Intimate partner violence perpetration among veterans: associations with neuropsychiatric symptoms and limbic microstructure.

Background: Intimate partner violence (IPV) perpetration is highly prevalent among veterans. Suggested risk factors of IPV perpetration include combat exposure, post-traumatic stress disorder (PTSD), depression, alcohol use, and mild traumatic brain injury (mTBI). While the underlying brain pathophysiological characteristics associated with IPV perpetration remain largely unknown, previous studies have linked aggression and violence to alterations of the limbic system. Here, we investigate whether IPV perpetration is associated with limbic microstructural abnormalities in military veterans. Further, we test the effect of potential risk factors (i.e., PTSD, depression, substance use disorder, mTBI, and war zone-related stress) on the prevalence of IPV perpetration. Methods: Structural and diffusion-weighted magnetic resonance imaging (dMRI) data were acquired from 49 male veterans of the Iraq and Afghanistan wars (Operation Enduring Freedom/Operation Iraqi Freedom; OEF/OIF) of the Translational Research Center for TBI and Stress Disorders (TRACTS) study. IPV perpetration was assessed using the psychological aggression and physical assault sub-scales of the Revised Conflict Tactics Scales (CTS2). Odds ratios were calculated to assess the likelihood of IPV perpetration in veterans with either of the following diagnoses: PTSD, depression, substance use disorder, or mTBI. Fractional anisotropy tissue (FA) measures were calculated for limbic gray matter structures (amygdala-hippocampus complex, cingulate, parahippocampal gyrus, entorhinal cortex). Partial correlations were calculated between IPV perpetration, neuropsychiatric symptoms, and FA. Results: Veterans with a diagnosis of PTSD, depression, substance use disorder, or mTBI had higher odds of perpetrating IPV. Greater war zone-related stress, and symptom severity of PTSD, depression, and mTBI were significantly associated with IPV perpetration. CTS2 (psychological aggression), a measure of IPV perpetration, was associated with higher FA in the right amygdala-hippocampus complex (r = 0.400, p = 0.005). Conclusion: Veterans with psychiatric disorders and/or mTBI exhibit higher odds of engaging in IPV perpetration. Further, the more severe the symptoms of PTSD, depression, or TBI, and the greater the war zone-related stress, the greater the frequency of IPV perpetration. Moreover, we report a significant association between psychological aggression against an intimate partner and microstructural alterations in the right amygdala-hippocampus complex. These findings suggest the possibility of a structural brain correlate underlying IPV perpetration that requires further research.

CHILDHOOD EXPERIENCES AND FACTORS ASSOCIATED WITH PERPETRATION OF VIOLENCE AMONG YOUNG ADULTS IN DELTA STATE PRISONS.

Background: Violent acts perpetrated by young people can cause physical and psychological harm to others and is of serious public health concern. This study was conducted to determine the prevalence of childhood trauma, and to assess the relationship between adverse childhood experiences and other predicting factors, and the perpetration of violence among young adults in Delta state prisons. Methods: A descriptive cross-sectional study design was conducted amongst 293 youths who were convicted prison inmates in Delta State Correctional facilities. Three out of the five facilities in Delta State were selected using simple random sampling, after which a total sampling of incarcerated inmates from the three selected facilities was carried out. Data were collected using the; Childhood Trauma Questionnaire (CTQ) to measure adverse childhood experiences, and a proforma to classify the offence of the inmate (whether violent or non-violent). Results: The mean age of the respondents was 28.4 ± 5.4 years. The overall prevalence of childhood trauma was 5.1%. The most common abuse/neglect experienced while growing up was physical neglect with 26.3% followed by emotional neglect (20.5%), physical abuse (7.2%), emotional abuse (2.4%) and sexual abuse (1%).The prevalence of violent offences was 46.1%. Age, (OR=0.3; CI= 0.2-0.6, p=0.001), attaining primary education (OR=3.4; CI= 1.5-7.8, p=0.004) and having witnessed violence while growing up (OR=2.0; CI= 1.2-3.3, p=0.007) were all significant predictors of the perpetration of violence. Conclusion: The overall prevalence of childhood trauma was low; however, the perpetuation of violence was found to be high in this study. Further research is required to develop study instruments for childhood trauma that are more context specific bearing in mind local sociocultural practices.

A cluster randomised controlled trial to determine the effect of community mobilisation and advocacy on men's use of violence in periurban South Africa: study protocol.

OBJECTIVE: This paper describes the design and methods of a cluster randomised controlled trial (C-RCT) to determine the effectiveness of a community mobilisation intervention that is designed to reduce the perpetration of violence against women (VAW). METHODS AND ANALYSIS: A C-RCT of nine intervention and nine control clusters is being carried out in a periurban, semiformal settlement near Johannesburg, South Africa, between 2016 and 2018. A community mobilisation and advocacy intervention, called Sonke CHANGE is being implemented over 18 months. It comprises local advocacy and group activities to engage community members to challenge harmful gender norms and reduce VAW. The intervention is hypothesised to improve equitable masculinities, reduce alcohol use and ultimately, to reduce VAW. Intervention effectiveness will be determined through an audio computer-assisted self-interview questionnaire with behavioural measures among 2600 men aged between 18 and 40 years at baseline, 12 months and 24 months. The primary trial outcome is men's use of physical and/or sexual VAW. Secondary outcomes include harmful alcohol use, gender attitudes, controlling behaviours, transactional sex and social cohesion. The main analysis will be intention-to-treat based on the randomisation of clusters. A qualitative process evaluation is being conducted alongside the C-RCT. Implementers and men participating in the intervention will be interviewed longitudinally over the period of intervention implementation and observations of the workshops and other intervention activities are being carried out. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee and procedures comply with ethical recommendations of the United Nations Multi-Country Study on Men and Violence. Dissemination of research findings will take place with local stakeholders and through peer-reviewed publications, with data available on request or after 5 years of trial completion. TRIAL REGISTRATION NUMBER: NCT02823288; Pre-result.

"What kept me going": A qualitative study of avoidant responses to war-related adversity and perpetration of violence by former forcibly recruited children and youth in the Acholi region of northern Uganda.

This qualitative study investigates what, according to 36 former forcibly recruited women and men, enabled them to "keep on going" during and after their forced recruitment in the twenty-year-long civil war in northern Uganda. Furthermore, the study conveys the ways most of the former forcibly recruited kept on going and today cope with ongoing war-related adversity and difficult reintegration processes without relying on psycho-social intervention. Thirty-five of the 36 women and men were forcibly recruited when they were children by the Lord's Resistance Army (LRA) from the Acholi region of northern Uganda. Over the course of five visits to the Acholi region from 2012 to 2016, 10 months of ethnographic fieldwork was carried out involving interviews and participant observation. The 36 Acholi women and men shared how they experienced and responded to suffering from brutal torture and being forced to perpetrate often lethal violence against fellow Acholi who had tried to escape the LRA. The article provides an overview of the responses to this war-related adversity and the results document how avoidant coping is the preferred and most common coping response among the 36 former forcibly recruited women and men in this study. We take an interdisciplinary approach to discussing how these avoidant coping responses resonate with psycho-traumatology research on responses to war-related trauma and with conceptualizations of resilience. We end with the argument that avoidant responses to war-related adversity, when faced in clinical and diagnostic settings, should not be understood exclusively from a biomedical perspective: Responses to war-related adversity must be carefully investigated in collaboration with the human beings who have experienced the war-related adversity and based on integrative and emic approaches that consider the locally situated notions of how to cope with adversity and "keep on going" in their own right.