Predicting High-Risk Behaviors in Veterans With Posttraumatic Stress Disorder

Health Services Research and Development, VA Palo Alto Health Care System, Palo Alto, CA, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 08/2005; 193(7):464-72. DOI: 10.1097/01.nmd.0000168238.13252.b3
Source: PubMed


The present study sought to identify posttraumatic stress disorder (PTSD) patients at high risk for negative behavioral outcomes (violence, suicide attempts, and substance use). The Mississippi Scale for Combat-Related PTSD, the Beck Depression Inventory, and demographic and behavioral data from 409 male combat veterans who completed a VA residential rehabilitation program for PTSD were analyzed using signal detection methods (receiver operating characteristics). A validation sample (N = 221) was then used to test interactions identified in the signal detection analyses. The best predictors of behaviors at follow-up were those same behaviors shortly before intake, followed by depressive and PTSD symptoms. However, for each of the models other than that for hard drug use, cutoffs determined at the symptom level did not lend themselves to replication. Recent high-risk behaviors, rather than patients' history, appear to be more predictive of high-risk behaviors postdischarge.

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Available from: Kent D Drescher, Jun 25, 2014
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    • "As a result, the temporal order of events usually was not examined. Case definitions were not consistent across studies and were based on a variety of methods, including a positive result on a symptom-based checklist or survey [11,18], an interview-based diagnosis [16,25], or hospitalization for PTSD [19,23]. Combat veterans were often compared with dissimilar control groups, such as non-deployable personnel or non-veterans, who may have different rates of misconduct outcomes. "
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    ABSTRACT: Research on Vietnam veterans suggests an association between psychological problems, including posttraumatic stress disorder (PTSD), and misconduct; however, this has rarely been studied in veterans of Operation Iraqi Freedom or Operation Enduring Freedom. The objective of this study was to investigate whether psychological problems were associated with three types of misconduct outcomes (demotions, drug-related discharges, and punitive discharges.) A population-based study was conducted on all U.S. Marines who entered the military between October 1, 2001, and September 30, 2006, and deployed outside of the United States before the end of the study period, September 30, 2007. Demographic, psychiatric, deployment, and personnel information was collected from military records. Cox proportional hazards regression analysis was conducted to investigate associations between the independent variables and the three types of misconduct in war-deployed (n = 77,998) and non-war-deployed (n = 13,944) Marines. Marines in both the war-deployed and non-war-deployed cohorts with a non-PTSD psychiatric diagnosis had an elevated risk for all three misconduct outcomes (hazard ratios ranged from 3.93 to 5.65). PTSD was a significant predictor of drug-related discharges in both the war-deployed and non-war-deployed cohorts. In the war-deployed cohort only, a specific diagnosis of PTSD was associated with an increased risk for both demotions (hazard ratio, 8.60; 95% confidence interval, 6.95 to 10.64) and punitive discharges (HR, 11.06; 95% CI, 8.06 to 15.16). These results provide evidence of an association between PTSD and behavior problems in Marines deployed to war. Moreover, because misconduct can lead to disqualification for some Veterans Administration benefits, personnel with the most serious manifestations of PTSD may face additional barriers to care.
    BMC Psychiatry 10/2010; 10(1):88. DOI:10.1186/1471-244X-10-88 · 2.21 Impact Factor
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    • "Depression has been found to be a predictor of aggression (Windle & Windle, 1995). In one study of N=630 Veterans, Among those who had committed one or more violent acts, the next best predictor was Beck Depression Inventory (BDI) scores (χ 2 (1, 247) = 9.40, p <.001) with patients scoring 34 or greater on the BDI comprising a higher risk group (68% vs. 48%)(Hartl et al., 2005). Dysphoric (Taft, Vogt et al., 2007) and psychotic symptoms (Lehmann et al., 1999; Yesavage, 1984) have also been linked to aggression in Veterans. "
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    ABSTRACT: Increased media attention to post-deployment violence highlights the need to develop effective models to guide risk assessment among military Veterans. Ideally, a method would help identify which Veterans are most at risk for violence so that it can be determined what could be done to prevent violent behavior. This article suggests how empirical approaches to risk assessment used successfully in civilian populations can be applied to Veterans. A review was conducted of the scientific literature on Veteran populations regarding factors related to interpersonal violence generally and to domestic violence specifically. A checklist was then generated of empirically-supported risk factors for clinicians to consider in practice. To conceptualize how these known risk factors relate to a Veteran's violence potential, risk assessment scholarship was utilized to develop an evidence-based method to guide mental health professionals. The goals of this approach are to integrate science into practice, overcome logistical barriers, and permit more effective assessment, monitoring, and management of violence risk for clinicians working with Veterans, both in Department of Veteran Affairs settings and in the broader community. Research is needed to test the predictive validity of risk assessment models. Ultimately, the use of a systematic, empirical framework could lead to improved clinical decision-making in the area of risk assessment and potentially help prevent violence among Veterans.
    Clinical psychology review 08/2010; 30(6):595-607. DOI:10.1016/j.cpr.2010.03.009 · 7.18 Impact Factor
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