with posttraumatic stress disorder) were chosen based on empirical support in published research. Scales measuring these risk factors were examined, and items with the most robust statistical association with outcomes were selected for the screening tool. Regression analyses were used to derive receiver operating characteristic curves of sensitivities and specificities, with area under the curve providing an index of predictive validity. RESULTS The resultant 5-item screening tool, called the Violence Screening and Assessment of Needs (VIO-SCAN), yielded area-under-the-curve statistics ranging from 0.74 to 0.78 for the national survey and from 0.74 to 0.80 for the in-depth assessments, depending on level of violence analyzed. CONCLUSIONS Although the VIO-SCAN does not constitute a comprehensive violence risk assessment and cannot replace fully informed clinical decision making, it is hoped that the screen will provide clinicians with a rapid, systematic method for identifying veterans at higher risk of violence, prioritizing those in need a full clinical workup, structuring review of empirically supported risk factors, and developing plans collaboratively with veterans to reduce risk and increase successful reintegration in the community.
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Affiliation(s)
- Eric B. Elbogen
- Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC,Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC
| | - Michelle Cueva
- Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC
| | - H. Ryan Wagner
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Shoba Sreenivasan
- Greater Los Angeles Veterans Affairs Forensic Outreach Services,University of Southern California, Keck School of Medicine, Department of Psychiatry
| | - Mira Brancu
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Jean C. Beckham
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Lynn Van Male
- Veteran Health Administration Office of Public Health,Oregon Health & Sciences University, Department of Psychiatry
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Flanagan JC, Teer A, Beylotte FM, Killeen TK, Back SE. Correlates of Recent and Lifetime Aggression among Veterans with Co-Occurring PTSD and Substance Use Disorders. ACTA ACUST UNITED AC 2014; 7:315-328. [PMID: 25419233 DOI: 10.1080/17523281.2014.924986] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Aggressive behavior is strongly associated with both posttraumatic stress disorder (PTSD) and substance use disorders (SUD) among civilians. However, little research has examined correlates of aggression among Veterans with co-occurring PTSD and SUD. METHODS This exploratory study examined the prevalence and correlates of recent (i.e., past 30 days) and lifetime aggressive behavior among a sample of U.S. Veterans (N=97) enrolled in a study examining integrated psychosocial treatment of co-occurring PTSD/SUD. RESULTS The findings revealed high rates of recent and lifetime aggressive behaviors (39.2% and 57.7%, respectively). Participants who endorsed recent aggressive behaviors were younger, had less education, more severe PTSD numbing and hyperarousal symptoms, were more likely to report recent suicidal ideation, more frequent alcohol and marijuana use, had higher rates of physical and sexual abuse, greater combat exposure, and more severe aftermath of battle experiences. Participants who endorsed lifetime aggression were younger, reported more total PTSD symptom severity, PTSD re-experiencing severity, depression severity, and fewer post-deployment stressors compared to those who did not. Logistic regression analyses indicated that education and number of drinking days were correlated with recent aggression while depression and post-deployment stressors were correlated with lifetime aggression. CONCLUSIONS The findings demonstrate high rates of aggressive behaviors among Veterans with PTSD/SUD, as well as clinically relevant correlates of aggressive behaviors. Although preliminary, the findings suggest potential targets for improving assessment and treatment of Veterans with PTSD/SUD.
