Witt Katrina, Lichtenstein Paul, Fazel Seena
Katrina Witt, DPhil, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Paul Lichtenstein, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Seena Fazel, MD, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
Br J Psychiatry. 2015 May;206(5):424-30. doi: 10.1192/bjp.bp.114.144485. Epub 2015 Feb 5.
Violence risk assessment in schizophrenia relies heavily on criminal history factors.
To investigate which criminal history factors are most strongly associated with violent crime in schizophrenia.
A total of 13 806 individuals (8891 men and 4915 women) with two or more hospital admissions for schizophrenia were followed up for violent convictions. Multivariate hazard ratios for 15 criminal history factors included in different risk assessment tools were calculated. The incremental predictive validity of these factors was estimated using tests of discrimination, calibration and reclassification.
Over a mean follow-up of 12.0 years, 17.3% of men (n = 1535) and 5.7% of women (n = 281) were convicted of a violent offence. Criminal history factors most strongly associated with subsequent violence for both men and women were a previous conviction for a violent offence; for assault, illegal threats and/or intimidation; and imprisonment. However, only a previous conviction for a violent offence was associated with incremental predictive validity in both genders following adjustment for young age and comorbid substance use disorder.
Clinical and actuarial approaches to assess violence risk can be improved if included risk factors are tested using multiple measures of performance.
精神分裂症的暴力风险评估在很大程度上依赖于犯罪史因素。
调查哪些犯罪史因素与精神分裂症患者的暴力犯罪关联最为紧密。
对13806名因精神分裂症住院两次或以上的个体（8891名男性和4915名女性）进行随访，以确定其暴力犯罪定罪情况。计算了不同风险评估工具中包含的15个犯罪史因素的多变量风险比。使用区分度、校准和重新分类测试来估计这些因素的增量预测效度。
在平均12.0年的随访期内，17.3%的男性（n = 1535）和5.7%的女性（n = 281）被判有暴力犯罪。与男性和女性随后的暴力行为关联最为紧密的犯罪史因素是曾因暴力犯罪被定罪；因袭击、非法威胁和/或恐吓被定罪；以及曾被监禁。然而，在对年轻年龄和合并物质使用障碍进行调整后，只有曾因暴力犯罪被定罪与两性的增量预测效度相关。
如果使用多种性能指标对纳入的风险因素进行测试，那么评估暴力风险的临床和精算方法可能会得到改进。
