Premorbid variables, especially pre-TBI felonies, were strongly linked to post-TBI criminal arrests. The relationship between TBI and arrest was complex, and different brain functions (eg, physical mobility) should be considered when understanding this association. Findings highlight that for post-TBI criminal behavior, many risk factors mirror those of the non-TBI general population.

Objective Violence toward others is a serious problem among a subset of military veterans. This study reports on predictive validity of a brief screening tool for violence in veterans. Methods 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) a national random sample survey of 1090 Iraq and Afghanistan veterans, and (b) in-depth assessments of 197 dyads of Iraq and Afghanistan veterans and collateral informants. Results We chose candidate risk factors—financial instability, combat experience, alcohol misuse, history of violence and arrests, and anger associated with posttraumatic stress disorder (PTSD)—based on empirical support in published research. Tools measuring these risk factors were examined, and items with the most robust statistical association to outcomes were selected. The resultant 5-item clinical tool, the Violence Screening and Assessment of Needs (VIO-SCAN), yielded area under the curve (AUC) statistics ranging from .74 – .78 for the national survey and from .74 – .80 for the in-depth assessments, depending on level of violence analyzed using multiple logistic regression. Conclusions To our knowledge, the VIO-SCAN is the first empirically-derived assessment tool for violence developed specifically for military veteran populations. As in civilians, past violence and arrest history had a robust association with future violence in veterans. Analyses show that individual factors examined in isolation (e.g., PTSD, combat experience) do not adequately convey a veteran’s level of violence risk; rather, as shown by the VIO-SCAN, multiple risk factors need to be taken into account in tandem when assessing risk in veterans. Use of evidence-based methods for assessing and managing violence in veterans is discussed, addressing benefits and limits of integrating risk assessment tools into clinical practice.

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