Screening for Violence Risk in Military Veterans: Predictive Validity of a Brief Clinical Tool

Abstract

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.

Predicting non-familial major physical violent crime perpetration in the US Army from administrative data

“…Three general observations about the variables in the final models are nonetheless noteworthy. First, these variables were highly consistent with previous military research in showing that violence was associated with young age and low rank, low socioeconomic and minority status, prior crime involvement, and mental disorders (Elbogen et al , 2014a, Elbogen et al , 2012, Elbogen et al , 2014b, Gallaway et al , 2012, Hellmuth et al , 2012, MacManus et al , 2012a, MacManus et al , 2013, Sullivan and Elbogen, 2014). …”

“…Numerous epidemiological studies have examined predictors of violence among active duty military personnel (Gallaway et al , 2012, Killgore et al , 2008, MacManus et al , 2012a, MacManus et al , 2012b, MacManus et al , 2013) and veterans (Elbogen et al , 2014a, Elbogen et al , 2013, Elbogen et al , 2012, Elbogen et al , 2014b, Elbogen et al , 2010b, Hellmuth et al , 2012, Jakupcak et al , 2007, Sullivan and Elbogen, 2014). A recent review (Elbogen et al , 2010a) organized the significant predictors in these studies into four broad categories: socio-demographic and dispositional (e.g., sex, race-ethnicity, personality); historical (e.g., childhood experiences, military career experiences, prior violence); clinical (e.g., mental and physical disorders); and contextual-environmental (e.g., access to weapons).…”

Risk of Recidivism Among Justice-Involved Veterans

“…; DSM-5; American Psychiatric Association, 2013), which now incorporates violent and impulsive behavior into the diagnostic criteria for PTSD. Furthermore, combat exposure and "probable PTSD plus anger" constitute two of the five items on the "VIO SCAN," a screener that was recently developed to predict risk for violence among military veterans (Elbogen et al, 2014).…”

“…Indeed, the literature on this issue is very limited and mixed. For example, although rates of homelessness prior to incarceration are comparable between veteran and nonveteran inmates (Mumola, 2000), "financial instability" is a robust predictor of violence risk per research on the VIO SCAN (Elbogen et al, 2014). Thus, homelessness may be linked to justice involvement among veterans via financial instability and in the context of other risk factors for violent offending such as PTSD and substance use.…”

“…The evidence for homelessness as a veteran-specific criminogenic need is limited. However, there is recent evidence for financial instability as a risk factor for violence among veterans (Elbogen et al, 2014).…”