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Affiliation(s)
- Julianne C Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew Teer
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Francis M Beylotte
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Sudie E Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA ; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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Elbogen EB, Johnson SC, Wagner HR, Sullivan C, Taft CT, Beckham JC. Violent behaviour and post-traumatic stress disorder in US Iraq and Afghanistan veterans. Br J Psychiatry 2014; 204:368-75. [PMID: 24578444 PMCID: PMC4006087 DOI: 10.1192/bjp.bp.113.134627] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Violence towards others in the community has been identified as a significant problem for a subset of Iraq and Afghanistan veterans. AIMS To investigate the extent to which post-traumatic stress disorder (PTSD) and other risk factors predict future violent behaviour in military veterans. METHOD A national, multiwave survey enrolling a random sample of all US veterans who served in the military after 11 September 2001 was conducted. A total of 1090 veterans from 50 US states and all military branches completed two survey waves mailed 1 year apart (retention rate = 79%). RESULTS Overall, 9% endorsed engaging in severe violence and 26% in other physical aggression in the previous year, as measured at Wave 2. Younger age, financial instability, history of violence before military service, higher combat exposure, PTSD, and alcohol misuse at Wave 1 were significantly associated with higher severe violence and other physical aggression in the past year at Wave 2. When combinations of these risk factors were present, predicted probability of violence in veterans rose sharply. Veterans with both PTSD and alcohol misuse had a substantially higher rate of subsequent severe violence (35.9%) compared with veterans with alcohol misuse without PTSD (10.6%), PTSD without alcohol misuse (10.0%) or neither PTSD nor alcohol misuse (5.3%). Using multiple regression, we found that veterans with PTSD and without alcohol misuse were not at significantly higher risk of severe violence than veterans with neither PTSD nor alcohol misuse. There was a trend for other physical aggression to be higher in veterans with PTSD without alcohol misuse. CONCLUSIONS Co-occurring PTSD and alcohol misuse was associated with a marked increase in violence and aggression in veterans. Compared with veterans with neither PTSD nor alcohol misuse, veterans with PTSD and no alcohol misuse were not significantly more likely to be severely violent and were only marginally more likely to engage in other physical aggression. Attention to cumulative effects of multiple risk factors beyond diagnosis--including demographics, violence history, combat exposure, and veterans' having money to cover basic needs like food, shelter, transportation, and medical care--is crucial for optimising violence risk management.
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Elbogen EB, Johnson SC, Newton VM, Timko C, Vasterling JJ, Van Male LM, Wagner HR, Beckham JC. Protective mechanisms and prevention of violence and aggression in veterans. Psychol Serv 2014; 11:220-8. [PMID: 24512537 DOI: 10.1037/a0035088] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although a subset of Iraq and Afghanistan Veterans show aggression toward others after they return home from military service, little is known about protective mechanisms that could be bolstered to prevent violence. A national longitudinal survey was conducted between 2009 and 2011 using a random sample of veterans who served in Operation Iraqi Freedom or Operation Enduring Freedom. One thousand and ninety veterans, from 50 states representing all military branches, completed 2 waves of data collection, 1 year apart (retention rate = 79%). The final sample resembled the U.S. military post 9/11 in terms of age, sex, ethnicity, geography, and service branch. Protective mechanisms in socioeconomic (money to cover basic needs, stable employment), psychosocial (resilience, perceiving control over one's life, social support), and physical (healthy sleep, no physical pain) domains were examined. We found these protective mechanisms predicted decreased aggression and violence at follow-up, particularly among higher risk veterans. Multivariable analyses confirmed that protective mechanisms lowered violence through their interaction with risk factors. This study identifies protective mechanisms related to decreased community violence in veterans and indicates that rehabilitation aimed at improving socioeconomic, psychosocial, and physical well-being has potential promise to reduce aggression and violence among veterans after returning home from military service.
