title: Aggressive and violent behavior among military personnel deployed to Iraq and Afghanistan: prevalence and link with deployment and combat exposure.
abstract: A systematic review and meta-analyses were conducted on studies of the prevalence of aggressive and violent behavior, as well as of violent offenses and convictions, among military personnel following deployment to Iraq and/or Afghanistan; the relationship with deployment and combat exposure; and the role that mental health problems, such as post-traumatic stress disorder (PTSD), have on the pathway between deployment and combat to violence. Seventeen studies published between January 1, 2001, and February 12, 2014, in the United States and the United Kingdom met the inclusion criteria. Despite methodological differences across studies, aggressive behavior was found to be prevalent among serving and formerly serving personnel, with pooled estimates of 10% (95% confidence interval (CI): 1, 20) for physical assault and 29% (95% CI: 25, 36) for all types of physical aggression in the last month, and worthy of further exploration. In both countries, rates were increased among combat-exposed, formerly serving personnel. The majority of studies suggested a small-to-moderate association between combat exposure and postdeployment physical aggression and violence, with a pooled estimate of the weighted odds ratio = 3.24 (95% CI: 2.75, 3.82), with several studies finding that violence increased with intensity and frequency of exposure to combat traumas. The review's findings support the mediating role of PTSD between combat and postdeployment violence and the importance of alcohol, especially if comorbid with PTSD.
authors.forename: Deirdre
authors.initials: D
authors.lastname: MacManus
authors.forename: Roberto
authors.initials: R
authors.lastname: Rona
authors.forename: Hannah
authors.initials: H
authors.lastname: Dickson
authors.forename: Greta
authors.initials: G
authors.lastname: Somaini
authors.forename: Nicola
authors.initials: N
authors.lastname: Fear
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
mesh_terms: D055826:Afghan Campaign 2001-; D000374:Aggression / Q000523:psychology*; D003130:Combat Disorders / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D054542:Iraq War, 2003-2011; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D006113:United Kingdom; D014481:United States; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data*
keywords: aggression; alcohol; combat; deployment; military; post-traumatic stress disorder; violence