Domestic Violence and Post-Traumatic Stress Disorder Severity for Participants of a Domestic Violence Rehabilitation Program

Military Medicine, Jun 2004 by Gerlock, April A

Domestic violence has been a long-standing problem for our nation's active duty and military veterans. The purpose of this article is to describe participants of a domestic violence program, the program design to help lessen attrition, and the completers and noncompleters of the program. There was a significant relationship between post-traumatic stress disorder (PTSD) and domestic violence severity for the sample. PTSD severity was also related to reports of domestic violence in the family of origin. Completers and noncompleters were compared on demographic and violence variables and on nine research measures. Completers were more likely younger than 35 years old, employed, had higher self-ratings of relationship mutuality, lower levels of stress and post-traumatic stress, and were regularly court monitored. The results of a logistic regression significantly predicted completers and noncompleters based on age, relationship mutuality, PTSD, and court-monitored status (model [chi]^sup 2^ statistic of 31.08, p = 0.0000).

Introduction

The cluster of domestic violence (DV) homicides and related suicides in the summer of 2002 at Fort Bragg, North Carolina, renewed the national interest and concern over the impact of war zone exposure and "high operations tempo" on marital stability. ' Although marital discord is identified as a factor in each case, barriers to seeking assistance such as fear over jeopardizing career and lack of TriCare reimbursement for private counseling are cited as preventing service members from getting adequate and early intervention.1

The incidence of DV is identified as higher in military than in civilian families.2,3 The unique stresses of military life such as frequent moves, deployments with prolonged separation from family, financial stress, combat training, and exposure to violence have all been identified as placing military personnel at increased risk for domestically violent behaviors.2,4-6 Additionally, family life has historically been molded to the needs of the military, placing the military goals first and family issues as a lesser priority.7

The exposure to combat and development of post-traumatic stress disorder (PTSD) symptoms places an additional risk to military veterans for becoming domestically violent. Veterans with PTSD are identified as more likely to display a pattern of relationship difficulties and DV than veterans without PTSD.8,10 Combat veterans with PTSD have a greater incidence of aggression and violence than those without PTSD.11 Analysis of data from the National Comorbidity Survey (a probability sample of men nationwide) revealed that 21% of current spouse or partner abuse was indirectly attributable to combat exposure and was mediated by the development of PTSD.12

Given the stresses of military life, the possibility of combat exposure, and development of PTSD, in addition to the barriers in seeking assistance, military personnel and veterans are at risk of becoming domestically violent, with the violence potentially ending in the death of a family member. A better understanding of the factors related to DV for active duty military and veterans, as well their response to specialized DV intervention is needed. This article describes a DV rehabilitation program for military personnel and veterans. Factors related to DV for a sample of men in the program and their program completion/ noncompletion is described.

Methods

In 1995, the Department of the Army and Department of Veterans Affairs (VA) entered into the first Sharing Agreement ever to combine resources in the delivery of a state certified rehabilitation program for DV perpetrators. The Madigan Army Medical Center and American Lake VA Medical Center provided personnel to jointly offer DV rehabilitation to active duty military and military veterans. From a convenience sample of men attending the program, 62 DV perpetrators were recruited during a 6-month period from june 1997 to December 1997. The purpose of the study was to describe the program participants and to track rehabilitation program completion or noncompletion. all participation was voluntary.

The Rehabilitation Program

The rehabilitation program was a Washington State DV-certified program and, as such, met all of the requirements mandated by the law (Washington Administrative Code 388-60). To meet program eligibility, veterans had to first meet VA eligibility criteria. There were no out-of-pocket costs to attend the program. Veterans and active duty military identified at least one incident of physical assault (or credible threat of assault) against an intimate partner, and identified themselves as having a problem. The men's cognitive and mental health states were stable and they were able to participate in a cognitive-behaviorally oriented program. State standards mandate a minimum of 1-year accountability to the program, but it often took longer to meet the behavioral criteria for completion.

The program consisted of four phases: assessment, orientation, rehabilitation, and maintenance (for a detailed description of each phase, see Gerlock13). Initial DV assessments were completed by specifically trained Madigan Army Medical Center Family Advocacy Program and American Lake VA Medical Center staff for active duty and veterans, respectively. The weekly orientation class met for 4 weeks, followed by rehabilitation lasting for a minimum of 26 weekly meetings, and finally, the maintenance phase consisting of a minimum of 6 months of monthly meetings. Each phase required successful completion of transition criteria. Criteria to transition into the maintenance phase was the most stringent and required stopping all physical violence, stopping their pattern of psychological abuse, remaining drug and alcohol free, and halting all blaming of the victim. To verify these criteria, interviews were conducted with the victim or a community contact.