Identifying Causal Risk Factors for Violence among Discharged Patients

Coid, Jeremy W.; Kallis, Constantinos; Doyle, Michael; Shaw, Jenny; Ullrich, Simone

doi:10.1371/journal.pone.0142493

Cited by 38 publications

(35 citation statements)

References 32 publications

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“…Coid et al, ; Ullrich, Keers, & Coid, ), points raised by these authors merit some discussion. In support of their cross‐sectional design, which they inappropriately identified as causal, Coid et al () state that “The risk factor may … no longer be present in a subsequent time window when violence is measured … [and] significant associations may consequentially be missed” (p. 2). However, it should be clear that cross‐sectional models are not a solution to a lack of spatiotemporal contiguity; research designs should observe hypothesized leading indicators and subsequent violence in closer temporal proximity.…”

Section: Discussionmentioning

confidence: 99%

Methodological limitations in the measurement and statistical modeling of violence among adults with mental illness

Johnson

Desmarais

Tueller

et al. 2019

Int J Methods Psych Res

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Objectives Methodological limitations of extant research hinder the development of effective violence risk screening, assessment, and management strategies for adults with mental illness. This study quantifies the effects of three common limitations: (a) insensitive measurement of violence that results in violence classification with high levels of information bias, (b) use of cross‐sectional data, and (c) use of data lacking spatiotemporal contiguity. Methods We utilize secondary data (N = 3,000 participants; N = 10,017 observations) and parametric and nonparametric bootstrap simulation methodologies. Results Not utilizing self‐reported violence data increases information bias. Furthermore, cross‐sectional data that exclude self‐reported violence produce biased associations between substance use and psychiatric symptoms and violence. Associations between baseline variables and subsequent violence attenuate over longer time lags and, when paired with high levels of violence information bias, result in fewer significant effects than should be present. Moreover, the true direction of the simulated relationship of some significant effects is reversed. Conclusions Our findings suggest that the validity of conclusions from some extant research on violence among adults with mental illness should be questioned. Efforts are needed to improve both the measurement of violence, through inclusion of self‐report, and the statistical modeling of violence, using lagged rather than nonlagged models with improved spatiotemporal contiguity.

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Section: Discussionmentioning

confidence: 99%

Methodological limitations in the measurement and statistical modeling of violence among adults with mental illness

Johnson

Desmarais

Tueller

et al. 2019

Int J Methods Psych Res

View full text Add to dashboard Cite

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“…Generalized estimating equations, rather than the more traditional methods of analyses, such as logistic regression, was used in an attempt to address some of the concerns in the literature about potential biases in regard to the predictive accuracy (Coid et al 2015). The results from the GEE produced larger standard errors and wider 95% CI, because the analyses took into account the correlated nature of the repeated measurements within individual patients in the present study.…”

Section: Dasa Risk Bandsmentioning

confidence: 99%

“…The use of logistic regression as an analytic approach does not take into account the repeated nature of the observations, which could result in bias (Coid et al . ) and erroneous conclusions regarding predictive accuracy.…”

Section: Introductionmentioning

confidence: 99%

“…Short-term risk-assessment research with instruments, such as the DASA, typically involves repeated daily measurement of risk on a small group of (usually male) patients, and matching the risk-assessment findings with outcomes over the following 24 hours (Barry-Walsh et al 2009;Chu et al 2013a;Dumais et al 2012;Griffith et al 2013). The use of logistic regression as an analytic approach does not take into account the repeated nature of the observations, which could result in bias (Coid et al 2015) and erroneous conclusions regarding predictive accuracy.…”

Section: Introductionmentioning

confidence: 99%

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Predicting aggressive behaviour in acute forensic mental health units: A re‐examination of the dynamic appraisal of situational aggression's predictive validity

Maguire

Daffern

Bowe

et al. 2017

Int J Mental Health Nurs

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In the present study, we explored the predictive validity of the Dynamic Appraisal of Situational Aggression (DASA) assessment tool in male (n = 30) and female (n = 30) patients admitted to the acute units of a forensic mental health hospital. We also tested the psychometric properties of the original DASA bands and novel risk bands. The first 60 days of each patient's file was reviewed to identify daily DASA scores and subsequent risk-related nursing interventions and aggressive behaviour within the following 24 hours. Risk assessments, followed by documented nursing interventions, were removed to preserve the integrity of the risk-assessment analysis. Receiver-operator characteristics were used to test the predictive accuracy of the DASA, and generalized estimating equations (GEE) were used to account for repeated risk assessments, which occurs when analysing short-term risk-assessment data. The results revealed modest predictive validity for males and females. GEE analyses suggested the need to adjust the DASA risk bands to the following (with associated odds ratios (OR) for aggressive behaviour): 0 = low risk; 1, 2, 3 = moderate-risk OR, 4.70 (95% confidence interval (CI): 2.84-7.80); and 4, 5, 6, 7 = high-risk OR, 16.13 (95% CI: 9.71-26.78). The adjusted DASA risk bands could assist nurses by prompting violence-prevention interventions when the level of risk is elevated.

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“…In addition, staff members may have their own untested traditions how to manage patients’ challenging behaviour on the wards because they are not always sufficiently aware which interventions are more cost-effective [42, 43] or are more effective, particularly in managing aggressive patient behaviour [40, 44] than others. Finally, the understanding of aggressive patient events is still unclear and there is a lack of studies investigating causal associations between risk factors and patient violence [45]. …”

Section: Introductionmentioning

confidence: 99%

Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services

et al. 2017

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BackgroundPeople admitted to psychiatric hospitals with a diagnosis of schizophrenia may display behavioural problems. These may require management approaches such as use of coercive practices, which impact the well-being of staff members, visiting families and friends, peers, as well as patients themselves. Studies have proposed that not only patients’ conditions, but also treatment environment and ward culture may affect patients’ behaviour. Seclusion and restraint could possibly be prevented with staff education about user-centred, more humane approaches. Staff education could also increase collaboration between patients, family members and staff, which may further positively affect treatment culture and lower the need for using coercive treatment methods.MethodsThis is a single-blind, two-arm cluster randomised controlled trial involving 28 psychiatric hospital wards across Finland. Units will be randomised to receive either a staff educational programme delivered by the team of researchers, or standard care. The primary outcome is the incidence of use of patient seclusion rooms, assessed from the local/national health registers. Secondary outcomes include use of other coercive methods (limb restraint, forced injection, and physical restraint), service use, treatment satisfaction, general functioning among patients, and team climate and employee turn-over (nursing staff).DiscussionThe study, designed in close collaboration with staff members, patients and their relatives, will provide evidence for a co-operative and user-centred educational intervention aiming to decrease the prevalence of coercive methods and service use in the units, increase the functional status of patients and improve team climate in the units. We have identified no similar trials.Trial registrationClinicalTrials.gov NCT02724748. Registered on 25th of April 2016.

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Identifying Causal Risk Factors for Violence among Discharged Patients

Cited by 38 publications

References 32 publications

Methodological limitations in the measurement and statistical modeling of violence among adults with mental illness

Methodological limitations in the measurement and statistical modeling of violence among adults with mental illness

Predicting aggressive behaviour in acute forensic mental health units: A re‐examination of the dynamic appraisal of situational aggression's predictive validity

Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services

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