Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-22T07:33:41.818Z Has data issue: false hasContentIssue false
  • English
  • Français

Violent behaviour and post-traumatic stress disorder in US Iraq and Afghanistan veterans

Published online by Cambridge University Press:  02 January 2018

Eric B. Elbogen ,
Sally C. Johnson ,
H. Ryan Wagner ,
Connor Sullivan ,
Casey T. Taft  and
Jean C. Beckham
Eric B. Elbogen*
Affiliation:
Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina – Chapel Hill School of Medicine, Chapel Hill, North Carolina, and Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center, Durham, North Carolina
Sally C. Johnson
Affiliation:
Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina – Chapel Hill School of Medicine, Chapel Hill, North Carolina
H. Ryan Wagner
Affiliation:
Durham VA Medical Center, Durham, North Carolina, and Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
Connor Sullivan
Affiliation:
Department of Psychiatry, Forensic Psychiatry Program and Clinic, University of North Carolina – Chapel Hill School of Medicine, Chapel Hill, North Carolina
Casey T. Taft
Affiliation:
Psychology Service, VA National Center for PTSD, VA Boston Healthcare, Boston, Massachusetts, and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
Jean C. Beckham
Affiliation:
Durham VA Medical Center, Durham, North Carolina, and Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina, USA
*
Eric B. Elbogen, University of North Carolina – Chapel Hill, Box 7160, Chapel Hill, NC 27599, USA. Email: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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.

Type
Papers
Information
The British Journal of Psychiatry , Volume 204 , Issue 5 , May 2014 , pp. 368 - 375
Copyright
Copyright © Royal College of Psychiatrists, 2014 

Footnotes

The US National Institute of Mental Health (NIMH) funded this project. The US Department of Veterans Affairs provided infrastructure to conduct the project. The authors' work on this manuscript was independent of the US NIMH and US Department of Veterans Affairs, which had no role in the analysis, interpretation or decision to submit this research report. Preparation of this manuscript was supported by the NIMH (R01MH080988), the Office for Research and Development Clinical Science and Health Services, Department of Veterans Affairs, and the Mid-Atlantic Mental Illness Research, Education and Clinical Center.

Declaration of interest

E.B.E., C.T.T. and J.C.B. are US government employees.

References

1 Jakupcak, M, Conybeare, D, Phelps, L, Hunt, S, Holmes, HA, Felker, B, et al. Anger, hostility, and aggression among Iraq and Afghanistan war veterans reporting PTSD and subthreshold PTSD. J Trauma Stress 2007; 20: 945–54.Google Scholar
2 Thomas, JL, Wilk, JE, Riviere, LA, McGurk, D, Castro, CA, Hoge, CW. Prevalence of mental health problems and functional impairment among Active Component and National Guard soldiers 3 and 12 months following combat in Iraq. Arch Gen Psychiatry 2010; 67: 614–23.Google Scholar
3 Marshall, AD, Panuzio, J, Taft, CT. Intimate partner violence among military veterans and active duty servicemen. Clin Psychol Rev 2005; 25: 862–76.Google Scholar
4 MacManus, D, Dean, K, Jones, M, Rona, RJ, Greenberg, N, Hull, L, et al. Violent offending by UK military personnel deployed to Iraq and Afghanistan: a data linkage cohort study. Lancet 2013; 381: 907–17.Google Scholar
5 Forbes, D, Bryant, RA. When the violence of war comes home. Lancet 2013; 381: 883–4.Google Scholar
6 Jones, AD. Intimate partner violence in military couples: a review of the literature. Aggress Violent Behav 2012; 17: 147–57.CrossRefGoogle Scholar
7 Elbogen, EB, Fuller, S, Johnson, SC, Brooks, S, Kinneer, P, Calhoun, PS, et al. Improving risk assessment of violence among military veterans: an evidence-based approach for clinical decision-making. Clin Psychol Rev 2010; 30: 595–607.CrossRefGoogle ScholarPubMed
8 Millikan, AM, Bell, MR, Gallaway, MS, Lagana, MT, Cox, AL, Sweda, MG. An epidemiologic investigation of homicides at Fort Carson, Colorado: summary of findings. Mil Med 2012; 177: 404–11.Google Scholar
9 Orcutt, HK, King, LA, King, DW. Male-perpetrated violence among Vietnam veteran couples: relationships with veteran's early life characteristics, trauma history, and PTSD symptomatology. J Trauma Stress 2003; 16: 381–90.Google Scholar
10 Savarese, VW, Suvak, MK, King, LA, King, DW. Relationships among alcohol use, hyperarousal, and marital abuse and violence in Vietnam veterans. J Trauma Stress 2001; 14: 717–32.Google Scholar
11 McFall, M, Fontana, A, Raskind, M, Rosenheck, R. Analysis of violent behavior in Vietnam combat veteran psychiatric inpatients with posttraumatic stress disorder. J Trauma Stress 1999; 12: 501–17.Google Scholar
12 Taft, CT, Pless, AP, Stalans, LJ, Koenen, KC, King, LA, King, DW. Risk factors for partner violence among a national sample of combat veterans. J Consult Clin Psychol 2005; 73: 151–9.Google Scholar
13 Taft, CT, Kaloupek, DG, Schumm, JA, Marshall, AD, Panuzio, J, King, DW, et al. Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans. J Abnorm Psychol 2007; 116: 498–507.Google Scholar
14 Iversen, AC, van Staden, L, Hughes, JH, Browne, T, Hull, L, Hall, J, et al. The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study. BMC Psychiatry 2009; 9: 68.Google Scholar
15 Tanielian, T, Jaycox, L. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. RAND Corporation, 2008.Google Scholar
16 Hoge, CW, Castro, C, Messer, S, McGurk, D, Cotting, D, Koffman, R. Combat duty in Iraq and Afghanistan: mental health problems and barriers to care. N Engl J Med 2004; 351: 13–22.CrossRefGoogle ScholarPubMed
17 Swanson, JW, Holzer, CE. Violence and ECA data. Hosp Community Psychiatry 1991; 42: 954–5.Google Scholar
18 Steadman, HJ, Mulvey, EP, Monahan, J, Robbins, PC, Appelbaum, PS, Grisso, T, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998; 55: 393–401.Google Scholar
19 Denson, TF, DeWall, CN, Finkel, EJ. Self-control and aggression. Curr Dir Psychol Sci 2012; 21: 20–5.CrossRefGoogle Scholar
20 Finkel, EJ. Impelling and inhibiting forces in the perpetration of intimate partner violence. Rev Gen Psychol 2007; 11: 193–207.Google Scholar
21 Taft, CT, Kachadourian, LK, Suvak, MK, Pinto, LA, Miller, MM, Knight, JA, et al. Examining impelling and disinhibiting factors for intimate partner violence in veterans. J Fam Psychol 2012; 26: 285–9.Google Scholar
22 Elbogen, EB, Wagner, HR, Johnson, SC, Kinneer, P, Kang, H, Vasterling, JJ, et al. Are Iraq and Afghanistan veterans using mental health services? New data from a national random sample survey. Psychiatr Serv 2013; 64: 134–41.Google Scholar
