Elbogen Eric B, Cueva Michelle, Wagner H Ryan, Sreenivasan Shoba, Brancu Mira, Beckham Jean C, Van Male Lynn
Am J Psychiatry. 2014 Jul;171(7):749-57. doi: 10.1176/appi.ajp.2014.13101316.
Violence toward others is a serious problem among a subset of military veterans. The authors evaluated the predictive validity of a brief decision support tool to screen veterans for problems with violence and identify potential candidates for a comprehensive risk assessment.
Data on risk factors at an initial wave and on violent behavior at 1-year follow-up were collected in two independent sampling frames: a national random-sample survey of 1,090 Iraq and Afghanistan veterans and in-depth assessments of 197 dyads of veterans and collateral informants. Risk factors (lacking money for basic needs, combat experience, alcohol misuse, history of violence and arrests, and anger associated with posttraumatic stress disorder) were chosen based on empirical support in published research. Scales measuring these risk factors were examined, and items with the most robust statistical association with outcomes were selected for the screening tool. Regression analyses were used to derive receiver operating characteristic curves of sensitivities and specificities, with area under the curve providing an index of predictive validity.
The resultant 5-item screening tool, called the Violence Screening and Assessment of Needs (VIO-SCAN), yielded area-under-the-curve statistics ranging from 0.74 to 0.78 for the national survey and from 0.74 to 0.80 for the in-depth assessments, depending on level of violence analyzed.
Although the VIO-SCAN does not constitute a comprehensive violence risk assessment and cannot replace fully informed clinical decision making, it is hoped that the screen will provide clinicians with a rapid, systematic method for identifying veterans at higher risk of violence, prioritizing those in need a full clinical workup, structuring review of empirically supported risk factors, and developing plans collaboratively with veterans to reduce risk and increase successful reintegration in the community.
对他人实施暴力是部分退伍军人中存在的一个严重问题。作者评估了一种简短决策支持工具在筛查退伍军人暴力问题及识别全面风险评估潜在对象方面的预测效度。
在两个独立抽样框架中收集了首波调查时的风险因素数据以及1年随访时的暴力行为数据：对1090名伊拉克和阿富汗退伍军人进行的全国随机抽样调查，以及对197对退伍军人及其间接信息提供者的深入评估。基于已发表研究中的实证支持，选取了风险因素（基本生活需求缺钱、战斗经历、酒精滥用、暴力和被捕史，以及与创伤后应激障碍相关的愤怒情绪）。对测量这些风险因素的量表进行了检查，并选择了与结果有最有力统计关联的项目用于筛查工具。采用回归分析得出敏感性和特异性的受试者工作特征曲线，曲线下面积提供了预测效度指标。
由此产生的一个名为“暴力筛查与需求评估”（VIO-SCAN）的5项筛查工具，在全国调查中的曲线下面积统计值在0.74至0.78之间，在深入评估中的统计值在0.74至0.80之间，具体取决于所分析的暴力程度。
尽管VIO-SCAN并不构成全面的暴力风险评估，也无法完全取代充分知情的临床决策，但希望该筛查能为临床医生提供一种快速、系统的方法，以识别暴力风险较高的退伍军人，对那些需要全面临床检查的人进行优先排序，构建对经实证支持的风险因素的审查，并与退伍军人共同制定降低风险和增加成功重新融入社区几率的计划。
