The impact of machine learning in predicting risk of violence: a systematic review

Background: Inpatient violence in clinical and forensic settings is still an ongoing challenge to organizations and practitioners. Existing risk assessment instruments show only moderate benefits in clinical practice, are time consuming, and seem to scarcely generalize across different populations. In the last years, machine learning (ML) models have been applied in the study of risk factors for aggressive episodes. The objective of this systematic review is to investigate the potential of ML for identifying risk of violence in clinical and forensic populations.Methods: Following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a systematic review on the use of ML techniques in predicting risk of violence of psychiatric patients in clinical and forensic settings was performed. A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Risk of bias and applicability assessment was performed using Prediction model Risk Of Bias ASsessment Tool (PROBAST).Results: We identified 182 potentially eligible studies from 2,259 records, and 8 papers were included in this systematic review. A wide variability in the experimental settings and characteristics of the enrolled samples emerged across studies, which probably represented the major cause for the absence of shared common predictors of violence found by the models learned. Nonetheless, a general trend toward a better performance of ML methods compared to structured violence risk assessment instruments in predicting risk of violent episodes emerged, with three out of eight studies with an AUC above 0.80. However, because of the varied experimental protocols, and heterogeneity in study populations, caution is needed when trying to quantitatively compare (e.g., in terms of AUC) and derive general conclusions from these approaches. Another limitation is represented by the overall quality of the included studies that suffer from objective limitations, difficult to overcome, such as the common use of retrospective data.Conclusion: Despite these limitations, ML models represent a promising approach in shedding light on predictive factors of violent episodes in clinical and forensic settings. Further research and more investments are required, preferably in large and prospective groups, to boost the application of ML models in clinical practice

Use of the Parents Preference Test in Child Custody Evaluations: Preliminary Development of Conforming Parenting Index

The Parents Preference Test (PPT) is a graphical test comprised of 24 easy to understand images of daily family life, which is widely used in forensic assessments of parenting skills. Nevertheless, the PPT lacks validity scales to detect participants’ attitudes toward the test; this is an important oversight, as the tendency to demonstrate faking-good parenting behaviors is common in child custody litigants. Study 1 aimed at identifying the differences in PPT responses between a normative/control group (N = 110) and a sample of parents undergoing a psychological evaluation of parenting ability (N = 99). Chi-square goodness of fit tests showed significant differences in answer preferences between groups in 11 vignettes (almost half of the total PPT items). Study 2 aimed at developing an index to detect faking-good behaviors. On the 11 vignettes in which significant differences in answer preferences were found in Study 1, the alternatives chosen with the highest frequency by the forensic group were added to an index called the “Conforming Parenting Index” (CPI). The area under the curve (AUC) of a receiver operating characteristic (ROC) curve for a sample of 58 participants who completed the PPT under both standard and faking-good instructions demonstrated good classification accuracy (AUC= .813)

Decision-Making and Abuse, What Relationship in Victims of Violence?

Gender-Based violence is a worldwide persisting phenomenon: during their lifetime, 30% of women have experienced sexual and/or physical violence. The literature has investigated for several years the association between abuse and possible psychiatric and psychological consequences which may occur even after many years. The most common consequences involve mood and stress disorders (e.g., depression and PTSD). These disorders seem to have secondary long-term effects, such as decision-making and cognitive function impairments. Therefore, the present literature synthesis aimed to investigate whether and how the decision-making capacities of individuals experiencing violence can change because of abuse. We conducted a thematic synthesis using PRISMA guidelines: through a double-blind procedure, 4599 studies were screened; a total of 46 studies were selected for full-text reading, which was reduced to 13 by excluding papers with a wrong focus. To better understand the results of the thematic synthesis, two main focuses have been identified: "leave or stay decision making" and "multifactorial dimensions of decision making". Results showed that decision-making is an important process in avoiding secondary victimization

Teaching during the pandemic: a comparison in psychological wellbeing among smart working professions

Background: As a result of the COVID-19 pandemic, since March 2020, the Italian population was forced into lockdown to prevent the spread of the virus. The restrictive measures imposed forced many organizations and workers to work through online platforms and no longer in-person. Smart working, enjoyed by some workers for its flexibility, affected several professional categories. The purpose of this study was to investigate whether there are differences in the psychological variables related to four groups of professional categories (practitioners, managers, executive employees, teachers), particularly the teachers group. Methods: A total sample of 628 individuals was recruited through a random probability sample across Italy. Due to the lockdown, an online questionnaire was developed; several validated scales were chosen, and some ad hoc constructed items related to the smart working experience were included. Results: The results showed statistically significant differences between the four groups of examined smart workers. Conclusions: All workers have had to readjust to this new way of working, but our results show that teachers were the most affected, both in the perception of their psychological well-being and in the management of the smart working mode

