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A Screen to Predict Violence in Military Veterans

Summary and Comment |
June 3, 2014

A Screen to Predict Violence in Military Veterans

  1. Joel Yager, MD

A five-question screening test shows predictive validity and identifies individuals meriting more extensive investigation and intervention.

  1. Joel Yager, MD

Predicting violence in individuals is challenging and important, particularly in returning military veterans. Federally funded investigators developed the Violence Screening and Assessment of Needs instrument (VIO-SCAN) and applied it in two samples of post-9/11 veterans. Its five questions, in “yes” or “no” format, address financial instability (insufficient money to pay for ordinary needs), combat experience (witnessing serious injury or death), alcohol misuse, history of lifetime noncombat violence or arrest for crime, and probable post-traumatic stress disorder plus past-week irritability or angry outbursts. Severe violence was defined as using a knife or gun against someone, threatening to use a lethal weapon, beating up someone, or physically forcing a person to have sex.

In a national survey of 1090 veterans who completed self-reports and had 1-year follow-up, the predicted probability for severe violence during follow-up was 0.025 for a VIO-SCAN score of zero, compared with 0.539 for a score of 5. In a self-selected sample of 197 veterans with in-depth assessments (interviews, self-reports, and collateral informants' reports), the predicted probability for severe violence during 1-year follow-up was around 0.40 for a score of 5. In both samples, VIO-SCAN scores were linearly related to risk for subsequent violence; the predicted probability for severe violence at follow-up started at roughly 0.2 for scores ≥3.

Comment

Screening instruments cannot predict violence in individuals and are not comprehensive assessments. Still, they might identify high-risk individuals meriting more investigation and intervention. The findings suggest that combinations of factors, rather than single factors, may reach threshold burdens for individuals, which increase risk for severe violence. How VIO-SCAN scores might predict subsequent suicidality merits inquiry as well.

  • Disclosures for Joel Yager, MD at time of publication Grant /Research support AHRQ Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Prevention; Eating Disorders Review (Editor-in-Chief); International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry Leadership positions in professional societies American Psychiatric Association (Chair, Council of Quality Care)

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Reader Comments (2)

Lawrence Forsley Other, Other, US Navy

A cluster analysis of these scores in 5 dimensional space might reveal different loci of risk factors. Specifically, it's not just the score that's the tip-off, but certain categories' presence may correlate with different types of violence. Similarly, crossing the nature and frequency of the violence (against self, spouse/significant other, same sex, etc) against the loci of the score, with even such a small scoring system might indicate additional correlation between type of violence and specific risk factors.

Maze Susan MSW Other Healthcare Professional, Psychiatry, VA

work with offenders and victims, looking at different screens especially among militray

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