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Affiliation(s)
- Eric B Elbogen
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | - Sally C Johnson
- Department of Psychiatry, University of North Carolina-Chapel Hill
| | | | - Christine Timko
- Center for Health Care Evaluation, Health Services Research and Development Service, VA Palo Alto Healthcare System
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Sullivan CP, Elbogen EB. PTSD symptoms and family versus stranger violence in Iraq and Afghanistan veterans. LAW AND HUMAN BEHAVIOR 2014; 38:1-9. [PMID: 23646917 PMCID: PMC4394858 DOI: 10.1037/lhb0000035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
As a diagnosis, posttraumatic stress disorder (PTSD) has been associated with violence committed by veterans in many studies; however, a potential link to specific PTSD symptoms has received relatively less attention. This paper examines the relationship between PTSD symptoms and different types of violent behavior in Iraq and Afghanistan veterans. Participants were randomly sampled from a roster of all separated U.S. military service members or national guard/reservists who served after September 11, 2001. Data were collected at baseline and 1-year follow-up from a national sample of N = 1,090 veterans, from 50 states and all military branches. Of these veterans, 13% reported aggression toward a family member and 9% toward a stranger during the 1-year study period. Anger symptoms at baseline predicted higher odds of family violence at follow-up, both severe (OR = 1.30, CI [1.13, 1.48], p < .0001) and any (OR = 1.28, CI [1.19, 1.37], p < .0001). PTSD flashback symptoms at baseline predicted higher odds of stranger violence at follow-up, both severe (OR = 1.26, CI [1.11, 1.42], p < .0001) and any (OR = 1.16, CI [1.05, 1.28], p = .0029). Analyses revealed that males were more likely to engage in stranger violence, whereas females were more likely to endorse aggression in the family context. The results provide limited support to the hypothesis that PTSD "flashbacks" in veterans are linked to violence. The differing multivariate models illustrate distinct veteran characteristics associated with specific types of violence.
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Affiliation(s)
- Connor P Sullivan
- Department of Psychiatry, University of North Carolina-Chapel Hill School of Medicine
| | - Eric B Elbogen
- Department of Psychiatry, University of North Carolina-Chapel Hill School of Medicine
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Stappenbeck CA, Hellmuth JC, Simpson T, Jakupcak M. The Effects of Alcohol Problems, PTSD, and Combat Exposure on Nonphysical and Physical Aggression Among Iraq and Afghanistan War Veterans. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2014; 6:65-72. [PMID: 25225593 DOI: 10.1037/a0031468] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aggression among combat veterans is of great concern. Although some studies have found an association between combat exposure and aggressive behavior following deployment, others conclude that aggression is more strongly associated with symptoms of posttraumatic stress disorder (PTSD), and that alcohol misuse may influence this association. Many of these studies have assessed aggression as a single construct, whereas the current study explored both nonphysical aggression only and physical aggression in a sample of Iraq and Afghanistan war veterans (N = 337; 91% male). We found that alcohol problems interacted with PTSD symptom severity to predict nonphysical aggression only. At low levels of PTSD symptoms, veterans with alcohol problems were more likely to perpetrate nonphysical aggression only, as compared with no aggression, than veterans without an alcohol problem. There was no difference in the likelihood of nonphysical aggression only between those with and without alcohol problems at high levels of PTSD symptoms. The likelihood of nonphysical aggression only, as compared with no aggression, was also greater among younger veterans. Greater combat exposure and PTSD symptom severity were associated with an increased likelihood of perpetrating physical aggression, as compared with no aggression. Ethnic minority status and younger age were also associated with physical aggression, as compared with no aggression. Findings suggest that a more detailed assessment of veterans' aggressive behavior, as well as their alcohol problems and PTSD symptoms, by researchers and clinicians is needed in order to determine how best to intervene.
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Affiliation(s)
| | | | - Tracy Simpson
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington, and Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Matthew Jakupcak
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington, and University of Washington
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Williamson R, Lauricella K, Browning A, Tierney E, Chen J, Joseph S, Sharrock J, Trauer T, Hamilton B. Patient factors associated with incidents of aggression in a general inpatient setting. J Clin Nurs 2013; 23:1144-52. [DOI: 10.1111/jocn.12294] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Tom Trauer
- Department of Psychiatry; University of Melbourne and Principal Research Fellow, St. Vincent's Mental Health; Melbourne VIC Australia
| | - Bridget Hamilton
- St. Vincent's Mental Health; Melbourne VIC Australia
- Department of Nursing; University of Melbourne; Melbourne VIC Australia
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Abstract
This study, using a longitudinal design, attempted to identify whether self-reported problems with violence were empirically associated with future violent behavior among Iraq and Afghanistan war veterans and whether and how collateral informant interviews enhanced the risk assessment process. Data were gathered from N = 300 participants (n = 150 dyads of Iraq and Afghanistan war veterans and family/friends). The veterans completed baseline and follow-up interviews 3 years later on average, and family/friends provided collateral data on dependent measures at follow-up. Analyses showed that aggression toward others at follow-up was associated with younger age, posttraumatic stress disorder, combat exposure, and a history of having witnessed parental violence growing up. Self-reported problems controlling violence at baseline had robust statistical power in predicting aggression toward others at follow-up. Collateral report enhanced detection of dependent variables: 20% of cases positive for violence toward others would have been missed relying only on self-report. The results identify a subset of Iraq and Afghanistan war veterans at higher risk for problematic postdeployment adjustment and indicate that the veterans' self-report of violence was useful in predicting future aggression. Underreporting of violence was not evidenced by most veterans but could be improved upon by obtaining collateral information.
