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article imageOp-Ed: Veteran violence — Lancet study in UK raises some questions

By Paul Wallis     Mar 15, 2013 in Health
Sydney - The mix of PTSD, violence and combat service has attained urban legend status, but as usual with urban legends, facts have been sparse. A new study published in The Lancet at last provides some working numbers and opens the gate for more study.
The Lancet article starts with a definition:
Although the psychological effects of conflict are well documented, the potential legacy of violent offending has yet to be ascertained. We describe our use of criminal records to investigate the effect of deployment, combat, and post-deployment mental health problems on violent offending among military personnel relative to pre-existing risk factors.
The study parameters for analysing risk factors:
In this cohort study, we linked data from 13 856 randomly selected, serving and ex-serving UK military personnel with national criminal records stored on the Ministry of Justice Police National Computer database.
(You’ll note that the data relates to violence which was sufficient to create criminal records. Also please be aware that alcohol abuse and violence are major issues in the UK.)
The numbers, somewhat abbreviated:
2139 (weighted 17•0%) of 12 359 male UK military personnel Violent offenders (1369 [11•0%]) were the most prevalent offender types; prevalence was highest in men aged 30 years or younger (521 [20•6%] of 2728) and fell with age (164 [4•7%] of 3027 at age >45 years).
Alcohol-related violence: 9%.
Violence among those exposed to 2-4 traumatic events: 4.1%
Violence among those exposed to 5- 16 such events: 5.1%
PTSD: 8.6% for those with PTSD, 3.0% for those not diagnosed with PTSD.
The overall picture is of a working percentile base related to violence, but this information has a wide range of possible environmental factors.
In direct relation to deployment, the general picture is that the troops have a pretty respectable level of self-management after exposure to traumatic events. PTSD apparently increases the upper range significantly without specifying related traumatic events. PTSD achieves a major percentile as a factor in violence almost as bad as alcohol.
(Note: “diagnosed” PTSD is the important qualifier. Some personnel in the study may have un-diagnosed PTSD in some form. This isn’t a result of laxity in diagnosis but of people slipping through the net. Late onset of PTSD appears to be something like delayed shock.)
The significance of this study is that it does show some very clear spikes and risk factors. This sample has been rigorously evaluated in a range of high-value categories.
The risk to veterans
From the look of the Lancet’s information, veterans are at risk in multiple ways after deployment:
Most obviously in need of further study is the fact that a combination of circumstances, environments and stress are likely triggers.
Alcohol was famous among past generations of veterans as a troublemaker, and these figures indicate it still is. Alcoholism historically tends to emerge late after deployment, usually a few years. It’s both a stress factor and a silent killer.
PTSD is a complex condition. Recovery under the current regime of “familiar activities to re-hardwire the brain” takes time. Soft tissue damage to the brain is no minor event, and this very tricky recovery process is obviously at risk from the factors described above. Stress can be highly destructive even in people not subjected to combat situations.
Environmentally, the modern society isn’t a great place for those suffering from the effects of combat deployment. In the US, stories are emerging of ex-veterans employed as police or in other very stressful occupations in extremely difficult environments, with tales of related violence.
(A very strange point here is that such environments are likely to trigger combat reactions. “Violence” can be a trained response in veterans. Many soldiers function on auto pilot in situations which resemble those for which they were trained. Others will use their training as the default survival mechanism. It’s highly questionable whether direct exposure to more, very likely severe, stress is a good idea.)
In the UK, a violent environment is hardly the best place for those with violence management issues. It’s more like Russian roulette with a few extra loaded chambers. The overall figures seem to indicate that even among those with criminal records, violence isn’t quite in proportion to the statistical base.
Getting it right? Could be
An anomaly, maybe- 17% of the study had criminal records. 11% had a component of violence on their record. The figures for incidence of violence in the study are actually somewhat below the 11% mark. While the typical margin for error in studies is about 1-5%, the numbers are consistently below, and in some cases well below, the baseline of 11%.
Somebody must be doing something right, because in some cases the figures are far below that benchmark. The study does explain a diminishing rate of violence related to age and other factors, but when the number goes down to 1% in some categories, there are indications of success.
(I must point out that my view is based purely on disparity of numbers and extrapolation, but the very low percentiles look like a range of possible areas for further study. If someone is getting on top of the horrible situations to which veterans are exposed, it’d be nice to know how these much lower percentages happen.)
More study, please.
What’s very clear is that these veterans are going from “complex war” to a complex, often hostile range of environments and circumstances. They’re carrying a dead weight of issues, apparently including possible prior and subsequent psychological issues and facing the dubious pleasures of trying to make a living in the modern environment.
The authors of The Lancet study are to be commended for creating a much higher and well-organised level of visibility for the factors affecting violence and veterans.
Anyone with ex-military in the family since World War Two can tell you the problems- Hard data is lacking, policies and practices are nebulous, comprehension is pitiful, and verifiable information is needed. This type of information is very useful to veteran support groups and those working on their behalf, and there needs to be a lot more study to get a grip on these very difficult issues.
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of
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