Rates of violence in patients classified as high risk by structured risk assessment instruments
01 Mar 2014-British Journal of Psychiatry (Royal College of Psychiatrists)-Vol. 204, Iss: 3, pp 180-187
TL;DR: After controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation and assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base.
Abstract: Background
Rates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.
Aims
To analyse the variation in rates of violence in individuals identified as high risk by SRAIs.
Method
A systematic search of databases (1995-2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.
Results
Information was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.
Conclusions
After controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.
Citations
More filters
TL;DR: The present study aims at providing a first overview of the decision-making processes regarding granted leave in forensic psychiatry as a whole and the link between the particular steps of the process and absconding should be explored.
Abstract: Forensic-psychiatric patients reoffending or absconding during the leave granted to them (hereafter referred to as "granted leave") have gained increased attention by researchers and the general public. The patients' right to freedom on the one hand and the need for protection of the general public from serious harm on the other hand represent broadly discussed ethical issues. Thus, demands on quality regarding decisions on patients' granted leaves might be high. Despite such requirements, research on decision-making processes regarding granting leave in forensic psychiatry is very limited and focuses primarily on particular aspects. The present study aims at providing a first overview of the decision-making processes regarding granted leave in forensic psychiatry as a whole. Furthermore, the link between the particular steps of the process and absconding should be explored. In this way, the study results should contribute to provide a theoretical framework for the development of guidelines concerning granted leave in forensic psychiatry. A combination of qualitative and quantitative approaches will be used to collect data: information about risk assessment, decisions on granted leave, and documentation systems in forensic psychiatry will be collected via semi-structured interviews and quantified for further analyses using a checklist developed for this study; data on the implementation of risk assessment tools and documented patient information will be obtained via two self-constructed questionnaires; information about the absolute number of abscondences per hospital will be obtained from the Bavarian Authority for Forensic Commitment. The sample will include staff from all 13 forensic-psychiatric hospitals in Bavaria (Germany) comprising six professional groups: hospital directors, security officers, complementary therapists, psychiatrists, psychologists, social workers, and nursing staff. In each hospital, at least one member of each professional group should participate in the study. In total, 151 interviews will be held. As the study goals are descriptive, there are no pre-formulated hypotheses. Developing guidelines would be the first step towards further standardization of the granted leave decisional process in forensic psychiatry and to make it more transparent for patients, staff members, hospital directors, and the government.
8 citations
01 Jan 2015
TL;DR: Investigation of differences in symptoms of depression, anxiety and stress between victims and perpetrators of intimate partner violence and the relationship between psychological difficulties and the role of victim and perpetrator of IPV found that victims had higher scores on depression and anxiety compared to the perpetrators.
Abstract: Purpose To examine differences in symptoms of depression, anxiety and stress between victims and perpetrators of intimate partner violence and to examine the relationship between psychological difficulties and the role of victim and perpetrator of IPV, taking into account the form of violent behaviour. Design A total of 347 participants formed three groups of subjects: victims, perpetrators and two control groups of participants. The Revised Conflict Tactics Scale was used intimate partner violence. Negative emotional states were assessed with The Depression Anxiety and Stress Scale. Findings The results of the analyses showed that victims of IPV had higher scores on depression and anxiety compared to the perpetrators of IPV. Victims and perpetrators of IPV had significantly higher level of depression, anxiety and stress in comparison to the control group. Statistically significant correlations were found between depression, anxiety and stress and perpetration as well as victimization for all examined type of IPV. Research implication The results of this study point out the importance of focusing the attention on examining the mental health of the perpetrators, not only on victims.
7 citations
Cites result from "Rates of violence in patients class..."
...In contrast to the results of the before mentioned studies, Singh et al. (2014) did not found correlation between the acts of violence done by men and depression....
[...]
01 Sep 2014
TL;DR: In this paper, the authors provide an overview of 5 recommendations for innovation in risk assessment research: (a) move beyond focusing on the idiographicversus-nomothetic controversy and start focusing on nomothetic-versusnomothesis controversy, (b), move beyond discrimination validity, (c, move beyond using comparisons against chance, (d), and (e) use rules-of-thumb to justify claims of predictive validity.
Abstract: Structured risk assessment instruments are frequently used to aid in a number of medico-legal decisions. With hundreds of available risk assessment tools and a steadily growing literature on their utility, it is important to examine possibilities for research innovation. The present article provides an overview of 5 recommendations for innovation in risk assessment research: (a) move beyond focusing on the idiographicversus-nomothetic controversy and start focusing on the nomothetic-versus-nomothetic controversy, (b) move beyond discrimination validity, (c) move beyond using comparisons against chance, (d) move beyond using rules-of-thumb to justify claims of predictive validity, and (e) move beyond assuming incidents of recidivism occurred after index offenses.
6 citations
TL;DR: Inattention emerged as a strong predictor of patients’ risk of violence as well as patient’s vocational therapy engagement, and cognitive skills programs targeting attention problems should be introduced to improve outcomes for this population.
Abstract: Mentally disordered offenders (MDOs) endorse difficulties with attention, impulsivity, and hyperactivity. Assessing these difficulties among MDOs may confer practical benefits for the management and provision of care for this population, by informing strategies to improve rehabilitative engagement and risk assessments for violence. However, there is a dearth of literature exploring these cognitive problems in MDOs in relation to outcome factors. Forty-eight MDOs from a high-security hospital completed the QbTest, which measures the domains of inattention, impulsivity, and hyperactivity. Comprehensive file review of clinical and occupational/vocational rehabilitative engagement and Historical Clinical Risk Management-20 (HCR-20) were used as outcome measures of interest. Participants displayed greater cognitive deficits in attention, impulsivity, and hyperactivity compared to the general population. The domain of inattention and omission errors was related to occupational/vocational therapy engagement as well as a higher risk of present and future violence as measured by the HCR-20. The findings suggest that QbTest is a helpful objective tool that could be incorporated into the assessment of MDOs. Specifically, inattention emerged as a strong predictor of patients’ risk of violence as well as patient’s vocational therapy engagement. Therefore, cognitive skills programs targeting attention problems should be introduced to improve outcomes for this population.