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Abstract
The growing attention to acts of interpersonal violence and misconduct among military members has accompanied a host of research investigating the nature and causes associated with these behaviors. As such, a robust body of literature exists lending insight into risk factors and clinical presentations associated with anger and aggression; however, such factors are multidimensional and complex, particularly for those suffering with war stress injuries. Furthermore, mental health stigma and treatment compliance with exposure and cognitive-based models, particularly in clients with aggressive presentations, can impact successful outcomes. One active-duty marine was referred to an outpatient mental health clinic for the treatment of posttraumatic stress disorder (PTSD). Four sessions of eye movement desensitization and reprocessing (EMDR) were used to significantly reduce obsessive violent impulses, traumatic grief, and depression. The benefit of EMDR therapy as a treatment for violent impulses is explored. The results are promising, but more research is needed.
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Association of exposure to intimate-partner physical violence and potentially traumatic war-related events with mental health in Liberia. Soc Sci Med 2012; 77:41-9. [PMID: 23219850 DOI: 10.1016/j.socscimed.2012.10.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 08/23/2012] [Accepted: 10/31/2012] [Indexed: 11/22/2022]
Abstract
Liberia's wars between 1989 and 2003 resulted in hundreds of thousands of casualties and millions of victims. Gender-based violence was widespread during the conflict. Since the end of the war, however, little attention has been paid to ongoing violence against women, especially within the household. This research examines the relationships between intimate-partner physical violence, war experiences, and mental health nearly ten years after the end of the war. The study is based on a nationwide cross-sectional, multistage stratified cluster random survey of 4501 adults using structured interviews during a six-week period in November and December 2010. The main outcome measures are prevalence of intimate-partner physical violence, exposure to potentially traumatic war-related events, symptoms of Post-Traumatic Stress Disorder (PTSD) and depression. Among adult women, 37.7% (95%CI, 34.9-40.5; n = 852/2196) reported lifetime exposure to intimate-partner physical violence and 24.4% (95%CI, 22.1-26.9; n = 544/2196) reported incidence of intimate-partner physical violence over a one-year recall period. Among men, 23.2% (95%CI, 20.8-25.9, n = 475/2094) reported having severely beaten their spouse or partner over their lifetime; the incidence over the one-year recall was 12.2% (95%CI, 10.4-14.2, n = 259/2094). Among adult residents in Liberia, 10.6% (95%CI, 9.5-11.7, n = 546/4496) met the criteria for symptoms of depression, and 12.6% (95% CI, 11.5-13.9, n = 608/4496) met the criteria for symptoms of PTSD. Intimate-partner physical violence as a victim and as a perpetrator was significantly associated with exposure to potentially traumatic war-related events, especially among men. Among women, experiencing intimate-partner physical violence was associated with symptoms of PTSD and depression. Among men, perpetrating intimate-partner physical violence was associated with symptoms of PTSD and depression after adjusting for exposure to potentially traumatic war-related events. These findings suggest that intimate-partner physical violence may be a continued stressor in post-war societies that needs to be recognized and addressed as part of the reconstruction effort.
