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Symposia

Couples / Close Relationships

Learning from Risk Studies in Military and Veteran Couples: Embracing Complexity Across Levels of Care

2 - (SYM 73) Factors Associated with Risk of Intimate Partner Aggression in a Large National Sample of Veterans

Saturday, November 16, 2024

10:30 AM – 11:30 AM EST

Location: Grand Ballroom K/L, Level 5, Downtown Marriott

Speaker(s)

HU

Hajra Usman, B.A. (she/her/hers)

San Francisco VA Health Care System
San Jose, California, United States

Co-author(s)

DC

Dev Crasta, Ph.D.

Health Science Specialist
VISN 2 Center of Excellence for Suicide Prevention
Canandaigua, New York, United States
GM

Grace McKee, Ph.D.

Statistician
San Francisco VA Medical Center
San Francisco, California, United States
SM

Scott McDonald, Ph.D.

SCI Neuropsychologist
Central Virginia VA Medical Center
Richmond, Virginia, United States

Abstract Body

Background: Intimate Partner Aggression (IPA) has many negative health effects with the most severe behaviors increasing risk for severe injury or death. This has led the Department of Veterans Affairs (VA) to implement a nationwide two-stage screening process identifying presence of any IPA (Stage 1) and monitoring for risk factors for injury (Stage 2). While this screen-and-refer model has served as an effective tool for responding to IPA (i.e., indicated prevention), identifying factors that increase risk for IPA will allow us to intervene for some couples before IPA develops (i.e., selective prevention).

Methods: We extracted VA electronic health record data for the 275,305 veterans completing IPA screens nationwide from April 2019-Feb. 2020. Predictors included demographic variables, military service characteristics, and mental health conditions. Multiple logistic regression was used to test predictors of Stage 1 and Stage 2 positivity, respectively. Predictors were considered significant if they were associated with p < .05 and at least a small effect size. We defined severe IPV in the Stage 1 screen as endorsement of being threatened with harm, physically hurt, or forced/coerced into sexual contact.

Results: The sample was 24% female, 46% age 65 or older, 70% non-Hispanic White, and 56% married. Approximately 7.5% (n = 19,343) endorsed experiencing IPA (Stage 1). Of the 16,143 patients who completed a Stage 2 screen, 2635 (16.3%) endorsed at least one risk factor for injury. Factors associated with lower likelihood of experiencing any IPA were age over 65 and widowed marital status. Factors associated with higher risk included separated marital status, American Indian/Alaskan Native race. Mental health concerns such as PTSD, substance use disorders, and personality disorders all increased risk in unadjusted analyses. Veterans were more likely to report dangerousness factors in Stage 2 if they reported severe IPA behaviors such as threats, physical violence, or sexual violence at Stage 1, were female, or were gender non-conforming.

Discussion: The elevated risk in women, gender non-conforming, and younger veterans reflects screening guidance in civilian populations. Focusing on identified diagnoses such as PTSD, substance misuse, and personality disorders offers a feasible strategy for selective prevention. A notable opportunity for intervention is the occurrence of “separations,” which may indicate chaotic or rapidly changing relationship circumstances that require increased monitoring in contrast to formalized divorce.