6 citations
Cites methods from "Rates of violence in patients class..."
...The HCR-20—The HCR-20 V3 is one of the most commonly used tools to assess risk (32, 33)....
[...]
Dissertation•
01 Dec 2015
TL;DR: In this paper, a systematic review of the validity of risk assessments in predicting recidivism and violence for female offenders is presented, and it is suggested that further the gender-responsive approach to female offenders may be better adopted to the management of female offenders rather than to the assessment of their risk.
Abstract: Women comprise a minority of the offending population and their crimes are less likely to inflict serious harm when compared with male offenders. Although men may be the predominant perpetrators of violence this does not outweigh the need for evidence informed practice in the assessment and management of risk in female offenders. This thesis aims to explore the assessment of risk in female offenders through three pieces of research. Firstly, a systematic review of the validity of risk assessments in predicting recidivism and violence for female offenders is presented. This demonstrates that there was great variability with respect to the accuracy of risk assessment tools in predicting recidivism or violence. It also demonstrated that there is a significant gap in the empirical base with respect to assessing risk in female offenders. A critique of the HCR-20V3 is subsequently presented to assess its reliability and validity. The fourth chapter presents an empirical paper. This evaluated the predictive validity of gender-neutral and gender-responsive risk assessments in predicting inpatient violence in female psychiatric offenders. Results indicated that the gender neutral assessments did not perform significantly better than the traditional gender-specific risk assessments in predicting inpatient violence. The final chapter of the thesis concludes by discussing the overall findings as well as the implications for future research and clinical practice. It is suggested that further the gender-responsive approach to female offenders may be better adopted to the management of female offenders rather than to the assessment of their risk.
5 citations
References
More filters
TL;DR: A general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies is presented and tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interob server agreement are developed as generalized kappa-type statistics.
Abstract: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
64,109 citations
Book•
01 Jan 1974TL;DR: The authors described three heuristics that are employed in making judgements under uncertainty: representativeness, availability of instances or scenarios, and adjustment from an anchor, which is usually employed in numerical prediction when a relevant value is available.
Abstract: This article described three heuristics that are employed in making judgements under uncertainty: (i) representativeness, which is usually employed when people are asked to judge the probability that an object or event A belongs to class or process B; (ii) availability of instances or scenarios, which is often employed when people are asked to assess the frequency of a class or the plausibility of a particular development; and (iii) adjustment from an anchor, which is usually employed in numerical prediction when a relevant value is available. These heuristics are highly economical and usually effective, but they lead to systematic and predictable errors. A better understanding of these heuristics and of the biases to which they lead could improve judgements and decisions in situations of uncertainty.
31,082 citations
2,842 citations
TL;DR: The c statistic, or area under the receiver operating characteristic (ROC) curve, achieved popularity in diagnostic testing, in which the test characteristics of sensitivity and specificity are relevant to discriminating diseased versus nondiseased patients, may not be optimal in assessing models that predict future risk or stratify individuals into risk categories.
Abstract: The c statistic, or area under the receiver operating characteristic (ROC) curve, achieved popularity in diagnostic testing, in which the test characteristics of sensitivity and specificity are relevant to discriminating diseased versus nondiseased patients. The c statistic, however, may not be optimal in assessing models that predict future risk or stratify individuals into risk categories. In this setting, calibration is as important to the accurate assessment of risk. For example, a biomarker with an odds ratio of 3 may have little effect on the c statistic, yet an increased level could shift estimated 10-year cardiovascular risk for an individual patient from 8% to 24%, which would lead to different treatment recommendations under current Adult Treatment Panel III guidelines. Accepted risk factors such as lipids, hypertension, and smoking have only marginal impact on the c statistic individually yet lead to more accurate reclassification of large proportions of patients into higher-risk or lower-risk categories. Perfectly calibrated models for complex disease can, in fact, only achieve values for the c statistic well below the theoretical maximum of 1. Use of the c statistic for model selection could thus naively eliminate established risk factors from cardiovascular risk prediction scores. As novel risk factors are discovered, sole reliance on the c statistic to evaluate their utility as risk predictors thus seems ill-advised.
1,815 citations
TL;DR: Federal Abortion Policy and Politics: 1973-1996 Why is Abortion Such a Controversial issue in the United States Barriers to Access to Abortion Services The Impact of Anti-abortion Activities on Women Seeking Abortions
Abstract: Federal Abortion Policy and Politics: 1973-1996 Why is Abortion Such a Controversial issue in the United States Barriers to Access to Abortion Services The Impact of Anti-abortion Activities on Women Seeking Abortions Black Women and the Question of Abortion Latinos and Abortion Abortion and Asian Pacific Islander Americans The Acceptability of Medical Abortion to Women Understanding the Relationship of Violence Against Women to Unwanted Pregnancy and it's Resolution Testing a Model of the Psychological Consequences of Abortion Men and Abortion: The Gender Politics of Pregnancy Resolution Abortion Among Adolescents A Cognitive Approach to Patient-Centered Abortion Care Abortion Issues in Psychotherapy Bringing Lessons Learned to the United States Improving Access to Abortion Services Abortion Practice, Policy, and Research: Recommendations for the 21st Century
1,564 citations