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Hellmuth JC, Stappenbeck CA, Hoerster KD, Jakupcak M. Modeling PTSD symptom clusters, alcohol misuse, anger, and depression as they relate to aggression and suicidality in returning U.S. veterans. J Trauma Stress 2012; 25:527-34. [PMID: 23073972 PMCID: PMC4068010 DOI: 10.1002/jts.21732] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Suicidal ideation and aggression are common correlates of posttraumatic stress disorder (PTSD) among U.S. Iraq and Afghanistan war veterans. The existing literature has established a strong link between these factors, but a more nuanced understanding of how PTSD influences them is needed. The current study examined the direct and indirect relationships between PTSD symptom clusters and suicidal ideation in general aggression (without a specified target) regarding depression, alcohol misuse, and trait anger. Participants were 359 (92% male) U.S. Iraq/Afghanistan war veterans. Path analysis results suggested that the PTSD numbing cluster was directly (β = .28, p < .01) and indirectly (β = .17, p = .001) related through depression. The PTSD hyperarousal cluster was indirectly related to suicidal ideation through depression (β = .13, p < .001). The PTSD reexperiencing cluster was directly related to aggression (β = .17, p < .05), whereas the PTSD numbing and hyperarousal clusters were indirectly related to aggression through trait anger (β = .05, p < .05; β = .20, p < .001). These findings indicate that adjunct treatments aimed at stabilizing anger, depression, and alcohol misuse may help clinicians ameliorate the maladaptive patterns often observed in veterans. These results also point to specific manifestations of PTSD and co-occurring conditions that may inform clinicians in their attempts to identify at risk veterans and facilitate preventative interventions.
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Affiliation(s)
| | | | - Katherine D. Hoerster
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Matthew Jakupcak
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Elbogen EB, Johnson SC, Wagner HR, Newton VM, Timko C, Vasterling JJ, Beckham JC. Protective factors and risk modification of violence in Iraq and Afghanistan War veterans. J Clin Psychiatry 2012; 73:e767-73. [PMID: 22795217 PMCID: PMC3399731 DOI: 10.4088/jcp.11m07593] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE After returning home, a subset of Iraq and Afghanistan War veterans report engaging in aggression toward others. This study is the first to identify variables empirically related to decreased risk of community violence among veterans. METHOD The authors conducted a national survey from July 2009 to April 2010 in which participants were randomly drawn from over 1 million US military service members who served after September 11, 2001. Data were collected from a total of 1,388 Iraq and Afghanistan War era and theater veterans. The final sample included veterans from all 50 states and all military branches. RESULTS One-third of survey respondents self-identified committing an act of aggression toward others during the past year, mostly involving minor aggressive behavior. Younger age, criminal arrest record, combat exposure, probable posttraumatic stress disorder, and alcohol misuse were positively related to violence toward others. Controlling for these covariates, multivariate analyses showed that stable living situation and the perception of having control over one's life were associated with reduced odds of severe violence (R2 = 0.24, χ27 = 145.03, P < .0001). Greater resilience, perceiving positive social support, and having money to cover basic needs were linked to reduced odds of other physical aggression (R2 = 0.20, χ28 = 188.27, P < .0001). CONCLUSIONS The study identifies aggression as a problem for a subset of Iraq and Afghanistan War veterans who endorsed few protective factors. Analyses revealed that protective factors added incremental value to statistical modeling of violence, even when controlling for robust risk factors. The data indicate that, in addition to clinical interventions directed at treating mental health and substance abuse problems, psychosocial rehabilitation approaches aimed at improving domains of basic functioning and psychological well-being may also be effective in modifying risk and reducing violence among veterans.
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Affiliation(s)
- Eric B. Elbogen
- Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC
| | - Sally C. Johnson
- Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC
| | - H. Ryan Wagner
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
| | - Virginia M. Newton
- Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC,VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC
| | - Christine Timko
- Center for Health Care Evaluation, Health Services Research & Development Service, VA Palo Health Care System,Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Jennifer J. Vasterling
- Psychology Service, VA National Center for PTSD, VA Boston Healthcare System, Boston, MA,Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | - Jean C. Beckham
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC,Department of Psychiatry, Duke University Medical Center, Durham, NC
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