Assessing and Reducing Post-Deployment Violence Risk

描述(由申请人提供)：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广泛的公众关注，表明迫切需要开发基于证据的方法来评估和降低部署后的暴力风险。人们对在伊拉克和阿富汗经历过战斗的退伍军人知之甚少。早期数据显示，许多回国士兵被诊断出患有创伤后应激障碍或酒精使用障碍。许多人也经历过创伤性脑损伤。这些情况中的每一种都可能增加暴力风险。目前还没有有效的经验工具来筛选退伍军人和确定那些处于危险中的人，以便协调干预措施和防止这些悲剧再次发生。此R01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的暴力行为有实证相关的风险和保护因素；2)检查与以前冲突中的退伍军人中的暴力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，尤其是创伤后应激障碍、酒精使用障碍和创伤性脑损伤；以及3)开发一种基于证据的风险评估工具，用于对伊拉克和阿富汗退伍军人进行管理，以确定那些最需要服务的人。我们建议采用两个抽样框架来实现这些目标。首先，我们将在基线和一年内对从伊拉克或阿富汗作战归来的1000名具有全国代表性的退伍军人进行调查，了解以前文献中显示的与其他退伍军人中的暴力行为有关的暴力行为和因素。其次，我们将利用中大西洋精神疾病研究教育和临床中心(MIRECC)的基础设施，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、家庭适应、创伤后应激障碍和就业状况。2005年，达勒姆退伍军人医疗中心(Durham VA Medical Center)建立了伊拉克和阿富汗退伍军人、警卫/预备役人员和现役人员的登记。这两种办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者，我们将在后续赠款申请中制定和验证该工具。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和重要的科学数据。此外，通过遵循已经成功地在平民人口中开发暴力风险工具的概念和方法框架，我们希望开发一种经经验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发生暴力的机会。 公共卫生相关性：当退伍军人变得暴力时，个人、他们的家庭、他们的社区和社会付出的代价是巨大的。未来几年，数以万计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比率，我们迫切需要理论上成熟的、基于证据的知识，了解哪些回国的退伍军人最容易发生暴力，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的指导，目前的应用不仅旨在了解退伍军人暴力的原因，而且还旨在开发经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.