Older Adolescents Who Did or Did Not Experience COVID-19 Symptoms: Associations with Mental Health, Risk Perception and Social Connection

After a decrease in detected cases in the summer, Europe faced the emergence of a second wave of coronavirus disease 19 (COVID-19). Few studies have investigated adolescents, who may constitute a target group with possible lower compliance to public health measures, particularly the social distancing measures. A total sample of 492 participants was included in the study, and the ages of the participants ranged from 18–24 years. According to the hypothesis of our study, the sample was divided into two groups: those who experienced COVID-19 symptoms and those who did not experience COVID-19 symptoms. Demographic characteristics, knowledge, perceptions, and behaviors related to COVID-19 were investigated with ad hoc items; in addition, mood disorders, self-efficacy, and social connectedness were explored. Our results showed significant differences in the variables of risk perception, self-efficacy, and measures of belongingness among older adolescents who did or did not experience COVID-19 symptoms. In this period, adolescents experienced unprecedented disruptions in their daily lives, leading them to isolation and loneliness. Compliance with restrictive measures is considered both a proactive behavior and a social responsibility, especially if supported by prosocial reasons to prevent others from getting sick; therefore, this must be the focus of raising awareness of anti-COVID-19 compliance among adolescents

Decisional capacity to consent to treatment and research in patients affected by Mild Cognitive Impairment. A systematic review and meta-analysis.

ABSTRACTObjectives:To perform a meta-analysis of clinical studies on the differences in treatment or research decision-making capacity among patients with Mild Cognitive Impairment (MCI), Alzheimer's disease (AD), and healthy comparisons (HCs).Design:A systematic search was conducted on Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus. Standardized mean differences and random-effects model were used in all cases.Setting:The United States, France, Japan, and China.Participants:Four hundred and ten patients with MCI, 149 with AD, and 368 HCs were included.Measurements:The studies we included in the analysis assessed decisional capacity to consent by the MacArthur Competence Assessment Tool for Treatment (MAcCAT-T), MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), Capacity to Consent to Treatment Instrument (CCTI), and University of California Brief Assessment of Capacity to Consent (UBACC).Results:We identified 109 potentially eligible studies from 1672 records, and 7 papers were included in the meta-analysis. The meta-analysis showed that there was significant impairment in a decision-making capacity in MCI patients compared to the HCs group in terms of Understanding (SMD = −1.04, 95% CI: −1.31 to −0.77, P < 0.001; I2 = 52%, P = 0.07), Appreciation (SMD = −0.51, 95% CI: −0.66 to −0.36, P < 0.001; I2 = 0%, P = 0.97), and Reasoning (SMD = −0.62, 95% CI: −0.77, −0.47, P < 0.001; I2=0%, P =0.46). MCI patients scored significantly higher in Understanding (SMD = 1.50, 95% CI: 0.91, 2.09, P = 0.01, I2 = 78%, P = 0.00001) compared to patients affected by AD.Conclusions:Patients affected by MCI are at higher risk of impaired capacity to consent to treatment and research compared to HCs, despite being at lower risk compared to patients affected by AD. Clinicians and researchers need to carefully evaluate decisional capacity in MCI patients providing informed consent

Psychological Health Status of Psychiatric Patients Living in Treatment Communities before and during the COVID-19 Lockdown: A Brief Report

Many studies investigated the psychological impact of lockdown measures on the general population, while few studies focused on the psychiatric population. This study aimed to investigate the role of therapeutic communities in the management and containment of symptoms of patients with psychosis living in psychiatric residential facilities. Data were collected at two different points: November 2019 (Coronavirus disease 19 had not yet spread) and April 2020 (during the lockdown in Italy). Twenty-two study participants were recruited from three residential accredited psychiatric facilities. During lockdown, the patients showed a small increase in symptomatology in terms of emotional isolation. In addition, it was been observed significant differences in certain functional areas of the behavior, measured as lower inclination towards violent behaviors during lockdown, and higher scores in substance abuse and medical impairment. The lockdown condition could represent a form of containment; daily routines, along with adequate social support, are important aspects of the stability and the level of behavioral functioning of psychiatric patients. Social support and continuity of care offered by psychiatric communities can be an effective safeguard against the psychological impact of the COVID-19 epidemic

Sexual Habits and Sexual Dysfunctions in a Sample of Patients with Psychotic Disorders Compared to a Group of Healthy Adults

Background: There is a growing body of literature on the association between psychosis and sexual dysfunction. However, most studies have focused on sexual dysfunction and have not investigated the sexual lives of patients with psychosis across a broader range. Material and Methods: Consecutive patients with a diagnosis of acute psychosis or schizophrenia were recruited to the study after obtaining informed consent (n = 46). In addition, healthy control subjects were recruited (n = 52). Sociodemographic and clinical data, psychopathology, and sexual functioning were assessed. Independent sample t-test to determine group differences was obtained. Results: In both the male and female groups, there are significant differences between psychotic individuals and healthy controls in several areas of their sexual functioning: the control group seemed to better perceive Couple sexuality, Self-eroticism, and overall appeared to have a higher Quality of sexual life; on the other hand, the group of patients with psychosis displayed higher scores in Sexual dysfunction. Conclusions: A poor sexual quality of life may be found in patients with psychotic disorders. Assessment of sexual function in these patients is necessary to identify and manage issues and provide support and help to patients in this important area of life

Evaluation of Official Procedures for Suicide Prevention in Hospital From a Forensic Psychiatric and a Risk Management Perspective

Background: Suicide is a severe public health problem, in 2008 the Italian ministerial recommendation n° 4 on the management of suicide defined key areas for the identification of suicidal risk in hospital wards. The guidelines are important in defining professional liability issues, in line with Law 24 of 8/3/2017 'Gelli-Bianco'. Our study aimed to investigate the appropriateness of the official documents on suicide prevention delivered by Italian hospitals and their compliance with the ministerial recommendation.Methods: The Italian hospitals' public procedures on suicide prevention issued between 2008 and 2019 (n = 33) were retrieved thorough web search and further evaluated according to their compliance with the 2008 Italian ministerial recommendations.Results: The guidelines documents were generally in line with the ministerial recommendation. However, we found a lack of implementation in the specific training of health professionals. Most guidelines provided no risk stratification, nor specific procedures for different risk degrees or diagnoses. More than half of the documents did not report standardised tools for the assessment of suicidal risk.Conclusions: The public procedures on suicide prevention in Italian hospitals present general indications, leaving room for interpretation. Public procedures should be implemented with greater attention to the elements of judgement in the assessment of suicidal risk.KEY POINTSProcedures for suicide prevention are of uttermost importance for psychiatrist working in hospital.Standards in suicide risk evaluations are needed.Comparison between procedures can improve risk assessment and evaluatio

Managing and preventing acts of violence against health workers: results of a review evaluating hospital control procedures

Purpose – Violence against health-care workers represents a public health issue that affects individuals, organizations and may have legal consequences. In Italy, workplace violence (WPV) constitutes a ‘‘sentinel event’’, defined as a particularly serious, potentially avoidable adverse event, which may result in death or serious harm to health-care workers, and which leads to a loss of public confidence in the health-care system. In 2007, the Italian Ministry of Health issued Recommendation No. 8, ‘‘Preventing acts of violence against health workers’’, inviting each Italian Hospital to develop procedures and guidelines for dealing with and preventing acts of aggression. This study aimed at investigating the appropriateness of the procedures and guidelines developed by the Italian hospitals. Design/methodology/approach – Procedures on preventing violence against health-care workers published by 29 Italian Hospitals between 2007 and 2020 were collected retrospectively via Web searches and further evaluated according to their compliance with the 2007 Italian ministerial recommendations. Findings – A total of 9 documents out of 29 were fully compliant with the 2007 Ministerial Recommendation, 18 were partially compliant, while 2 were totally non-compliant. A total of 24 documents explicitly addressed the management of verbal and physical aggression, whereas 20 set appropriate training on de-escalation techniques for nurses and medical staff. Psychological support was fully considered in 11 procedures, partially considered in 14, while not included at all in 4. Originality/value – Public procedures on preventing violence against health-care workers in Italian hospitals are scarcely compliant with the Ministerial Recommendations. The absence of specific instructions to address the needs at territorial level and the lack of support provided to health-care workers is a weak point in the effectivemanagement of WPV