Alec Buchanan1, Elina Stefanovics1, Robert A Rosenheck1. 1. The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut. Dr. Buchanan is also with the Department of Psychiatry, U.S. Department of Veterans Affairs Connecticut Health Care System, West Haven. Dr. Stefanovics and Dr. Rosenheck are also with the New England VISN 1 Mental Illness Research, Education and Clinical Center, West Haven.
Abstract
OBJECTIVE: Posttraumatic stress disorder (PTSD) has been linked to violent behavior, especially among military personnel returning from service in a war zone. Little is known, however, about whether the extent of violent behavior among persons with PTSD changes in response to intensive treatment or about the predictors and correlates of any such change. METHODS: The study examined data from over 35,000 U.S. military veterans treated in specialized intensive Veterans Health Administration PTSD programs. Data were collected at program entry and four months after discharge. Variables studied documented sociodemographic and biographical data, program participation, and clinical factors such as PTSD symptom severity and substance use. Violence was assessed by a self-report measure that addressed property damage, threatening behavior, and physical assault. RESULTS: Violence declined significantly between program entry and four-month postdischarge, with a moderate effect size. Most of the variance was explained by baseline levels of violence; those who reported the most violent behavior at baseline showed the largest reductions four months after discharge. The reduction in violence was more strongly correlated with reductions in patients' PTSD symptomatology and substance use than with their incarceration history or with other sociodemographic and biographical variables. CONCLUSIONS: Although an observational study cannot identify specific causes of reductions in violent behavior, these data suggest that the short-term support, shelter, and asylum that formed part of intensive treatment are associated with reduced violent behavior and that such services play an important role in the spectrum of care for war-related PTSD.
OBJECTIVE:Posttraumatic stress disorder (PTSD) has been linked to violent behavior, especially among military personnel returning from service in a war zone. Little is known, however, about whether the extent of violent behavior among persons with PTSD changes in response to intensive treatment or about the predictors and correlates of any such change. METHODS: The study examined data from over 35,000 U.S. military veterans treated in specialized intensive Veterans Health Administration PTSD programs. Data were collected at program entry and four months after discharge. Variables studied documented sociodemographic and biographical data, program participation, and clinical factors such as PTSD symptom severity and substance use. Violence was assessed by a self-report measure that addressed property damage, threatening behavior, and physical assault. RESULTS: Violence declined significantly between program entry and four-month postdischarge, with a moderate effect size. Most of the variance was explained by baseline levels of violence; those who reported the most violent behavior at baseline showed the largest reductions four months after discharge. The reduction in violence was more strongly correlated with reductions in patients' PTSD symptomatology and substance use than with their incarceration history or with other sociodemographic and biographical variables. CONCLUSIONS: Although an observational study cannot identify specific causes of reductions in violent behavior, these data suggest that the short-term support, shelter, and asylum that formed part of intensive treatment are associated with reduced violent behavior and that such services play an important role in the spectrum of care for war-related PTSD.