Evidence-Based Reviews

Chief complaint: Homicidal. Assessing violence risk

Current Psychiatry. 2018 May;17(5):26-28,30-32,34,55

References

1. Skeem J, Kennealy P, Monahan J, et al. Psychosis uncommonly and inconsistently precedes violence among high-risk individuals. Clin Psychol Sci. 2016;4(1):40-49.
2. McGinty E, Frattaroli S, Appelbaum PS, et al. Using research evidence to reframe the policy debate around mental illness and guns: process and recommendations. Am J Public Health. 2014;104(11):e22-e26.
3. Sumner SA, Mercy JA, Dahlberg LL, et al. Violence in the United States: status, challenges, and opportunities. JAMA. 2015;314(5):478-488.
4. Heron M. Deaths: leading causes for 2014. Natl Vital Stat Rep. 2016;65(5):1-96.
5. Borum R, Swartz M, Swanson J. Assessing and managing violence risk in clinical practice. J Prac Psychiatry Behav Health. 1996;2(4):205-215.
6. Swanson JW, Holzer CE 3rd, Ganju VK, et al. Violence and psychiatric disorder in the community: Evidence from the epidemiologic catchment area surveys. Hosp Community Psychiatry. 1990;41(7):761-770.
7. Swanson JW. Explaining rare acts of violence: the limits of evidence from population research. Psychiatr Serv. 2011;62(11):1369-1371.
8. Bonta J, Law M, Hanson K. The prediction of criminal and violent recidivism among mentally disordered offenders: a meta-analysis. Psychol Bull. 1998;123(2):123-142.
9. Monahan J. The inclusion of biological risk factors in violence risk assessments. In: Singh I, Sinnott-Armstrong W, Savulescu J, eds. Bioprediction, biomarkers, and bad behavior: scientific, legal, and ethical implications. New York, NY: Oxford University Press; 2014:57-76.
10. Murray J, Thomson ME. Clinical judgement in violence risk assessment. Eur J Psychol. 2010;6(1):128-149.
11. Mossman D. Violence risk: is clinical judgment enough? Current Psychiatry. 2008;7(6):66-72.
12. Douglas T, Pugh J, Singh I, et al. Risk assessment tools in criminal justice and forensic psychiatry: the need for better data. Eur Psychiatry. 2017;42:134-137.
13. Dolan M, Doyle M. Violence risk prediction. Clinical and actuarial measures and the role of the psychopathy checklist. Br J Psychiatry. 2000;177:303-311.
14. Fazel S, Singh J, Doll H, et al. Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24 827 people: systematic review and meta-analysis. BMJ. 2012;345:e4692. doi: 10.1136/bmj.e4692.
15. National Collaborating Centre for Mental Health (UK). Violence and aggression: short- term management in mental health, health, and community settings: updated edition. London: British Psychological Society; 2015. NICE Guideline, No 10.
16. Klassen D, O’Connor WA. Predicting violence in schizophrenic and non-schizophrenic patients: a prospective study. J Community Psychol. 1988;16(2):217-227.
17. Scott C, Resnick P. Clinical assessment of aggression and violence. In: Rosner R, Scott C, eds. Principles and practice of forensic psychiatry, 3rd ed. Boca Raton, FL: CRC Press; 2017:623-631.
18. Tardiff K, Sweillam A. Assault, suicide, and mental illness. Arch Gen Psychiatry. 1980;37(2):164-169.
19. Lidz CW, Mulvey EP, Gardner W. The accuracy of predictions of violence to others. JAMA. 1993;269(8):1007-1011.
20. Newhill CE, Mulvey EP, Lidz CW. Characteristics of violence in the community by female patients seen in a psychiatric emergency service. Psychiatric Serv. 1995;46(8):785-789.
21. Mulvey E, Lidz C. Clinical considerations in the prediction of dangerousness in mental patients. Clin Psychol Rev. 1984;4(4):379-401.
22. Link BG, Andrews H, Cullen FT. The violent and illegal behavior of mental patients reconsidered. Am Sociol Rev. 1992;57(3):275-292.
23. Harris GT, Rice ME, Quinsey VL. Violent recidivism of mentally disordered offenders: the development of a statistical prediction instrument. Crim Justice and Behav. 1993;20(4):315-335.
24. Klassen D, O’Connor W. Demographic and case history variables in risk assessment. In: Monahan J, Steadman H, eds. Violence and mental disorder: developments in risk assessment. Chicago, IL: University of Chicago Press; 1994:229-257.
25. Hart SD, Hare RD, Forth AE. Psychopathy as a risk marker for violence: development and validation of a screening version of the revised Psychopathy Checklist. In: Monahan J, Steadman HJ, eds. Violence and mental disorder: developments in risk assessment. Chicago, IL: University of Chicago Press; 1994:81-98.
26. Cleckley H. The mask of sanity. St. Louis, MO: Mosby; 1941.
27. Harris GT, Rice ME, Cormier CA. Psychopathy and violent recidivism. Law Hum Behav. 1991;15(6):625-637.
28. Steadman HJ, Mulvey EP, Monahan J. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry. 1998;55:393-401.
29. Meloy JR, White SG, Hart S. Workplace assessment of targeted violence risk: the development and reliability of the WAVR-21. J Forensic Sci. 2013;58(5):1353-1358.
30. Borum R, Fein R, Vossekuil B, et al. Threat assessment: defining an approach for evaluating risk of targeted violence. Behav Sci Law. 1999;17(3):323-337.
31. Tyrer P, Bateman AW. Drug treatment for personality disorders. Adv Psychiatr Treat. 2004;10(5):389-398.

Structured professional judgment is a hybrid of unaided clinical judgment and actuarial methods. Structured professional judgment tools help the evaluator identify empirically established risk factors. Once the information is collected, it is combined with clinical judgment in decision making.^9,10 There are now more than 200 structured tools available for assessing violence risk in criminal justice and forensic mental health populations.¹²

Clinical judgment, although commonly used in practice, is less accurate than actuarial tools or structured professional judgment.^10,11 In general, risk assessment tools offer moderate levels of accuracy in categorizing people at low risk vs high risk.^5,13 The tools have better ability to accurately categorize individuals at low risk, compared with high risk, where false positives are common.^12,14

Two types of risk factors

Risk factors for violence are commonly categorized as static or dynamic factors. Static factors are historical factors that cannot be changed with intervention (eg, age, sex, history of abuse). Dynamic factors can be changed with intervention (eg, substance abuse).¹⁵

Static risk factors. The best predictor of future violence is past violent behavior.^5,16,17 Violence risk increases with each prior episode of violence.⁵ Prior arrests for any crime, especially if the individual was a juvenile at the time of arrest for his or her first violent offense, increase future violence risk.⁵ Other important static violence risk factors include demographic factors such as age, sex, and socioeconomic status. Swanson et al⁶ reviewed a large pool of data (approximately 10,000 respondents) from the Epidemiologic Catchment Area survey. Being young, male, and of low socioeconomic status were all associated with violence in the community.⁶The highest-risk age group for violence is age 15 to 24.⁵ Males perpetrate violence in the community at a rate 10 times that of females.¹⁸ However, among individuals with severe mental illness, men and women have similar rates of violence.^19,20 Unstable employment,²¹ less education,²² low intelligence,¹⁶ and a history of a significant head injury⁵ also are risk factors for violence.⁵

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Chief complaint: Homicidal. Assessing violence risk

References

Two types of risk factors

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