Penney Stephanie R, Marshall Lisa A, Simpson Alexander I F
Centre for Addiction and Mental Health.
Ontario Shores Centre for Mental Health Sciences.
Law Hum Behav. 2016 Aug;40(4):374-86. doi: 10.1037/lhb0000183. Epub 2016 Feb 25.
Individuals with serious mental illness (SMI; i.e., psychotic or major mood disorders) are vulnerable to experiencing multiple forms of adverse safety events in community settings, including violence perpetration and victimization. This study investigates the predictive validity and clinical utility of modifiable risk factors for violence in a sample of 87 forensic psychiatric patients found Not Criminally Responsible on Account of Mental Disorder (NCRMD) transitioning to the community. Using a repeated-measures prospective design, we assessed theoretically based dynamic risk factors (e.g., insight, psychiatric symptoms, negative affect, treatment compliance) before hospital discharge, and at 1 and 6 months postdischarge. Adverse outcomes relevant to this population (e.g., violence, victimization, hospital readmission) were measured at each community follow-up, and at 12 months postdischarge. The base rate of violence (23%) was similar to prior studies of discharged psychiatric patients, but results also highlighted elevated rates of victimization (29%) and hospital readmission (28%) characterizing this sample. Many of the dynamic risk indicators exhibited significant change across time and this change was related to clinically relevant outcomes. Specifically, while controlling for baseline level of risk, fluctuations in dynamic risk factors predicted the likelihood of violence and hospital readmission most consistently (hazard ratios [HR] = 1.35-1.84). Results provide direct support for the utility of dynamic factors in the assessment of violence risk and other adverse community outcomes, and emphasize the importance of incorporating time-sensitive methodologies into predictive models examining dynamic risk. (PsycINFO Database Record
患有严重精神疾病（即精神病性或重度心境障碍）的个体在社区环境中容易遭遇多种形式的不良安全事件，包括暴力行为和成为受害者。本研究调查了87名因精神障碍而被判定无刑事责任能力（NCRMD）并过渡到社区的法医精神病患者样本中，暴力行为可改变风险因素的预测效度和临床效用。采用重复测量前瞻性设计，我们在出院前、出院后1个月和6个月评估了基于理论的动态风险因素（如洞察力、精神症状、消极情绪、治疗依从性）。在每次社区随访时以及出院后12个月测量与该人群相关的不良结局（如暴力行为、成为受害者、再次入院）。暴力行为的基线发生率（23%）与先前对出院精神病患者的研究相似，但结果也凸显了该样本中较高的受害率（29%）和再次入院率（28%）。许多动态风险指标随时间呈现出显著变化，且这种变化与临床相关结局有关。具体而言，在控制风险基线水平的同时，动态风险因素的波动最一致地预测了暴力行为和再次入院的可能性（风险比[HR]=1.35 - 1.84）。结果为动态因素在暴力风险和其他不良社区结局评估中的效用提供了直接支持，并强调了将对时间敏感的方法纳入检查动态风险的预测模型的重要性。（PsycINFO数据库记录）
