Improving risk assessment of violence among military veterans

 
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Why do some veterans become violent after deployment and others slip easily back into normal life? What experiences either post-, pre- or during service can trigger aggression or domestic violence? How can clinicians sort through the myriad risk factors? Experts say that despite increased media attention to post-deployment violence, there are not enough tools to adequately assess triggers. In evaluating potential perpetrators of domestic violence, clinicians may miss information not readily available to them or attribute symptoms or behaviors to unrelated causes.

A 2010 paper published in Clinical Psychology Review, “Improving Risk Assessment of Violence among Military Veterans: An Evidence-based Approach for Clinical Decision-making,” reviews 72 previous studies to help identify domestic violence risk factors. The researchers, from Duke, Drexel, UNC-Chapel Hill and Durham VA Medical Center, propose a three-part, empirically-supported method of assessing risk. Designed to move beyond civilian-specific assessments, the veteran-focused checklist is involves: 1) establishing demographic and historic risk factors (gender, age, previous incidents of violence); 2) adjusting those to clinical diagnosis (depression, PSTD); 3) and examining current living situations (unemployment, financial instability.) The paper is meant as guidance to clinicians, but it also usefully surveys the state of research knowledge in this area for all those interested in veterans issues. It highlights the importance of considering the full history and current life conditions of veterans, in addition to their specific experiences in battle and related conditions such as PTSD.

The following risk factors are considered:

  • Age of veterans: research shows that younger veterans are more likely to commit violence against intimate partners than older veterans.
  • Length of deployment/exposure to combat: One study found that combat exposure more than quadruples risk of domestic violence. Another study found severity of spousal aggression increases with length of deployment.
  • History of violent behavior: Some research shows that veterans with previous arrests are three times as likely to commit severe spousal assault as those with no prior arrests.
  • Unstable childhood homes: Several studies have linked dysfunctional family origin, poor maternal relationships and physical fighting between parents to violence among veterans.
  • Other risk factors to violence in the home include financial instability, unemployment, substance abuse and depression.

A more thorough assessment process will not eliminate risk, the researchers note, but it will help doctors reduce decision-making errors and minimize the chances that veterans may engage in violent behavior in the future: “Clinicians working with veterans who regularly document assessing dynamic factors will find they increase their chances of recognizing patients who are moving toward increased risk by positioning themselves to take steps to reduce that risk.” The study also recommends further analysis to identify protective factors in order to prevent violence, as well as to to further analyze risk factors among female veterans.

Tags: veterans, mental health, PTSD

Last updated: January 8, 2013

 

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Citation: Elbogen, Eric B.; Fuller, Sara F.; Johnson, Sally C.; Brooks, Stephanie; Kinneer,Patricia; Calhoun, Patrick S.; Beckham, Jean C. "Improving Risk Assessment of Violence Among Military Veterans: An Evidence-Based Approach for Clinical Decision-Making," Clinical Psychology Review, August 2010, 30 (6), 595–607. doi: 10.1016/j.cpr.2010.03.009.