Predicting community violence from patients discharged from acute mental health units in England

Abstract

The risk factors and risk measures that have been found to be predictive in forensic samples are also predictive in acute mental health samples, although the effects are not as large. Future research needs to be conducted with a larger sample to include investigation of differences in risk factors based on gender and social support. Services and clinicians need to consider how to integrate findings into useful frameworks to support decisions and contribute to managing risk. This should assist in identifying interventions aimed at preventing community violence.

A Field Study of a Comprehensive Violence Risk Assessment Battery

“…The NAS-PI has been shown to substantially correlate in the expected direction with other measures of anger and hostility, observers' ratings of angry behaviors, and occurrence of violent behaviors (Grisso, Davis, Vesselinov, Appelbaum, & Monahan, 2000;Novaco, 2003;Steadman et al, 2000). Doyle et al (2012) found the NAS to be predictive of community violence following discharge from acute psychiatric hospitals in England up to 20 weeks post-discharge, and noted that anger was more predictive of violence than impulsiveness and psychopathy.…”

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…A substantial body of epidemiological, cohort, and case-control studies has shown associations between the risk factors described in this guideline and medium-to long-term relative risk of aggression in populations (Coid et al 2006;Doyle and Dolan 2006;Doyle et al 2012;Elbogen and Johnson 2009;Elbogen et al 2006;Eriksson et al 2011;Falk et al 2014;Harford et al 2013;Swanson et al 1990;Ten Have et al 2014;Van Dorn et al 2012;Whittington et al 2013;Witt et al 2013). However, there is no evidence that assessment of any of these factors can predict aggression in an individual (Buchanan et al 2012;Fazel et al 2012;Large et al 2011b;Rossegger et al 2013;Singh et al 2011Singh et al , 2014Thomas et al 2005).…”

“…For example, determining whether the patient shows an "increased use of alcohol or other substances" will require a comparison of patterns of use at two or more points and then determining if a clinically significant change has occurred. Diagnostic considerations can also be relevant, because research studies have identified diagnostic subgroups, such as individuals with substance use disorders or antisocial personality disorder, who show an increased relative risk of aggression on a longterm basis in community settings (for more information, see Coid et al 2006;Doyle and Dolan 2006;Doyle et al 2012;Elbogen and Johnson 2009;Elbogen et al 2006;Eriksson et al 2011;Falk et al 2014;Harford et al 2013;Swanson et al 1990;Ten Have et al 2014;Van Dorn et al 2012). Individuals in other settings, including psychiatric inpatient or forensic units, or with specific diagnoses may show somewhat different patterns of risk factors (Cornaggia et al 2011;Dack et al 2013;Douglas et al 2009;Doyle et al 2012;Fazel et al 2009aFazel et al , 2010, with substantial variability across studies.…”

Evaluation of the predictive validity of the Violence Risk Scale in a paroled offender sample: a seven-year prospective study

“…The VRS has been found to be valid and reliable in the prediction of recidivism in offender and mentally disordered samples (Dolan & Fullam, 2007;Doyle, Carter, Shaw, & Dolan, 2011;Wong & Gordon, 2006). In a recent prospective study (Doyle et al, 2011), the predictive validity of the VRS, among other commonly used risk assessment tools, was examined using 114 mixed gender and mentally ill patients released to the community in the UK and followed up for 20 weeks using self and collaterally reported violence as outcomes.…”

“…In a recent prospective study (Doyle et al, 2011), the predictive validity of the VRS, among other commonly used risk assessment tools, was examined using 114 mixed gender and mentally ill patients released to the community in the UK and followed up for 20 weeks using self and collaterally reported violence as outcomes. The VRS significantly predicted violent outcomes [areas under the curve (AUC) ¼ .66; p 5 .02] irrespective of age in both male and females patients (using logistic regression to control for age and gender; adjusted OR ¼ 1.064; p 5 .002).…”