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
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Molde University College1, North Carolina State University2, University of South Florida3, University of Barcelona4, University of New South Wales5, Centre for Mental Health6, National University of La Plata7, Universidad Autónoma de Yucatán8, Karolinska Institutet9, Castle Peak Hospital10, University of Southern Denmark11, University of Mons12, Simon Fraser University13, University of Mainz14, Maastricht University15, University of Konstanz16
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References
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TL;DR: The tested measures turned out to be useful instruments for risk assessments and may be conducive for a more systemized practice, but due to the limitations inherent, they should be seen as a complement to a careful and clinically informed appraisal and not a substitute.
122 citations
Additional excerpts
...…Kropp (2000)52 Kloezeman (2004)51 Jovanovic (2009)49 Hill (2008b)47 Gretton (2002)44 Gibas (2008)41 Gammelgard (2008)40 Douglas (2005b)35 Douglas (2003)34 Dempster (1998a)32 Dahle (2006b)29 Arbach (2007)25 – – – – – – – – – – – – – – – – – – – – – – – – 0 10 20 30 40 50 60 70 Rate, % 80 90 100 Fig....
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...…(1999)43 Friendship (2003)39 Eher (2009)36 Eher (2008b)37 Eher (2008a)37 Douglas (2005a)35 Dempster (2001)33 Dempster (1998c)32 Dempster (1998b)32 Dahle (2006a)29 Caperton (2005)28 Bengtson (2008)27 Beggs (2008)26 – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – 0 10 20 30 40 50…...
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TL;DR: In this paper, the authors identify those adolescents who are at the highest risk for future violence in the youth justice system and propose a method for identifying those adolescents at risk of future violence.
Abstract: Violence is a serious social problem that is often encountered in the youth justice system. Identifying those adolescents who are at the highest risk for future violence is an important step toward...
110 citations
TL;DR: Examination of relationships between SAVRY scores and various types of disruptive behavior during residential treatment finds the Dutch version of the Structured Assessment of Violence Risk in Youth (SAVRY) had good predictive validity for violence against objects, verbal threats and violations of rules, but not for verbal abuse.
109 citations
TL;DR: Recidivism with any violent reoffence was associated with age-related factors: young age at first sexual offence, at homicide, and at release and duration of detention, whereas increased nonsexual violent recidivism was related to previous sexual and nonsexual delinquency, psychopathic symptoms, and higher scores in risk assessment instruments.
Abstract: Forensic psychiatric reports on 166 sexual homicide perpetrators in Germany were retrospectively analyzed for criminal risk factors. Follow-up information about release and reconvictions from federal criminal records was available for 139 offenders; 90 (64.7%) had been released. The estimated recidivism rate (Kaplan-Meier analyses) for 20 years at risk was 23.1% for sexual and 18.3% for nonsexual violent reoffences. Three men (3.3%) were reconvicted for attempted or completed homicide. Only young age at the time of sexual homicide resulted in higher sexual recidivism, whereas increased nonsexual violent recidivism was related to previous sexual and nonsexual delinquency, psychopathic symptoms, and higher scores in risk assessment instruments. Increased recidivism with any violent reoffence was associated with age-related factors: young age at first sexual offence, at homicide, and at release and duration of detention. The impacts of the results for risk assessment, relapse prevention, and supervision are discussed.
103 citations
TL;DR: Nearly a fifth of community-dwelling women with chronic psychosis committed assault over a period of 2 years, and violent women were found to be more costly to services.
Abstract: Background Little is known about the determinants of violence in women with psychosis.
Aims To identify predictors of violence in a community sample of women with chronic psychosis.
Method The 2-year prevalence of physical assault was estimated for a sample of 304 women with psychosis. Baseline socio-demographic and clinical factors were used to identify predictors of assault.
Results The 2-year prevalence of assault in the sample was 17%. Assaultive behaviour was associated with previous violence (OR=5.87,95% CI 2.42–14.25), non-violentconvictions (OR=2.63,95% CI 1.17–5.93), victimisation (OR=2.46, 95% CI1.02–5.93), African–Caribbean ethnicity (OR=2.24,95% CI1.02–4.77), cluster B personality disorder (OR=2.66, 95% CI1.11–6.38) and high levels of unmet need (OR=1.17,95% CI1.01–1.35). An interaction between African–Caribbean ethnicity and cluster B personality disorder was identified in relation to violent outcome. Violent women were found to be more costly to services.
Conclusions Nearly a fifth of community-dwelling women with chronic psychosis committed assault over a period of 2 years. Six independent risk factors were found to predict violence.
99 citations