Five-question tool helps screen risk of violence in veterans

A new brief five-question screening tool can help clinicians identify which veterans may be at greater risk of violence, according to a new study led by a UNC researcher.

The study, published online by the American Journal of Psychiatry, is based on a national survey sample of veterans combined with a smaller, in-depth assessment sample. The screening tool, called the Violence Screening and Assessment of Needs (VIO-SCAN), asked veterans about financial stability, combat experience, alcohol misuse, history of violence or arrests and probable post-traumatic stress disorder (PTSD) plus anger.

“When we hear about a veteran being violent, there is a knee-jerk reaction that it stems from PTSD. The VIO-SCAN shows that PTSD is relevant to screening risk but is only the tip of the iceberg. Non-PTSD factors need to be looked at, such as alcohol abuse or past criminal behavior, just like in civilians,” said study lead author Eric Elbogen, research director of the Forensic Psychiatry Program in the University of North Carolina School of Medicine and Psychologist in the U.S. Department of Veterans Affairs.

On the VIO-SCAN, veterans give yes or no answers to questions such as, “Did you personally witness someone being seriously wounded or killed?” and “Have you ever been violent towards others or arrested for a crime?” The answer to each question is scored as either 0 or 1. The score for each answer is combined to yield an overall score ranging from 0 to 5, with 0 indicating generally lower risk and 5 indicating generally higher risk.

“We believe this screening tool will provide clinicians with a rapid, systematic method for identifying veterans at higher risk of violence,” Elbogen said. “It can help prioritize those in need a full clinical workup, structure review of empirically supported risk factors and develop plans collaboratively with veterans to reduce risk and increase successful reintegration in the community.”

However, Elbogen cautions, the VIO-SCAN is not intended to be a comprehensive assessment of whether a veteran will or will not be violent. Instead, it is a screen identifying whether a veteran may be at high risk and thereby require a full clinical workup to make a final risk judgment.

Co-authors of the article are Michelle Cueva, PhD at UNC; H. Ryan Wagner, PhD, Mira Brancu, PhD and Jean C. Beckham at the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center and Duke University; Shoba Sreenivasan, PhD at the Greater Los Angeles Veterans Affairs Forensic Outreach Services, and Lynn Van Male, PhD at the Veterans Health Administration Office of Public Health.

The study was funded in part by the National Institute of Mental Health; the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Office of Mental Health Services; and the Office of Research and Development Clinical Science and Health Services, Department of Veterans Affairs.

Click here for the American Journal of Psychiatry article.

Read more at UNC Healthcare.

By Tom Hughes, UNC Healthcare

Published June 5, 2014