Mental Health Street Team of Madrid (ECASAM) of the Psychiatric Care Programme for Homeless Mentally Ill Persons. Madrid.
Institute of Psychiatry and Mental Health. Hospital Clínico San Carlos. Madrid.
Rev Esp Sanid Penit. 2020 Jan-Apr;22(1):23-31. doi: 10.18176/resp.0004. Epub 2020 Apr 27.
To examine the predictive validity of the HCR-20 (The Historical Clinical Risk Management-20) to predict future violent incidents in a representative sample of patients with severe mental disorders and with a history of previous admission to prison, who after release are in a situation of extreme social exclusion.
The study sample was selected from the 235 patients treated by the Mental Health Street Team of Madrid (ECASAM) from June 2014 to June 2017, including those with a previous history of a previous internment in a penitentiary (about which, the HCR-20 was completed).
Of the 44 patients included, 29.6% (n=13) ended up participating in a violent incident after the release. The ROC curves (Receiver Operating Characteristic) analysis indicated that the total score of HCR-20 (AUC 0.98, p=0.01) has a high predictive validity.
The social and medical changes that take place after the release of patients with severe mental illness justify the need to reassess the risk of violence. In this evaluation, the HCR-20 guide is a useful tool for predicting the risk of involvement in future violent incidents, and the inclusion of factors such as social exclusion and its consequences, as well as problems with substance use is especially important.
在一个具有严重精神障碍病史和曾入狱史的代表性患者样本中，检验 HCR-20（历史临床风险管理-20）对未来暴力事件的预测效度，这些患者在出狱后面临极端的社会排斥。
本研究的样本选自马德里精神卫生街头小组（ECASAM） 2014 年 6 月至 2017 年 6 月期间治疗的 235 名患者，其中包括曾有入狱史的患者（对此，完成了 HCR-20）。
在纳入的 44 名患者中，29.6%（n=13）在出狱后最终参与了暴力事件。ROC 曲线（Receiver Operating Characteristic）分析表明，HCR-20 的总分（AUC 0.98，p=0.01）具有较高的预测效度。
严重精神疾病患者出狱后发生的社会和医疗变化，证明了有必要重新评估暴力风险。在这种评估中，HCR-20 指南是预测未来暴力事件风险的有用工具，特别重要的是纳入社会排斥及其后果以及物质使用问题等因素。
