Clinical Topics   /   Mental Health

Validity of Brief Screening Tool to Identify Violent Veterans

By US Medicine

CHAPEL HILL, NC – With growing concerns about shooting sprees by troubled veterans, the Violence Screening and Assessment of Needs instrument (VIO-SCAN) was developed to try to identify veterans who should have comprehensive risk assessments for violent tendencies.

A group led by researchers from the University of North Carolina at Chapel Hill and including representatives from VAMCs in Durham, NC, and Los Angeles sought to evaluate the predictive ability of the brief screening tool. Their report was published in the American Journal of Psychiatry.1

To do so, data on risk factors and on violent behavior at one-year follow-up were collected, including from a national random-sample survey of 1,090 Iraq and Afghanistan veterans.

Risk factors included in the screening tool — lacking money for basic needs, combat experience, alcohol misuse, history of violence and arrests, and anger associated with posttraumatic stress disorder — were identified and measured.

In the national survey, the predicted probability for severe violence during follow-up was 0.025 for a VIO-SCAN score of zero, compared with 0.539 for a score of 5. In a self-selected sample of 197 veterans with in-depth assessments — interviews, self-reports, and collateral informants’ reports — the predicted probability for severe violence during one-year follow-up was around 0.4 for a score of 5.

Results indicated that, in both samples, VIO-SCAN scores were linearly related to risk for subsequent violence, with the predicted probability for severe violence at follow-up started at roughly 0.2 for scores ≥3.

Overall, the screening tool 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, according to the report.

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 of 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,” the authors wrote.

1Elbogen EB, Cueva M, Wagner HR, Sreenivasan S, Brancu M, Beckham JC, Van Male L. Screening for Violence Risk in Military Veterans: Predictive Validity of aBrief Clinical Tool. Am J Psychiatry. 2014 May 16. doi:10.1176/appi.ajp.2014.13101316. [Epub ahead of print] PubMed PMID: 24832765.

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