This study was funded by the UK National
Institute for Health Research (NIHR) under its
Programme Grants for Applied Research funding
scheme (RP-PG-0407-10500)

AB Hill

CD Webster

Constantinos Kallis

D Cooke

Delphine S. Courvoisier

DG Kroner

E Elbogen

J Bonta

J Coid

J Monahan

Jenny Shaw

Jeremy W. Coid

JK Peterson

JL Skeem

JL Whitwell

K Douglas

L O'Shea

M Doyle

M Yang

MD Schlager

Mike Doyle

MM Large

NAC Troquete

NJ Jones

P Falzer

PD Howard

PR Kropp

PS Appelbaum

R Borum

R Gueorguieva

R Van Dorn

S Brown

S Fazel

S Ullrich

SD Hart

Simone Ullrich

SJ Prins

VL Quinsey

PLoS ONE

PubMed

<div>BackgroundStructured Professional Judgement (SPJ) is routinely administered in mental health and criminal justice settings but cannot identify violence risk above moderate accuracy. There is no current evidence that violence can be prevented using SPJ. This may be explained by routine application of predictive instead of causal statistical models when standardising SPJ instruments.MethodsWe carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Historical, Clinical and Risk-20 items version 3 (HCR-20v3) and Structural Assessment of Protective Factors (SAPROF). Information on violence was obtained via the McArthur community violence instrument and the Police National Computer.ResultsIn a lagged model, HCR-20v3 and SAPROF items were poor predictors of violence. Eight items of the HCR-20v3 and 4 SAPROF items did not predict violent behaviour better than chance. In re-analyses considering temporal proximity of risk/ protective factors (exposure) on violence (outcome), risk was elevated due to violent ideation (OR 6.98, 95% CI 13.85–12.65, P<0.001), instability (OR 5.41, 95% CI 3.44–8.50, P<0.001), and poor coping/ stress (OR 8.35, 95% CI 4.21–16.57, P<0.001). All 3 risk factors were explanatory variables which drove the association with violent outcome. Self-control (OR 0.13, 95% CI 0.08–0.24, P<0.001) conveyed protective effects and explained the association of other protective factors with violence.ConclusionsUsing two standardised SPJ instruments, predictive (lagged) methods could not identify risk and protective factors which must be targeted in interventions for discharged patients with severe mental illness. Predictive methods should be abandoned if the aim is to progress from risk assessment to effective risk management and replaced by methods which identify factors causally associated with violence.</div

Jeremy W. Coid (462419)

Constantinos Kallis (462418)

Mike Doyle (824417)

Jenny Shaw (824418)

Simone Ullrich (824419)

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Identifying Causal Risk Factors for Violence among Discharged Patients

Structured Professional Judgement (SPJ) is routinely administered in mental health and criminal justice settings but cannot identify violence risk above moderate accuracy. There is no current evidence that violence can be prevented using SPJ. This may be explained by routine application of predictive instead of causal statistical models when standardising SPJ instruments.We carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Historical, Clinical and Risk-20 items version 3 (HCR-20v3) and Structural Assessment of Protective Factors (SAPROF). Information on violence was obtained via the McArthur community violence instrument and the Police National Computer.In a lagged model, HCR-20v3 and SAPROF items were poor predictors of violence. Eight items of the HCR-20v3 and 4 SAPROF items did not predict violent behaviour better than chance. In re-analyses considering temporal proximity of risk/ protective factors (exposure) on violence (outcome), risk was elevated due to violent ideation (OR 6.98, 95% CI 13.85-12.65, P<0.001), instability (OR 5.41, 95% CI 3.44-8.50, P<0.001), and poor coping/ stress (OR 8.35, 95% CI 4.21-16.57, P<0.001). All 3 risk factors were explanatory variables which drove the association with violent outcome. Self-control (OR 0.13, 95% CI 0.08-0.24, P<0.001) conveyed protective effects and explained the association of other protective factors with violence.Using two standardised SPJ instruments, predictive (lagged) methods could not identify risk and protective factors which must be targeted in interventions for discharged patients with severe mental illness. Predictive methods should be abandoned if the aim is to progress from risk assessment to effective risk management and replaced by methods which identify factors causally associated with violence

Jeremy W Coid

Directory of Open Access Journals

Identifying Causal Risk Factors for Violence among Discharged Patients.

Coid, JW

Kallis, C

Doyle, M

Shaw, J

Ullrich, S

Queen Mary Research Online

Crossref

https://qmro.qmul.ac.uk/xmlui/bitstream/handle/123456789/13803/Ullrich%20Identifying%20Causal%20Risk%20Factors%202015%20Publsihed.pdf?sequence=1

Identifying Causal Risk Factors for Violence among Discharged Patients

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Directory of Open Access Journals

Queen Mary Research Online

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