Screening for Violence Risk in Military Veterans: Predictive Validity of a Brief Clinical Tool
Screening for Violence Risk in Military Veterans: Predictive Validity of a Brief Clinical Tool
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DOI：
10.1176/appi.ajp.2014.13101316
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发表时间：
2014-07-01
影响因子：
17.7
通讯作者：
Van Male, Lynn
中科院分区：
文献类型：
--
作者：
Elbogen, Eric B.;Cueva, Michelle;Van Male, Lynn
目标：对他人的暴力行为是一部分退伍军人面临的严重问题。作者评估了一个简短的决策支持工具的预测有效性，以筛选退伍军人的暴力问题，并确定潜在的候选人进行全面的风险assessment.Method：数据的风险因素在初始波和暴力行为在1年的后续行动收集在两个独立的抽样框架：对1,090名伊拉克和阿富汗退伍军人进行了全国随机抽样调查，并对197名退伍军人和间接线人进行了深入评估。风险因素（缺乏基本需求的资金，战斗经验，酒精滥用，暴力和逮捕的历史，以及与创伤后应激障碍相关的愤怒）是根据已发表研究的经验支持选择的。测量这些风险因素的量表进行了检查，并选择与结果具有最强统计学关联的项目作为筛选工具。回归分析用于推导灵敏度和特异性的受试者操作特征曲线，曲线下面积提供预测有效性指标。结果：由此产生的5项筛选工具，称为暴力筛选和需求评估（VIO-SCAN）得出的曲线下面积统计数据范围为：国家调查的曲线下面积为0.74至0.78，深入评估的曲线下面积为0.74至0.80，取决于分析的暴力程度。虽然VIO-SCAN并不构成全面的暴力风险评估，也不能取代充分知情的临床决策，但希望该筛查能为临床医生提供一种快速、系统的方法，用于识别暴力风险较高的退伍军人，优先考虑那些需要全面临床检查的人，对经验支持的风险因素进行结构性审查，并与退伍军人合作制定计划，以减少风险并增加成功重返社区的机会。
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.