23 Dillman, DA, Smyth, JD, Christian, LM. Internet, Mail, and Mixed-Mode Surveys: The Tailored Design Method (3rd edn). John Wiley, 2009.Google Scholar
24 Vogt, D, Vaughn, R, Glickman, ME, Schultz, M, Drainoni, ML, Elwy, R, et al. Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans. J Abnorm Psychol 2011; 120: 797–806.Google Scholar
25 Beckham, JC, Becker, ME, Hamlett-Berry, KW, Drury, PD, Kang, HK, Wiley, MT, et al. Preliminary findings from a clinical demonstration project for veterans returning from Iraq or Afghanistan. Mil Med 2008; 173: 448–51.Google Scholar
26 Hotopf, M, Hull, L, Fear, NT, Browne, T, Horn, O, Iversen, A, et al. The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 2006; 367: 1731–41.Google Scholar
27 Defense Equal Opportunity Management Institute. FY2009 Annual Demographic Profile of Military Members in the Department of Defense and U.S. Coast Guard. Defense Equal Opportunity Management Institute, 2010.Google Scholar
28 Davidson, JRT, Book, SW, Colket, JT, Tupler, LA, Roth, S, David, D, et al. Assessment of a new self-rating scale for posttraumatic stress disorder. Psychol Med 1997; 27: 153–60.Google Scholar
29 McDonald, SD, Beckham, JC, Morey, RA, Calhoun, PS. The validity and diagnostic efficiency of the Davidson Trauma Scale in military veterans who have served since September 11th, 2001. J Anxiety Disord 2009; 23: 247–55.Google Scholar
30 Bradley, KA, Bush, KR. Screening for problem drinking: comparison of CAGE and AUDIT. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. J Gen Intern Med 1998; 13: 379–88.Google Scholar
31 Lehman, AF. A quality of life interview for the chronically mentally ill. Eval Program Plan 1988; 11: 51–62.Google Scholar
32 King, DW, King, LA, Vogt, DS. Manual for the Deployment Risk and Resilience Inventory (DRRI): A Collection of Measures for Studying Deployment Related Experiences of Military Veterans. National Center for PTSD, 2003.Google Scholar
33 Monahan, J, Steadman, HJ. Violence and Mental Disorder: Developments in Risk Assessment. University of Chicago Press, 1994.Google Scholar
34 Straus, MA. Measuring intrafamily conflict and violence: the Conflict Tactics Scales. J Marriage Fam 1979; 41: 75–88.Google Scholar
35 Steadman, HJ, Silver, E, Monahan, J, Appelbaum, PS, Robbins, PC, Mulvey, EP, et al. A classification tree approach to the development of actuarial violence risk assessment tools. Law Hum Behav 2000; 24: 83–100.Google Scholar
36 MacManus, D, Dean, K, Al Bakir, M, Iversen, AC, Hull, L, Fahy, T, et al. Violent behaviour in UK military personnel returning home after deployment. Psychol Med 2012; 42: 1663–73.CrossRefGoogle ScholarPubMed
37 Elbogen, EB, Johnson, SC, Newton, VM, Fuller, SR, Wagner, HR, Beckham, JC. Self-report and longitudinal predictors of violence in Iraq and Afghanistan veterans. J Nerv Ment Dis 2013; 201: 872–6.CrossRefGoogle Scholar
38 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. Psychol Trauma 2013; 1 Apr ePub ahead of print (doi: 10.1037/a0031468).CrossRefGoogle Scholar
39 Adler, AB, Bliese, PD, McGurk, D, Hoge, CW, Castro, CA. Battlemind debriefing and battlemind training as early interventions with soldiers returning from iraq: randomization by platoon. J Consult Clin Psychol 2009; 77: 928–40.CrossRefGoogle ScholarPubMed
40 Reivich, KJ, Seligman, MEP, McBride, S. Master resilience training in the U.S. Army. Am Psychol 2011; 66: 25–34.Google Scholar
41 Garber, BG, Zamorski, MA. Evaluation of a third-location decompression program for Canadian forces members returning from Afghanistan. Mil Med 2012; 177: 397–403.Google Scholar
42 Cohn, A, Crane, MF, Hodson, SE. Psychological Resilience Training in the Australian Defence Force. Nova Scotia Publishers, 2011.Google Scholar
43 Greenberg, N, Langston, V, Iversen, AC, Wessely, S. The acceptability of ‘Trauma Risk Management’ within the UK armed forces. Occup Med (Lond) 2011; 61: 184–9.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.