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Gulf War and Health, Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress
least one or more act of psychologic violence toward their partners in the preceding year, and 21% had engaged in physical violence; men who engaged in psychologic abuse are more likely also to engage in physical abuse. Both physical and psychologic abuse were associated with hyperarousal symptoms and this association was exacerbated when excessive alcohol was consumed on an occasion. However, frequent consumption of small quantities of alcohol, even during high hyperarousal conditions, does not increase, and may even mitigate, husband-to-wife violence.
Beckham et al. (1997) conducted two studies to explore PTSD, intimate partner violence, and their correlates in Vietnam-combat veterans. The first study assessed 37 male outpatients at a VA medical center: 17 help-seeking combat veterans with PTSD and 20 combat veterans without PTSD recruited from all veterans who had attended the VA center within the past year. The second study involved 118 male Vietnam veterans who were also outpatients at the PTSD clinic. The SCID or Clinician-Administered PTSD Scale (CAPS) was used to diagnose PTSD. In the first study all veterans and a family member or friend completed the Standard Family Violence Index of the CTS; in the second study only the veterans completed the Standard Family Violence Index and they also completed the CAGE screening questionnaire for alcohol use. In the first study, veterans with PTSD reported significantly greater occurrences of violent behavior during the preceding year than veterans without PTSD (22 acts vs 0.2 acts of violence). Both PTSD and combat exposure had a significant main effect on interpersonal violence (χ2 = 9.4, p = 0.002, and χ2 = 4.2, p = 0.04, respectively). In the second study, risk factors for increased intimate partner violence, in order of importance, were lower socioeconomic status (χ2 = 6.0, p = 0.01), increased aggressiveness (χ2 = 5.7, p = 0.02), and greater PTSD severity (χ2 = 4.4, p = 0.04). Current problems with alcohol abuse were not associated with intimate partner violence.
An association between PTSD in veterans and heightened violence was demonstrated in a study by McFall et al. (1999). They compared 228 Vietnam-combat veterans seeking inpatient treatment for PTSD at a VA medical center with 64 psychiatric inpatients without PTSD who had served during the Vietnam War but not served in a war zone. An additional comparison was with 273 community-dwelling Vietnam veterans with PTSD (assessed with the Mississippi Scale for Combat-Related PTSD), who had never been hospitalized for the disorder. PTSD was diagnosed with a standard clinical interview by a psychiatrist. The sample of community-dwelling PTSD veterans was derived from the NVVRS data set; veterans were selected to have a level of combat exposure comparable with that of the inpatient PTSD veterans. Data from the NVVRS, CTS, and clinician interviews were used to assess the level of violence engaged in by the veterans. PTSD inpatients were significantly more likely to report having engaged in one or more acts of violence in the preceding month than the psychiatric inpatients (OR 7.40, p < 0.001), particularly having destroyed property, threatened others with or without a weapon, or been involved in a physical fight. Comparison with the community sample of veterans who had PTSD yielded similar findings except that the community veterans were more likely than the PTSD inpatients to have destroyed property. Symptom severity and, to a lesser degree, substance abuse were correlated with violence among the PTSD inpatients. It should be noted that this study did not include intimate partner violence as a violence endpoint.
Deployment Impacts on Families and Children
Young families are at greatest risk for coping with children who are distressed by deployment of one of their parents. The distress may be related to anxieties or worries about