Violent behaviour and post-traumatic stress disorder in US Iraq and Afghanistan veterans
Violent behaviour and post-traumatic stress disorder in US Iraq and Afghanistan veterans
复制标题
DOI：
10.1192/bjp.bp.113.134627
复制
发表时间：
2014-05-01
影响因子：
10.5
通讯作者：
Beckham, Jean C.
中科院分区：
文献类型：
--
作者：
Elbogen, Eric B.;Johnson, Sally C.;Beckham, Jean C.
社区中对他人的暴力行为已被确定为伊拉克和阿富汗退伍军人的一个重要问题。目的探讨创伤后应激障碍（PTSD）和其他危险因素对退伍军人未来暴力行为的影响程度。方法对2001年9月11日以后在军队服役的所有美国退伍军人进行了一项全国性的多波调查。来自美国50个州和所有军种的1090名退伍军人完成了间隔1年的两次调查（保留率=79%）。结果总体而言，根据第二波的测量，9%的人承认在前一年有过严重暴力行为，26%有过其他身体攻击行为。年龄更小、经济不稳定、服役前的暴力史、更高的战斗暴露、创伤后应激障碍和酒精滥用在第一波中与过去一年中第二波中更高的严重暴力和其他身体攻击显著相关。当这些风险因素的组合出现时，预测退伍军人发生暴力的可能性急剧上升。与没有PTSD的酗酒退伍军人（10.6%）、PTSD没有酒精滥用（10.0%）或既没有PTSD也没有酒精滥用（5.3%）相比，同时患有PTSD和酒精滥用的退伍军人随后发生严重暴力的比例（35.9%）要高得多。使用多元回归，我们发现患有创伤后应激障碍和没有酒精滥用的退伍军人发生严重暴力的风险并不比没有创伤后应激障碍和酒精滥用的退伍军人高。在没有酒精滥用的PTSD退伍军人中，其他身体攻击的趋势更高。结论创伤后应激障碍和酒精滥用与退伍军人暴力和攻击行为的显著增加有关。与既没有创伤后应激障碍也没有酗酒的退伍军人相比，有创伤后应激障碍但没有酗酒的退伍军人并没有明显地更有可能严重暴力，只是稍微更有可能从事其他身体攻击。关注诊断之外的多种风险因素的累积效应——包括人口统计、暴力史、战斗经历以及退伍军人是否有钱满足食物、住所、交通和医疗等基本需求——对于优化暴力风险管理至关重要。
BackgroundViolence towards others in the community has been identified as a significant problem for a subset of Iraq and Afghanistan veterans.AimsTo investigate the extent to which post-traumatic stress disorder (PTSD) and other risk factors predict future violent behaviour in military veterans.MethodA 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%).ResultsOverall, 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.ConclusionsCo-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.