A new screening tool can identify veterans with a greater risk of violence, according to a new study published online by the American Journal of Psychiatry. This important new tool could help identify veterans at risk of violent behavior, which could get them on a treatment that better suits their needs.

Researchers at the University of North Carolina developed the Violence Screening and Assessment of Needs (VIO-SCAN), a five question screening that asks veterans about common Post-traumatic Stress Disorder (PTSD)-related trends as well as civilian factors that can lead to violence.

They observed these factors to see if PTSD was the only explanation for anger in veterans. The study's lead author, Eric Elbogen, Ph.D., says, “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."

The Study

Using a national random sample of 1,090 Iraq and Afghanistan war veterans and an in-depth assessment of 197 pairs of veterans and collateral informants, researchers measured these risk factors and evaluated their association with violence:

  • Lacking money for basic needs
  • Combat experience
  • Alcohol misuse
  • History of violence and arrests
  • Anger associated with PTSD

The resulting questionnaire asked questions like: “In the past week, how many times have you been irritable or had outbursts of anger?" and “Has a relative or friend, or a doctor or health care worker, been concerned about your drinking [alcohol] or suggested you cut down?" Responses were given a value of either 0 or 1. The responses to these questions were added up and given a value ranging from zero to five, zero indicating a low risk of violence and five indicating a high risk.

Results showed that the VIO-SCAN is an accurate indicator of violent tendencies.

What it Means

Each year, about 5.2 million people are diagnosed with PTSD. This includes about 11 to 20 percent of Iraq and Afghanistan war veterans and 10 percent of Gulf War veterans. It is one of the most commonly diagnosed mental illnesses for military veterans. At the same time, violence towards others is not always connected to PTSD, though it is a symptom. A correct diagnosis is key to properly treating our veterans with mental illnesses. This simple questionnaire will help mental health professionals correctly diagnose PTSD, which will ultimately help veterans and patients with violent outbursts access the services they need.

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American Journal of Psychiatry

Eric B. Elbogen, PhD, Michelle Cueva, PhD, H. Ryan Wagner, PhD, Shoba Sreenivasan, PhD, Mira Brancu, PhD, Jean C. Beckham, PhD, Lynn Van Male, PhD. Screening for Violence Risk in Military Veterans: Predictive Validity of A Brief Clinical Tool. American Journal of Psychiatry 2014; DOI: 10.1176

Date of original publication: