Swogger M T, Walsh Z, Homaifar B Y, Caine E D, Conner K R
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
University of British Columbia, Okanagan, Canada.
Psychol Med. 2012 Feb;42(2):371-9. doi: 10.1017/S0033291711001243. Epub 2011 Jul 18.
We examined the extent to which trait anger and psychopathic traits predicted post-discharge self-directed violence (SDV) and other-directed violence (ODV) among psychiatric patients.
Participants were 851 psychiatric patients sampled from in-patient hospitals for the MacArthur Violence Risk Assessment Study (MVRAS). Participants were administered baseline interviews at the hospital and five follow-up interviews in the community at approximately 10-week intervals. Psychopathy and trait anger were assessed with the Psychopathy Checklist: Screening Version (PSC:SV) and the Novaco Anger Scale (NAS) respectively. SDV was assessed during follow-ups with participants and ODV was assessed during interviews with participants and collateral informants. Psychopathy facets and anger were entered in logistic regression models to predict membership in one of four groups indicating violence status during follow-up: (1) SDV, (2) ODV, (3) co-occurring violence (COV), and (4) no violence.
Anger predicted membership in all three violence groups relative to a non-violent reference group. In unadjusted models, all psychopathy facets predicted ODV and COV during follow-up. In adjusted models, interpersonal and antisocial traits of psychopathy predicted membership in the ODV group whereas only antisocial traits predicted membership in the COV group.
Although our results provide evidence for a broad role for trait anger in predicting SDV and ODV among discharged psychiatric patients, they suggest that unique patterns of psychopathic traits differentially predict violence toward self and others. The measurement of anger and facets of psychopathy during discharge planning for psychiatric patients may provide clinicians with information regarding risk for specific types of violence.
我们研究了特质愤怒和精神病态特质在预测精神科患者出院后自我导向暴力（SDV）和他人导向暴力（ODV）方面的程度。
参与者为851名从住院医院抽取的精神科患者，参与麦克阿瑟暴力风险评估研究（MVRAS）。参与者在医院接受基线访谈，并在社区接受五次随访访谈，间隔约为10周。分别使用精神病态检查表：筛查版（PSC:SV）和诺瓦科愤怒量表（NAS）评估精神病态和特质愤怒。随访期间对参与者评估SDV，访谈参与者和旁系 informant 时评估ODV。将精神病态方面和愤怒纳入逻辑回归模型，以预测随访期间表明暴力状态的四个组之一的成员身份：（1）SDV，（2）ODV，（3）并发暴力（COV），以及（4）无暴力。
相对于非暴力参考组，愤怒可预测所有三个暴力组的成员身份。在未调整的模型中，所有精神病态方面在随访期间都可预测ODV和COV。在调整后的模型中，精神病态的人际和反社会特质可预测ODV组的成员身份，而只有反社会特质可预测COV组的成员身份。
虽然我们的结果为特质愤怒在预测出院精神科患者的SDV和ODV方面的广泛作用提供了证据，但它们表明精神病态特质的独特模式对自我和他人的暴力有不同的预测作用。在精神科患者出院计划期间测量愤怒和精神病态方面的内容，可能会为临床医生提供有关特定类型暴力风险的信息。
