(PHILADELPHIA) – In a study that appears
in the current issue of Military
C. Holmes, MD, MSCE, Assistant Professor of Medicine
and Epidemiology, University
of Pennsylvania School of Medicine, and lead author
of the paper, assesses veterans’ tolerance for detainee abuse
and variables associated with it.
In the study, three scenarios of detainee abuse, taken directly
from Abu Ghraib prison in Iraq, were presented to veterans. After
each scenario, zero tolerance – or the belief that abuse is
“completely unacceptable” regardless of who the detainee
is – was assessed for the described abuse. Holmes, who is
also an investigator at the Center
for Health Equity Research and Promotion at the Philadelphia
VA Medical Center, found that:
- Only 16% of veterans indicated zero tolerance for detainee exposure
- Only 31% indicated zero tolerance for detainee exposure and
- Not even half (48%) indicated zero tolerance for detainee rape
“The level of tolerance exhibited by these findings is surprising,
but may not be true for all veterans and certainly cannot be said
to be representative of active-duty military,” says Holmes.
He adds, “These findings do indicate, however, the value of
assessing tolerance for abuse, and for using scenario-based assessment
to do that; it provides an argument for similar work being done
in active-duty military, particularly those who are heading to Iraq
to become involved in sensitive, oversight positions.”
The study was completed by administering paper questionnaires to
351 veteran volunteers at the Philadelphia VA Medical Center’s
Mental Health Clinic, Primary Care Clinic, and Women’s Health
Center. Participants were asked a number of sociodemographic questions
(e.g., age, sex) and other questions (e.g., period of service, service
in a war zone). Symptoms of depression
traumatic stress disorder (PTSD) were also assessed.
Although every questionnaire administered the three increasingly-severe
abuse scenarios, there were three questionnaire versions used: all
scenarios of one version ended by stating that the abusing soldier
was not ordered by a superior to treat the detainee in this way;
all scenarios of the second version ended by stating that the abusing
soldier was ordered by a superior to treat the detainee in this
way; and all scenarios of the third version ended by stating that
a second soldier stated, “This treatment is wrong,”
and reported it.
In general, veterans’ tolerance for abuse was least when
soldier-initiated, and greatest when superior-ordered. Tolerance
for abuse also was high when a whistleblower was involved.
The strongest, most consistently significant variable related to
tolerance was depression and comorbid
depression/posttraumatic stress disorder (PTSD). Those with depression
alone and those with comorbid depression/PTSD exhibited odds that
were approximately two and three times more tolerant of abuse than
those with neither depression or PTSD. Sex of the respondent also
was related to tolerance. Men exhibited odds that were ~4 to 20
times more tolerant of abuse than women.
Holmes notes that future studies using scenario-based questionnaire
methods are warranted in generalizable war zone samples. “If
our results are replicated in active-duty soldiers,” he challenges,
“one could imagine the use of scenario-based questionnaires
of this type to provide risk stratification of a soldiers’
likelihood for abuse upon entry into a sensitive oversight position.
The frequent development of depression and PTSD in soldiers in Afghanistan
and Iraq would suggest that completion of the questionnaire occur
intermittently during their tour of duty as well.”
Holmes is supported by a VA
Health Services Research and Development Research
Career Development Award; this work was supported by funds from
Integrated Service Network 4.
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