In a study that appears in the current issue of Military Medicine, William 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 Resesarch and Promotion at the Philadelphia VA Medical Center, found that:

* Only 16% of veterans indicated zero tolerance for detainee exposure and deprivation

* Only 31% indicated zero tolerance for detainee exposure and sexualized humiliation

* 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 351veteran 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 and post 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 co-morbid 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.”

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Contact: Kate Olderman

University of Pennsylvania School of Medicine