National Forensic Mental Health Service, Central Mental Hospital, Dublin 14, Dundrum, Ireland.
BMC Psychiatry. 2013 Jul 27;13:197. doi: 10.1186/1471-244X-13-197.
The START and SAPROF are newly developed fourth generation structured professional judgement instruments assessing strengths and protective factors. The DUNDRUM-3 and DUNDRUM-4 also measure positive factors, programme completion and recovery in forensic settings.
We compared these instruments with other validated risk instruments (HCR-20, S-RAMM), a measure of psychopathology (PANSS) and global function (GAF). We prospectively tested whether any of these instruments predict violence or self harm in a secure hospital setting (n = 98) and whether they had true protective effects, interacting with and off-setting risk measures.
SAPROF and START-strengths had strong inverse (negative) correlations with the HCR-20 and S-RAMM. SAPROF correlated strongly with GAF (r = 0.745). In the prospective in-patient study, SAPROF predicted absence of violence, AUC = 0.847 and absence of self-harm AUC = 0.766. START-strengths predicted absence of violence AUC = 0.776, but did not predict absence of self-harm AUC = 0.644. The DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales also predicted in-patient violence (AUC 0.832 and 0.728 respectively), and both predicted in-patient self-harm (AUC 0.750 and 0.713 respectively). When adjusted for the HCR-20 total score however, SAPROF, START-S, DUNDRUM-3 and DUNDRUM-4 scores were not significantly different for those who were violent or for those who self harmed. The SAPROF had a significant interactive effect with the HCR-dynamic score. Item to outcome studies often showed a range of strengths of association with outcomes, which may be specific to the in-patient setting and patient group studied.
The START and SAPROF, DUNDRUM-3 and DUNDRUM-4 can be used to assess both reduced and increased risk of violence and self-harm in mentally ill in-patients in a secure setting. They were not consistently better than the GAF, HCR-20, S-RAMM, or PANSS when predicting adverse events. Only the SAPROF had an interactive effect with the HCR-20 risk assessment indicating a true protective effect but as structured professional judgement instruments all have additional content (items) complementary to existing risk assessments, useful for planning treatment and risk management.
START 和 SAPROF 是新开发的第四代结构化专业判断工具，用于评估优势和保护因素。DUNDRUM-3 和 DUNDRUM-4 也在法医环境中测量积极因素、方案完成情况和康复情况。
我们将这些工具与其他经过验证的风险工具（HCR-20、S-RAMM）、精神病理学量表（PANSS）和一般功能量表（GAF）进行了比较。我们前瞻性地测试了这些工具是否可以预测安全医院环境中的暴力或自残行为（n=98），以及它们是否具有真正的保护作用，是否可以与风险措施相互作用和抵消。
SAPROF 和 START 优势与 HCR-20 和 S-RAMM 呈强烈的负相关。SAPROF 与 GAF 相关性很强（r=0.745）。在前瞻性住院研究中，SAPROF 预测无暴力发生的 AUC 值为 0.847，预测无自残发生的 AUC 值为 0.766。START 优势预测无暴力发生的 AUC 值为 0.776，但预测无自残发生的 AUC 值为 0.644。DUNDRUM-3 方案完成和 DUNDRUM-4 恢复量表也预测住院暴力（AUC 分别为 0.832 和 0.728），并且都预测住院自残（AUC 分别为 0.750 和 0.713）。然而，当调整 HCR-20 总分后，SAPROF、START-S、DUNDRUM-3 和 DUNDRUM-4 得分在暴力者和自残者之间没有显著差异。SAPROF 与 HCR 动态评分具有显著的交互作用。项目到结果研究通常显示出与结果相关的一系列关联强度，这可能特定于住院环境和所研究的患者群体。
在安全环境中，START 和 SAPROF、DUNDRUM-3 和 DUNDRUM-4 可用于评估精神病住院患者暴力和自残风险的降低和增加。在预测不良事件时，它们并不总是优于 GAF、HCR-20、S-RAMM 或 PANSS。只有 SAPROF 与 HCR-20 风险评估具有交互作用，表明具有真正的保护作用，但作为结构化专业判断工具，它们都具有与现有风险评估互补的额外内容（项目），有助于治疗计划和风险管理。
