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Violent behaviour in UK military personnel returning home after deployment

Published online by Cambridge University Press:  25 November 2011

D. MacManus ,
K. Dean ,
M. Al Bakir ,
A. C. Iversen ,
L. Hull ,
T. Fahy ,
S. Wessely  and
N. T. Fear
D. MacManus*
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK King's Centre for Military Health Research, King's College London, London, UK
K. Dean
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
M. Al Bakir
Affiliation:
King's Centre for Military Health Research, King's College London, London, UK
A. C. Iversen
Affiliation:
King's Centre for Military Health Research, King's College London, London, UK
L. Hull
Affiliation:
King's Centre for Military Health Research, King's College London, London, UK
T. Fahy
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
S. Wessely
Affiliation:
Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK King's Centre for Military Health Research, King's College London, London, UK
N. T. Fear
Affiliation:
King's Centre for Military Health Research, King's College London, London, UK
*
*Address for correspondence: D. MacManus, BSc, MBChB, MSc, MRCPsych, Honorary Specialist Registrar in Forensic Psychiatry, MRC Research Training Fellow, Institute of Psychiatry PO23, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. (Email: deirdre.macmanus@kcl.ac.uk)
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Abstract

Background

There is growing concern about an alleged rise in violent behaviour amongst military personnel returning from deployment to Iraq and Afghanistan. The aims of this study were to determine the prevalence of violence in a sample of UK military personnel following homecoming from deployment in Iraq and to examine the impact of deployment-related experiences, such as combat trauma, on violence, and the role of sociodemographics and pre-enlistment antisocial behaviour.

Method

This study used baseline data from a cohort study of a large randomly selected sample of UK Armed Forces personnel in service at the time of the Iraq war (2003). Regular personnel (n=4928) who had been deployed to Iraq were included. Data, collected by questionnaire, included information on deployment experiences, sociodemographic and military characteristics, pre-enlistment antisocial behaviour, post-deployment health outcomes and a self-report measure of physical violence in the weeks following return from deployment.

Results

Prevalence of violence was 12.6%. This was strongly associated with pre-enlistment antisocial behaviour [adjusted odds ratio (aOR) 3.6, 95% confidence interval (CI) 2.9–4.4]. After controlling for pre-enlistment antisocial behaviour, sociodemographics and military factors, violence was still strongly associated with holding a combat role (aOR 2.0, 95% CI 1.6–2.5) and having experienced multiple traumatic events on deployment (aOR for four or more traumatic events 3.7, 95% CI 2.5–5.5). Violence on homecoming was also associated with mental health problems such as post-traumatic stress disorder (aOR 4.8, 95% CI 3.2–7.2) and alcohol misuse (aOR 3.1, 95% CI 2.5–3.9).

Conclusions

Experiences of combat and trauma during deployment were significantly associated with violent behaviour following homecoming in UK military personnel. Post-deployment mental health problems and alcohol misuse are also associated with increased violence.

Keywords

Combatdeploymentmilitarytraumaviolence
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 8 , August 2012 , pp. 1663 - 1673
Copyright
Copyright © Cambridge University Press 2011

