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，这表明迫切需要开发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过战斗的退伍军人知之甚少。早期数据显示，许多回国的士兵被诊断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，识别那些有风险的人，以协调干预措施，防止这些悲剧重演。这个R01应用程序旨在：1)识别从伊拉克和阿富汗返回的退伍军人中与暴力行为相关的风险和保护因素；2)研究与伊拉克和阿富汗战争退伍军人暴力相关的具体因素与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；3)开发一种基于证据的风险评估工具，用于管理伊拉克和阿富汗退伍军人，以确定那些最需要服务的人。我们建议采用两个采样帧来满足这些目标。首先，我们将对从伊拉克或阿富汗战场返回的1000名具有全国代表性的退伍军人进行基线和一年的调查，调查先前文献中显示的与其他退伍军人暴力行为相关的暴力行为和因素。其次，我们将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，在2005年在达勒姆退伍军人医疗中心建立的退伍军人、警卫队/预备役人员和伊拉克和阿富汗现役人员的登记，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、物质使用、家庭适应、创伤后应激障碍和就业状况。在这两种方法中，与暴力有关的风险和保护因素将成为暴力风险精算评估工具的候选对象，我们将在后续拨款申请中开发和验证该工具。这项研究将为身体攻击、环境压力和创伤性事件之间复杂的相互关系提供独特而重要的科学数据。此外，通过遵循在平民人口中成功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验验证和临床相关的风险评估工具，以帮助减少现在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。

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.