Department of Psychiatry, National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Psychiatry, University of Oxford, Oxford, UK.
BMC Psychiatry. 2021 Mar 2;21(1):120. doi: 10.1186/s12888-021-03115-3.
Violence risk assessment is a routine part of clinical services in mental health, and in particular secure psychiatric hospitals. The use of prediction models and risk tools can assist clinical decision-making on risk management, including decisions about further assessments, referral, hospitalization and treatment. In recent years, scalable evidence-based tools, such as Forensic Psychiatry and Violent Oxford (FoVOx), have been developed and validated for patients with mental illness. However, their acceptability and utility in clinical settings is not known. Therefore, we conducted a clinical impact study in multiple institutions that provided specialist mental health service.
We followed a two-step mixed-methods design. In phase one, we examined baseline risk factors on 330 psychiatric patients from seven forensic psychiatric institutes in China. In phase two, we conducted semi-structured interviews with 11 clinicians regarding violence risk assessment from ten mental health centres. We compared the FoVOx score on each admission (n = 110) to unstructured clinical risk assessment and used a thematic analysis to assess clinician views on the accuracy and utility of this tool.
The median estimated probability of violent reoffending (FoVOx score) within 1 year was 7% (range 1-40%). There was fair agreement (72/99, 73% agreement) on the risk categories between FoVOx and clinicians' assessment on risk categories, and moderate agreement (10/12, 83% agreement) when examining low and high risk categories. In a majority of cases (56/101, 55%), clinicians thought the FoVOx score was an accurate representation of the violent risk of an individual patient. Clinicians suggested some additional clinical, social and criminal risk factors should be considered during any comprehensive assessment. In addition, FoVOx was considered to be helpful in assisting clinical decision-making and individual risk assessment. Ten out of 11 clinicians reported that FoVOx was easy to use, eight out of 11 was practical, and all clinicians would consider using it in the future.
Clinicians found that violence risk assessment could be improved by using a simple, scalable tool, and that FoVOx was feasible and practical to use.
暴力风险评估是精神卫生临床服务的常规组成部分，尤其是在安全精神病院。预测模型和风险工具的使用可以协助风险管理的临床决策，包括关于进一步评估、转介、住院和治疗的决策。近年来，为精神疾病患者开发并验证了可扩展的基于证据的工具，例如法医精神病学和暴力牛津（FoVOx）。然而，其在临床环境中的可接受性和实用性尚不清楚。因此，我们在中国的七个法医精神病院进行了一项多机构临床影响研究。
我们采用了两步混合方法设计。在第一阶段，我们对来自中国七个法医精神病院的 330 名精神病患者进行了基线风险因素检查。在第二阶段，我们对来自十个心理健康中心的 11 名临床医生进行了关于暴力风险评估的半结构式访谈。我们比较了 FoVOx 每个入院患者的分数（n=110）与非结构化临床风险评估，并使用主题分析评估了临床医生对该工具准确性和实用性的看法。
1 年内暴力再犯罪的估计概率（FoVOx 分数）中位数为 7%（范围 1-40%）。在风险类别方面，FoVOx 与临床医生的评估之间存在中等程度的一致性（72/99，73%的一致性），而在低风险类别和高风险类别方面存在中度一致性（10/12，83%的一致性）。在大多数情况下（56/101，55%），临床医生认为 FoVOx 分数准确反映了个体患者的暴力风险。临床医生建议在任何全面评估中都应考虑一些额外的临床、社会和犯罪风险因素。此外，FoVOx 被认为有助于协助临床决策和个体风险评估。11 名临床医生中的 10 名报告 FoVOx 易于使用，11 名中的 8 名报告 FoVOx 实用，所有临床医生都表示将来会考虑使用它。
临床医生发现，使用简单、可扩展的工具可以改善暴力风险评估，并且 FoVOx 易于使用且实用。
