New research indicates that post-traumatic stress disorder is a common factor in violent acts committed by troops and veterans, but the same study shows that other factors also are usually in play.

That gives mental health and primary care physicians the opportunity to identify those who may be at risk and keep them — and others — safe, a Veterans Affairs Department researcher said June 25.

According to research conducted at the University of North Carolina-Chapel Hill School of Medicine on a random sample of 1,000 post-9/11 veterans, one-third reported being involved in an incident of physical aggression the previous year and 11 percent engaged in acts of severe or lethal violence.

Researcher Eric Elbogen, an associate professor at the school, found that PTSD is "the risk factor most consistently associated with violence."

But other circumstances — age, history of abuse as a child, financial stress and substance abuse — also contribute, Elbogen said. And by knowing a patient's history for these factors, doctors can tailor treatments that may reduce the likelihood of patients being involved in violence or running afoul of the law.

"When the news media hears a report of a veteran involved in violence, there's a knee-jerk reaction to blame PTSD," Elbogen told physicians, military personnel, social workers and other participants in a webinar on PTSD and violence sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

PTSD "might be relevant," said Elbogen, "but it's important to go below the surface, figure out what about PTSD is relevant,"

For example, Elbogen noted, alcohol abuse plays a major role in increasing violent tendencies for those with PTSD.

According to the research, veterans with PTSD who don't abuse alcohol engage in violence at about the same rate as civilians, and the same is true for veterans who abuse alcohol but don't have PTSD.

But alcohol and PTSD combined are a risky union that can increase a patient involvement in violence three-fold, Elbogen said.

"It's a combination of PTSD impelling them to be violent and inhibition lifted as the result of alcohol misuse, making them more prone to violence," Elbogen said.

Understanding a patient's history — whether he or she drinks, says they are irritated or angry often or experienced flashbacks — can help physicians gauge whether their patients may be at risk for committing a violent act.

But understanding the risk is of no use unless there are steps that can be taken to mitigate the problem. Elbogen's research indicates there are protective lifestyle factors that can improve a service member's or veteran's sense of well-being and reduce risk.

According to the research, veterans who work, whose basic needs for food, housing, transportation and health care are met, who believe they are in control and have a sense of purpose and have spiritual faith or family support are at significant reduced risk for engaging in violent behavior.

The more protective factors the veteran has, the lower the risk for aggression, Elbogen said.

Providers can use screening tools such as the Violence Screening and Assessment of Needs for Veterans, and get to know their patients to develop effective treatments, he added.

And treatment doesn't always involve medication. According to Elgoben, resiliency appears to play a role in preventing violent behavior in troops and veterans, as do lifestyle factors.

"In addition to treating mental health and substance abuse problems, promising rehabilitation approaches to reduce violence risk should target ... basic functioning — living, financial, vocational — and well-being," Elbogen said.

He added that his views are based on his research and are not representative of the VA.

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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