Hartvig Pål, Alfarnes Svein, Ostberg Bjørn, Skjønberg Mona, Moger Tron A
Centre for Research and Education in Forensic Psychiatry, Ullevaal University Hospital, Bygg 7, Gaustad, NO-0320, Oslo, Norway.
Nord J Psychiatry. 2006;60(3):243-8. doi: 10.1080/08039480600780532.
Violence risk assessment instruments are increasingly being used. Their use has, however, mostly been confined to forensic psychiatry for assessing the risk among perpetrators to repeat violent acts. In general psychiatry, very few studies of violence risk among discharged persons from acute inpatient units have been conducted. The available instruments are extensive and time consuming. This study aimed at the construction of a brief checklist. A 33-item scale, the PS (Preliminary Scheme), strongly influenced by the established HCR-20 (Historical, Clinical and Risk Management Assessment Scheme) was developed to undergo logistic regression analysis and possible item reduction. One hundred and ten patients from an acute inpatient unit, scored with PS at discharge, were monitored for violent episodes throughout the following year. Risk assessments and violence registrations were then compared. Of the 110 patients, 29 (26%) had acted violently during the follow-up, with the PS showing a definite association with post-discharge violence. Receiver operating characteristics (ROC) for the instrument yielded an area under the curve (AUC) of 0.71 (P<0.01). Regression analysis indicated that the number of PS items could be strongly reduced without losing predictive validity. Even a four-item checklist showed a higher AUC (0.77) than the PS did with all 33 items. The four items were: 1) Previous violence, 2) Substance use problems, 3) Lack of empathy and 4) Stress. The development of a brief risk assessment instrument with good predictive properties seems possible. Further clinical trials are planned. Ethical aspects of violence prediction must always be considered.
暴力风险评估工具的使用越来越广泛。然而，其应用大多局限于法医精神病学领域，用于评估犯罪者再次实施暴力行为的风险。在普通精神病学中，针对急性住院部出院患者的暴力风险研究极少。现有的评估工具内容繁多且耗时。本研究旨在构建一份简短的检查表。我们开发了一个受既定的HCR - 20（历史、临床和风险管理评估方案）强烈影响的包含33个条目的量表，即PS（初步方案），以进行逻辑回归分析及可能的条目删减。对来自急性住院部的110名患者在出院时进行PS评分，并在接下来的一年中监测其暴力事件。然后将风险评估与暴力记录进行比较。在这110名患者中，29名（26%）在随访期间有暴力行为，PS显示出与出院后暴力行为有明确关联。该工具的受试者工作特征曲线（ROC）下的面积（AUC）为0.71（P<0.01）。回归分析表明，PS条目的数量可以大幅减少而不丧失预测效度。即便一个四项检查表的AUC（0.77）也高于包含所有33个条目的PS。这四个条目分别是：1）既往暴力史，2）物质使用问题，3）缺乏同理心，4）压力。开发一种具有良好预测性能的简短风险评估工具似乎是可行的。计划开展进一步的临床试验。暴力预测的伦理问题必须始终予以考虑。
