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Protective Factors and Risk Modification of Violence in Iraq and Afghanistan War Veterans

J Clin Psychiatry 2012;73(6):e767-e773
10.4088/JCP.11m07593

Objective: After returning home, a subset of Iraq and Afghanistan War veterans report engaging in aggression toward others. This study is the first to identify variables empirically related to decreased risk of community violence among veterans.

Method: The authors conducted a national survey from July 2009 to April 2010 in which participants were randomly drawn from over 1 million US military service members who served after September 11, 2001. Data were collected from a total of 1,388 Iraq and Afghanistan War era and theater veterans. The final sample included veterans from all 50 states and all military branches.

Results: One-third of survey respondents self-identified committing an act of aggression toward others during the past year, mostly involving minor aggressive behavior. Younger age, criminal arrest record, combat exposure, probable posttraumatic stress disorder, and alcohol misuse were positively related to violence toward others. Controlling for these covariates, multivariate analyses showed that stable living situation and the perception of having control over one’s life were associated with reduced odds of severe violence (R2 = 0.24, χ27 = 145.03, P < .0001). Greater resilience, perceiving positive social support, and having money to cover basic needs were linked to reduced odds of other physical aggression (R2 = 0.20, χ28 = 188.27, P < .0001).

Conclusions: The study identifies aggression as a problem for a subset of Iraq and Afghanistan War veterans who endorsed few protective factors. Analyses revealed that protective factors added incremental value to statistical modeling of violence, even when controlling for robust risk factors. The data indicate that, in addition to clinical interventions directed at treating mental health and substance abuse problems, psychosocial rehabilitation approaches aimed at improving domains of basic functioning and psychological well-being may also be effective in modifying risk and reducing violence among veterans.

J Clin Psychiatry 2012;73(6):e767–e773

Submitted: December 19, 2011; accepted April 18, 2012 (doi:10.4088/JCP.11m07593).

Corresponding author: Eric B. Elbogen, PhD, University of North Carolina-Chapel Hill School of Medicine, Forensic Psychiatry Program and Clinic, Department of Psychiatry, CB #7167, Chapel Hill, NC 27599 (eric.elbogen@unc.edu).