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Rates of violence in patients classified as high risk by structured risk assessment instruments

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Singh, Swaran P., Fazel, Seena, Gueorguieva, R. and Buchanan, Allen E. (2014) Rates of violence in patients classified as high risk by structured risk assessment instruments. British Journal of Psychiatry, 204 (3). pp. 180-187. doi:10.1192/bjp.bp.113.131938 ISSN 0007-1250.

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Official URL: http://dx.doi.org/10.1192/bjp.bp.113.131938

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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

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Dangerously mentally ill, Violence, Violence -- Forecasting, Risk assessment, Forensic psychiatry
Journal or Publication Title: British Journal of Psychiatry
Publisher: Royal College of Psychiatrists
ISSN: 0007-1250
Official Date: March 2014
Dates:
DateEvent
March 2014Published
3 March 2014Available
5 September 2013Accepted
4 May 2013Submitted
Volume: 204
Number: 3
Page Range: pp. 180-187
DOI: 10.1192/bjp.bp.113.131938
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
UNSPECIFIEDWellcome Trusthttp://dx.doi.org/10.13039/100010269
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