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References

Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG (eds) (2001). AUDIT: The Alcohol Use Disorders Identification Test. World Health Organization: Geneva.Google Scholar
Beckham, JC, Feldman, ME, Kirby, AC, Hertzberg, MA, Moore, SD (1997). Interpersonal violence and its correlates in Vietnam veterans with chronic posttraumatic stress disorder. Journal of Clinical Psychology 53, 859–869.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Black, DW, Carney, CP, Peloso, PM, Woolson, RF, Letuchy, E, Doebbeling, BN (2005). Incarceration and veterans of the first Gulf war. Military Medicine 170, 612–618.CrossRefGoogle ScholarPubMed
Blanchard, E, Jones-Alexander, J, Buckley, T, Forneris, C (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy 34, 669–673.CrossRefGoogle ScholarPubMed
Booth-Kewley, S, Highfill-McRoy, RM, Larson, GE, Garland, CF (2010 a). Psychosocial predictors of military misconduct. Journal of Nervous and Mental Disease 198, 91–98.CrossRefGoogle ScholarPubMed
Booth-Kewley, S, Larson, GE, Highfill-McRoy, RM, Garland, CF, Gaskin, TA (2010 b). Factors associated with antisocial behavior in combat veterans. Aggressive Behavior 36, 330–337.CrossRefGoogle ScholarPubMed
Browne, T, Hull, L, Horn, O, Jones, M, Murphy, D, Fear, N, Greenberg, N, French, C, Rona, R, Wessely, S (2007). Explanations for the increase in mental health problems in UK reserve forces who have served in Iraq. British Journal of Psychiatry 190, 484–489.CrossRefGoogle ScholarPubMed
Byrne, CA, Riggs, DS (1996). The cycle of trauma: relationship aggression in male Vietnam veterans with symptoms of posttraumatic stress disorder. Violence and Victims 11, 213–225.CrossRefGoogle ScholarPubMed
Caesar, E (2010). From hero to zero. The Sunday Times, 4 April 2010 (http://www.timesonline.co.uk/tol/news/uk/article7084032.ece).Google Scholar
Clayton, D, Hills, M (1993). Statistical Models in Epidemiology. Oxford University Press: New York.Google Scholar
DASA (2003). TSP 8 – Age distribution of UK regular forces. In Historical National Statistics Publications [Annual Publication]. Ministry of Defence: London.Google Scholar
Elbogen, EB, Wagner, HR, Fuller, SR, Calhoun, PS, Kinneer, PM; Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, Beckham, JC (2010). Correlates of anger and hostility in Iraq and Afghanistan war veterans. American Journal of Psychiatry 167, 1051–1058.CrossRefGoogle ScholarPubMed
Fear, N, Iversen, A, Meltzer, H, Workman, L, Hull, L, Greenberg, N, Barker, C, Browne, T, Earnshaw, M, Horn, O (2007). Patterns of drinking in the UK armed forces. Addiction 102, 1749–1759.CrossRefGoogle ScholarPubMed
Fear, NT, Jones, M, Murphy, D, Hull, L, Iversen, AC, Coker, B, Machell, L, Sundin, J, Woodhead, C, Jones, N, Greenberg, N, Landau, S, Dandeker, C, Rona, RJ, Hotopf, M, Wessely, S (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study. Lancet 375, 1783–1797.CrossRefGoogle ScholarPubMed
Fontana, A, Rosenheck, R (2005). The role of war-zone trauma and PTSD in the etiology of antisocial behavior. Journal of Nervous and Mental Disease 193, 203–209.CrossRefGoogle ScholarPubMed
Gimbel, C, Booth, A (1994). Why does military combat experience adversely affect marital relations? Journal of Marriage and Family 56, 691–703.CrossRefGoogle Scholar
Goldberg, D (1972). The Detection of Psychiatric Illness by Questionnaire: A Technique for the Identification and Assessment of Non-Psychotic Psychiatric Illness. Oxford University Press: Oxford.Google Scholar
Goldberg, DP, Gater, R, Sartorius, N, Ustun, TB, Piccinnelli, M, Gureje, O, Rutter, C (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine 27, 191–197.CrossRefGoogle ScholarPubMed
Hotopf, M, Hull, L, Fear, NT, Browne, T, Horn, O, Iversen, A, Jones, M, Murphy, D, Bland, D, Earnshaw, M, Greenberg, N, Hacker Hughes, J, Tate, AR, Dandeker, C, Rona, R, Wessely, S (2006). The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 367, 1731–1741.CrossRefGoogle Scholar
Iversen, A, Fear, N, Simonoff, E, Hull, L, Horn, O, Greenberg, N, Hotopf, M, Rona, R, Wessely, S (2007). Influence of childhood adversity on health among male UK military personnel. British Journal of Psychiatry 191, 506–511.CrossRefGoogle ScholarPubMed
Iversen, A, van Staden, L, Hughes, J, Browne, T, Hull, L, Hall, J, Greenberg, N, Rona, R, Hotopf, M, Wessely, S, Fear, N (2009). The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study. BMC Psychiatry 9, 68.CrossRefGoogle ScholarPubMed
James, E (2010). Why are so many former soldiers in prison? The Guardian, 9 February 2010 (http://www.guardian.co.uk/society/2010/feb/09/erwin-james-soldiers-prison).Google Scholar
