scispace - formally typeset
Search or ask a question
Author

Eric Silver

Bio: Eric Silver is an academic researcher from Pennsylvania State University. The author has contributed to research in topics: Poison control & Risk assessment. The author has an hindex of 38, co-authored 58 publications receiving 7624 citations.


Papers
More filters
Journal ArticleDOI
TL;DR: The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.
Abstract: Background The public perception that mental disorder is strongly associated with violence drives both legal policy (eg, civil commitment) and social practice (eg, stigma) toward people with mental disorders. This study describes and characterizes the prevalence of community violence in a sample of people discharged from acute psychiatric facilities at 3 sites. At one site, a comparison group of other residents in the same neighborhoods was also assessed. Methods We enrolled 1136 male and female patients with mental disorders between the ages of 18 and 40 years in a study that monitored violence to others every 10 weeks during their first year after discharge from the hospital. Patient self-reports were augmented by reports from collateral informants and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks. Results There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. Violence in both patient and comparison groups was most frequently targeted at family members and friends, and most often took place at home. Conclusions "Discharged mental patients" do not form a homogeneous group in relation to violence in the community. The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.

1,372 citations

Book
01 Jan 2001
TL;DR: Rethinking Risk Assessment as discussed by the authors is a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence.
Abstract: Rethinking Risk Assessment tells the story of a pioneering investigation that challenges preconceptions about the frequency and nature of violence among persons with mental disorders, and suggests an innovative approach to predicting its occurrence.

1,060 citations

Journal ArticleDOI
TL;DR: The relationship between neighborhood structural characteristics and mental disorder using data from the National Institute of Mental Health's Epidemiological Catchment surveys was found to be negative, with neighborhood disadvantage associated with higher rates of major depression and substance abuse disorder.

437 citations

Journal ArticleDOI
TL;DR: This work proposes a classification tree rather than a main effects regression approach for actuarial violence risk assessment tools, and suggests that by employing two decision thresholds for identifying high- and low-risk cases, the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced.
Abstract: Since the 1970s, a wide body of research has suggested that the accuracy of clinical risk assessments of violence might be increased if clinicians used actuarial tools. Despite considerable progress in recent years in the development of such tools for violence risk assessment, they remain primarily research instruments, largely ignored in daily clinical practice. We argue that because most existing actuarial tools are based on a main effects regression approach, they do not adequately reflect the contingent nature of the clinical assessment processes. To enhance the use of actuarial violence risk assessment tools, we propose a classification tree rather than a main effects regression approach. In addition, we suggest that by employing two decision thresholds for identifying high- and low-risk cases--instead of the standard single threshold--the use of actuarial tools to make dichotomous risk classification decisions may be further enhanced. These claims are supported with empirical data from the MacArthur Violence Risk Assessment Study.

398 citations

Journal ArticleDOI
TL;DR: A clinically useful actuarial method exists to assist in violence risk assessment and this work aims to increase the clinical utility of the ICT method by restricting the risk factors used to generate the actuarial tool to those commonly available in hospital records or capable of being routinely assessed in clinical practice.
Abstract: Background A new actuarial method for violence risk assessment - the Iterative Classification Tree (ICT) - has become available. It has a high degree of accuracy but can be time and resource intensive to administer. Aims To increase the clinical utility of the ICT method by restricting the risk factors used to generate the actuarial tool to those commonly available in hospital records or capable of being routinely assessed in clinical practice. Method A total of 939 male and female civil psychiatric patients between 18 and 40 years old were assessed on 106 risk factors in the hospital and monitored for violence to others during the first 20 weeks after discharge. Results The ICT classified 72.6% of the sample as either low risk (less than half of the sample's base rate of violence) or high risk (more than twice the sample's base rate of violence). Conclusions A clinically useful actuarial method exists to assist in violence risk assessment.

