Assessing and Reducing Post-Deployment Violence Risk

从伊拉克和阿富汗返回美国后犯下暴力行为的退伍军人引起了公众的广泛关注，这表明迫切需要制定基于证据的方法来评估和减少部署后的暴力风险。人们对在伊拉克和阿富汗经历战斗的退伍军人知之甚少。早期数据显示，许多退伍士兵被诊断出患有创伤后应激障碍或酗酒障碍。许多人也经历过创伤性脑损伤。每一种情况都可能增加暴力风险。没有有效的经验工具来筛选战斗退伍军人和确定那些有风险的人，以协调干预措施，防止这些悲剧重演。该R 01应用程序旨在：1）确定与从伊拉克和阿富汗返回的退伍军人中暴力行为相关的风险和保护因素; 2）检查与先前冲突退伍军人中暴力行为相关的特定因素与伊拉克和阿富汗退伍军人中部署后暴力风险之间的联系，特别是创伤后应激障碍，酒精使用障碍和创伤性脑损伤;以及3）开发一个以证据为基础的风险评估工具，用于管理伊拉克和阿富汗退伍军人，以确定最需要服务的人。我们建议，以满足这些目标，采用两个抽样框架。首先，我们将在基线和一年N=1000全国代表性的退伍军人谁已经从伊拉克或阿富汗的战斗中返回的暴力行为和因素在以前的文献中显示，与其他退伍军人之间的暴力行为进行调查。其次，我们将在基线和一年内采访N=300名退伍军人及其家庭成员，了解暴力，药物使用，家庭调整，创伤后应激障碍和就业状况，利用大西洋中部精神疾病研究教育和临床中心（MIRECC）的基础设施，其中退伍军人，警卫/预备役，来自伊拉克和阿富汗的现役人员于2005年在达勒姆退伍军人医疗中心成立。在这两种方法中，与暴力有关的风险和保护因素将成为精算暴力风险评估工具的候选因素，我们将在后续赠款申请中开发和验证该工具。这项研究将产生关于身体攻击、环境压力和创伤事件之间错综复杂的相互关系的独特而重要的科学数据。此外，通过遵循已经成功开发平民暴力风险工具的概念和方法框架，我们希望开发一种经过临床验证和临床相关的风险评估工具，以帮助减少目前从伊拉克和阿富汗返回的数千名退伍军人的暴力机会。 公共卫生相关性：当退伍军人变得暴力时，个人、家庭、社区和社会的代价都是巨大的。未来几年，成千上万的士兵将从伊拉克和阿富汗的战斗中返回家园，鉴于数据显示部署后心理健康问题的高发生率，我们迫切需要理论上复杂的，基于证据的知识，即返回的退伍军人最容易发生暴力行为，以及如何有效管理他们对自己，家人和其他人构成的风险。通过遵循关于平民风险评估的科学文献指南，目前的应用程序不仅旨在了解退伍军人暴力的原因，而且还开发了经验验证和临床有用的工具，以帮助心理健康提供者和军事人员评估和减少伊拉克和阿富汗退伍军人的暴力风险。

DESCRIPTION (provided by applicant): Broad public attention garnered by veterans who commit violent acts after returning to the U.S. from Iraq and Afghanistan demonstrates the urgent need to develop evidence-based approaches to assessing and reducing post-deployment violence risk. Little is known about veterans who have endured combat in Iraq and Afghanistan. Early data indicate many returning soldiers are being diagnosed with posttraumatic stress disorder or alcohol use disorder. Many have experienced traumatic brain injury, as well. Each of these conditions could elevate violence risk. There are no effective empirical tools for screening combat veterans and identifying those individuals at-risk in order to coordinate interventions and prevent these recurring tragedies. This R01 application aims to: 1) identify risk and protective factors empirically related to violent behavior among veterans who have returned from Iraq and Afghanistan; 2) examine the link between specific factors related to violence among veterans from previous conflicts and post-deployment violence risk among Iraq and Afghanistan veterans, especially posttraumatic stress disorder, alcohol use disorder, and traumatic brain injury; and 3) develop an evidence-based risk assessment instrument to administer to Iraq and Afghanistan veterans in order to identify those most in need of services. We propose to meet these aims employing two sampling frames. First, we will conduct survey at baseline and one year N=1000 nationally representative veterans who have returned from combat in Iraq or Afghanistan about violent behaviors and factors shown in previous literature to relate to violence among other veterans. Second, we will interview N=300 veterans and a member of their family at baseline and one-year about violence, substance use, family adjustment, posttraumatic stress disorder, and employment status, capitalizing on the infrastructure of the Mid Atlantic Mental Illness Research Education and Clinical Center (MIRECC) in which a registry of veteran, guard/reserve, and active duty personnel from the Iraq and Afghanistan was established at the Durham VA Medical Center in 2005. Risk and protective factors linked to violence in both approaches will be candidates for an actuarial violence risk assessment instrument, which we will develop and validate in a follow-up grant application. The research will yield unique and significant scientific data on the intricate interrelationships between physical aggression, environmental stress, and traumatic events. Further, by following a conceptual and methodological framework already successful for developing violence risk tools in civilian populations, we hope to develop an empirically-validated and clinically-relevant risk assessment instrument to help reduce chances of violence among the thousands of veterans now returning from Iraq and Afghanistan. Public Health Relevance: When veterans become violent, the costs to individuals, their families, their communities, and society are great. Tens of thousands of troops will be returning home from combat in Iraq and Afghanistan in the next few years and, given data showing high rates of post-deployment mental health problems, we urgently need theoretically sophisticated, evidence-based knowledge of which returning veterans are most prone to violence and how the risks they pose to themselves, their families, and others can be effectively managed. By following the guide of scientific literature on civilian risk assessment, the current application aims not only to understand the causes of veteran violence, but also to develop empirically validated and clinically useful tools to assist mental health providers and military staff assess and reduce violence risk among Iraq and Afghanistan veterans.