Johnstone, J (1978). Social class, social areas and delinquency. Sociology and Social Research 63, 49–72.Google Scholar
Killgore, WDS, Cotting, DI, Thomas, JL, Cox, AL, McGurk, D, Vo, AH, Castro, CA, Hoge, CW (2008). Post-combat invincibility: violent combat experiences are associated with increased risk-taking propensity following deployment. Journal of Psychiatric Research 42, 1112–1121.CrossRefGoogle ScholarPubMed
King, A (2009). We all have a duty to our troops. The Guardian, 25 September 2009 (http://www.guardian.co.uk/commentisfree/2009/sep/25/soldiers-army-troops).Google Scholar
Kulka, RA, Schlenger, WE, Fairbank, JA, Hough, RL, Jordan, BK, Marmar, CR, Weiss, DS (editors) (1990). The National Vietnam Veterans Readjustment Study: Tables of Findings and Technical Appendices. Brunner/Mazel: New York.Google Scholar
Lasko, NB, Gurvits, TV, Kuhne, AA, Orr, SP, Pitman, RK (1994). Aggression and its correlates in Vietnam veterans with and without chronic posttraumatic stress disorder. Comprehensive Psychiatry 35, 373–381.CrossRefGoogle ScholarPubMed
Lidz, CW, Mulvey, EP, Gardner, W (1993). The accuracy of predictions of violence to others. Journal of the American Medical Association 269, 1007–1011.CrossRefGoogle ScholarPubMed
MacManus, D, Dean, K, Iversen, AC, Hull, L, Jones, N, Fahy, T, Wessely, S, Fear, NT (2011). Impact of pre-enlistment antisocial behaviour on behavioural outcomes among UK military personnel. Social Psychiatry and Psychiatric Epidemiology. Published online: 29 October 2011. doi:10.1007/s00127-011-0443-z.Google Scholar
McFall, M, Fontana, A, Raskind, M, Rosenheck, R (1999). Analysis of violent behavior in Vietnam combat veteran psychiatric inpatients with posttraumatic stress disorder. Journal of Traumatic Stress 12, 501–517.CrossRefGoogle ScholarPubMed
Milliken, CS, Auchterlonie, JL, Hoge, CW (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. Journal of the American Medical Association 298, 2141–2148.CrossRefGoogle ScholarPubMed
Orcutt, HK, King, LA, King, DW (2003). Male-perpetrated violence among Vietnam veteran couples: relationships with veteran's early life characteristics, trauma history, and PTSD symptomatology. Journal of Traumatic Stress 16, 381–390.CrossRefGoogle ScholarPubMed
Orth, U, Wieland, E (2006). Anger, hostility, and posttraumatic stress disorder in trauma-exposed adults: a meta-analysis. Journal of Consulting and Clinical Psychology 74, 698–706.CrossRefGoogle ScholarPubMed
Resnick, HS, Foy, DW, Donahoe, CP, Miller, EN (1989). Antisocial behavior and post-traumatic stress disorder in Vietnam veterans. Journal of Clinical Psychology 45, 860–866.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
Smith, TC, Ryan, MAK, Wingard, DL, Slymen, DJ, Sallis, JF, Kritz-Silverstein, D (2008). New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study. British Medical Journal 336, 366–371.CrossRefGoogle ScholarPubMed
Swartz, MS, Swanson, JW, Hiday, VA, Borum, R, Wagner, HR, Burns, BJ (1998). Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. American Journal of Psychiatry 155, 226–231.CrossRefGoogle ScholarPubMed
Taft, CT, Kaloupek, DG, Schumm, JA, Marshall, AD, Panuzio, J, King, DW, Keane, TM (2007 a). Posttraumatic stress disorder symptoms, physiological reactivity, alcohol problems, and aggression among military veterans. Journal of Abnormal Psychology 116, 498–507.CrossRefGoogle ScholarPubMed
Taft, CT, Vogt, DS, Marshall, AD, Panuzio, J, Niles, BL (2007 b). Aggression among combat veterans: relationships with combat exposure and symptoms of posttraumatic stress disorder, dysphoria, and anxiety. Journal of Traumatic Stress 20, 135–145.CrossRefGoogle ScholarPubMed
Thomas, JL, Wilk, JE, Riviere, LA, McGurk, D, Castro, CA, Hoge, CW (2010). Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry 67, 614–623.CrossRefGoogle ScholarPubMed
Vaughan, D (2006). Demobilised and addicted to danger. Today's Officer Fall, 20–24.Google Scholar
Woodhead, C, Rona, RJ, Iversen, A, MacManus, D, Hotopf, M, Dean, K, McManus, S, Meltzer, H, Brugha, T, Jenkins, R, Wessely, S, Fear, NT (2011). Mental health and health service use among post-National Service veterans: results from the 2007 Adult Psychiatric Morbidity Survey of England. Psychological Medicine 41, 363–372.CrossRefGoogle ScholarPubMed
Yager, T, Laufer, R, Gallops, M (1984). Some problems associated with war experience in men of the Vietnam generation. Archives of General Psychiatry 41, 327–333.CrossRefGoogle ScholarPubMed
Yesavage, JA (1983). Differential effects of Vietnam combat experiences vs. criminality on dangerous behavior by Vietnam veterans with schizophrenia. Journal of Nervous and Mental Disease 171, 382–384.CrossRefGoogle ScholarPubMed