339 citations


Cited by
More filters
Journal ArticleDOI
TL;DR: In this article, the cumulative results of a new "neighborhood-effects" literature that examines social processes related to problem behaviors and health-related outcomes are assessed and synthesized.
Abstract: ▪ Abstract This paper assesses and synthesizes the cumulative results of a new “neighborhood-effects” literature that examines social processes related to problem behaviors and health-related outcomes. Our review identified over 40 relevant studies published in peer-reviewed journals from the mid-1990s to 2001, the take-off point for an increasing level of interest in neighborhood effects. Moving beyond traditional characteristics such as concentrated poverty, we evaluate the salience of social-interactional and institutional mechanisms hypothesized to account for neighborhood-level variations in a variety of phenomena (e.g., delinquency, violence, depression, high-risk behavior), especially among adolescents. We highlight neighborhood ties, social control, mutual trust, institutional resources, disorder, and routine activity patterns. We also discuss a set of thorny methodological problems that plague the study of neighborhood effects, with special attention to selection bias. We conclude with promising ...

3,694 citations

Journal ArticleDOI
TL;DR: The Multi-Ethnic Study of Atherosclerosis was initiated in July 2000 to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in a population-based sample of 6,500 men and women aged 45-84 years for identification and characterization of CVD events.
Abstract: The Multi-Ethnic Study of Atherosclerosis was initiated in July 2000 to investigate the prevalence, correlates, and progression of subclinical cardiovascular disease (CVD) in a population-based sample of 6,500 men and women aged 45-84 years. The cohort will be selected from six US field centers. Approximately 38% of the cohort will be White, 28% African-American, 23% Hispanic, and 11% Asian (of Chinese descent). Baseline measurements will include measurement of coronary calcium using computed tomography; measurement of ventricular mass and function using cardiac magnetic resonance imaging; measurement of flow-mediated brachial artery endothelial vasodilation, carotid intimal-medial wall thickness, and distensibility of the carotid arteries using ultrasonography; measurement of peripheral vascular disease using ankle and brachial blood pressures; electrocardiography; and assessments of microalbuminuria, standard CVD risk factors, sociodemographic factors, life habits, and psychosocial factors. Blood samples will be assayed for putative biochemical risk factors and stored for use in nested case-control studies. DNA will be extracted and lymphocytes will be immortalized for genetic studies. Measurement of selected subclinical disease indicators and risk factors will be repeated for the study of progression over 7 years. Participants will be followed through 2008 for identification and characterization of CVD events, including acute myocardial infarction and other coronary heart disease, stroke, peripheral vascular disease, and congestive heart failure; therapeutic interventions for CVD; and mortality.

3,367 citations

Journal ArticleDOI
TL;DR: In the 1966 paperback edition of a publication which first appeared in 1963 has by now been widely reviewed as a worthy contribution to the sociological study of deviant behavior as discussed by the authors, and the authors developed a sequential model of deviance relying on the concept of career, a concept originally developed in studies of occupations.
Abstract: This 1966 paperback edition of a publication which first appeared in 1963 has by now been widely reviewed as a worthy contribution to the sociological study of deviant behavior. Its current appearance as a paperback is a testimonial both to the quality of the work and to the prominence of deviant behavior in this generation. In general the author places deviance in perspective, identifies types of deviant behavior, considers the role of rule makers and enforcers, and some of the problems in studying deviance. In addition, he develops a sequential model of deviance relying on the concept of career, a concept originally developed in studies of occupations. In his study of a particular kind of deviance, the use of marihuana, the author posits and tests systematically an hypothesis about the genesis of marihuana use for pleasure. The hypothesis traces the sequence of changes in individual attitude

2,650 citations

Journal ArticleDOI
TL;DR: This chapter summarizes key work in this area with a particular focus on chronic disease outcomes (specifically obesity and related risk factors) and mental health ( specifically depression and depressive symptoms) and empirical work is classified into two main eras.
Abstract: Features of neighborhoods or residential environments may affect health and contribute to social and race/ethnic inequalities in health. The study of neighborhood health effects has grown exponentially over the past 15 years. This chapter summarizes key work in this area with a particular focus on chronic disease outcomes (specifically obesity and related risk factors) and mental health (specifically depression and depressive symptoms). Empirical work is classified into two main eras: studies that use census proxies and studies that directly measure neighborhood attributes using a variety of approaches. Key conceptual and methodological challenges in studying neighborhood health effects are reviewed. Existing gaps in knowledge and promising new directions in the field are highlighted.

2,471 citations

Journal ArticleDOI
TL;DR: A meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome suggests the need for a shift in focus from risk factors to machine learning-based risk algorithms.
Abstract: Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record

2,013 citations