Community Based Medicine, Adult Forensic Mental Health Services, Greater Manchester West NHS Mental Health Foundation Trust, University of Manchester, Room 2.311 2nd Floor, Jean McFarlane Building, University Place, Manchester M13 9PL, UK.
Soc Psychiatry Psychiatr Epidemiol. 2012 Apr;47(4):627-37. doi: 10.1007/s00127-011-0366-8. Epub 2011 Mar 10.
To investigate the validity of risk factors and established risk measures in predicting community violence in an acute mental health sample up to 20 weeks post-discharge.
Prospective cohort follow-up study conducted between January 2006 and August 2007. Baseline assessments were conducted while participants were inpatients. The measures were rated following interview with the participants, record review and speaking to someone who knows the person well (e.g. friend, relative, carer). Baseline measures were then compared with frequency and severity of violence in the community post-discharge at 20 weeks.
In the 20-week period post-discharge, 29 (25.4%) of the 114 participants were violent. All the risk measures and measures of impulsiveness and anger were predictive of violence where p < 0.05. The HCR-20 total, psychopathy and clinical factors were strongly correlated with the frequency of violence where p < 0.05.
The risk factors and risk measures that have been found to be predictive in forensic samples are also predictive in acute mental health samples, although the effects are not as large. Future research needs to be conducted with a larger sample to include investigation of differences in risk factors based on gender and social support. Services and clinicians need to consider how to integrate findings into useful frameworks to support decisions and contribute to managing risk. This should assist in identifying interventions aimed at preventing community violence.
调查风险因素和既定风险指标在预测急性心理健康样本出院后 20 周内社区暴力方面的有效性。
2006 年 1 月至 2007 年 8 月期间进行前瞻性队列随访研究。在参与者住院期间进行基线评估。通过与参与者面谈、病历审查以及与了解他们的人（如朋友、亲戚、护理人员）交谈来评估这些指标。然后将基线指标与出院后 20 周内社区暴力的频率和严重程度进行比较。
在出院后的 20 周内，114 名参与者中有 29 名（25.4%）发生暴力行为。所有风险指标以及冲动和愤怒指标均具有预测暴力行为的能力，p 值均小于 0.05。HCR-20 总分、精神病理和临床因素与暴力行为的频率密切相关，p 值小于 0.05。
在法医样本中被发现具有预测性的风险因素和风险指标在急性心理健康样本中也具有预测性，尽管效果不那么显著。未来的研究需要扩大样本量，包括根据性别和社会支持差异调查风险因素。服务机构和临床医生需要考虑如何将研究结果纳入有用的框架，以支持决策并有助于管理风险。这有助于确定旨在预防社区暴力的干预措施。
