Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
Int J Law Psychiatry. 2021 May-Jun;76:101701. doi: 10.1016/j.ijlp.2021.101701. Epub 2021 Apr 19.
Although the absolute risk of violence is small for individuals with mental illnesses, a specific subgroup of individuals who appear to be at increased risk for violence includes young people experiencing emerging or early psychosis. Prior research has identified risk factors for violence in this population, though no prior studies using a formal risk assessment tool have been identified. This study used the Historical Clinical Risk Management-20, version 3 (HCR-20) to identify risk of future violence among a sample of young adults with early psychosis and relevant predictors of risk unique to this population.
The HCR-20 was administered to a sample of young adults with early psychosis (N = 53) enrolled at one OnTrackNY site, part of a statewide program providing early intervention services to young adults presenting with a first episode of non-affective psychosis. A Confirmatory Factor Analysis (CFA) was conducted to explore the relative importance of the HCR-20 items for this population.
The average age of participants was 21.9 years (SD 3.6 years) and most were male (69.8%, n = 37). Most patients were assessed to be at low risk for future violence based on the Case Prioritization summary risk rating (67.9%, n = 36). The CFA identified 4 items that were not of relative predictive value in identifying the risk of violence in this sample: history of substance use (item H5), history of major mental disorder (item H6), living situation (item R2), and personal support (item R3).
This study presents a formal approach to assessing violence risk in a population at elevated risk of violence, demonstrates the feasibility of using a standardized risk assessment tool in early intervention services, and identifies factors of particular importance associated with predicting violence in this population. Future research should implement violence risk assessment with a structured tool such as the HCR-20 and assess its accuracy in predicting future violent behavior in this setting.
尽管患有精神疾病的个体发生暴力行为的绝对风险较小，但有一个特定的亚组个体似乎具有更高的暴力风险，包括出现或早期精神病的年轻人。先前的研究已经确定了该人群发生暴力行为的风险因素，但没有发现使用正式风险评估工具的先前研究。本研究使用历史临床风险管理-20 版 3（HCR-20）来确定早期精神病患者样本中未来暴力行为的风险，以及该人群特有的风险预测因素。
在 OnTrackNY 站点之一的一个样本中，对年轻的早期精神病患者（N=53）进行 HCR-20 测试，该站点是全州范围内为出现首发非情感性精神病的年轻成年人提供早期干预服务的项目的一部分。进行验证性因素分析（CFA）以探索 HCR-20 项目对该人群的相对重要性。
参与者的平均年龄为 21.9 岁（SD 3.6 岁），大多数为男性（69.8%，n=37）。大多数患者根据病例优先综合风险评分被评估为未来暴力风险低（67.9%，n=36）。CFA 确定了 4 个在本样本中识别暴力风险时没有相对预测价值的项目：物质使用史（项目 H5）、重大精神障碍史（项目 H6）、生活状况（项目 R2）和个人支持（项目 R3）。
本研究提出了一种正式的方法来评估高暴力风险人群的暴力风险，展示了在早期干预服务中使用标准化风险评估工具的可行性，并确定了与预测该人群暴力行为特别相关的因素。未来的研究应该使用 HCR-20 等结构化工具进行暴力风险评估，并评估其在该环境中预测未来暴力行为的准确性。
