Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
The Oxford Clinic, Littlemore Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.
Nord J Psychiatry. 2023 Apr;77(3):240-246. doi: 10.1080/08039488.2022.2084158. Epub 2022 Jun 13.
Risk assessment is integral to forensic psychiatry. Previous work has highlighted the benefits of using scalable and evidence-based actuarial risk tools developed within forensic populations, such as the online Forensic Psychiatry and Violence Oxford (FoVOx) violence risk assessment tool. We examined the feasibility of using FoVOx in a Swedish forensic cohort and tested whether adding modifiable (dynamic) factors would increase its useability to clinicians.
We completed FoVOx assessments on all patients discharged from forensic psychiatric hospitals in Stockholm County, Sweden, between 2012 and 2017 and investigated recidivism rates. In addition, interviews were conducted with the clinicians responsible for each patient on the perceived accuracy, usefulness, and impact of FoVOx, which was examined using thematic analysis.
Ninety-five discharges from forensic psychiatric hospitals were followed up. The median FoVOx score was a 7% likelihood of violent reoffending in two years after discharge. Six discharged patients (6%) were confirmed as violent recidivists using official records with a similar distribution of FoVOx risk categories as the rest of the sample. FoVOx was considered accurate by clinicians in more than half of cases, who suggested that modifiable risk factors could be added to increase acceptability. All clinicians thought that FoVOx was useful, and in 20% of discharges, it would have materially altered patient care. Overall, FoVOx was thought to impact decision-making and risk management, was practical to use, and could be completed without reference to written case material.
Completing FoVOx in forensic psychiatric hospitals can complement current approaches to clinical decision-making on violence risk assessment and management.
风险评估是法医精神病学的重要组成部分。之前的工作强调了使用在法医人群中开发的可扩展和基于证据的评估工具（如在线法医精神病学和暴力牛津（FoVOx）暴力风险评估工具）的好处。我们考察了在瑞典法医队列中使用 FoVOx 的可行性，并测试了添加可修改（动态）因素是否会提高其对临床医生的可用性。
我们对 2012 年至 2017 年间从斯德哥尔摩县瑞典法医精神病院出院的所有患者完成了 FoVOx 评估，并调查了累犯率。此外，我们对负责每位患者的临床医生进行了访谈，了解他们对 FoVOx 的准确性、有用性和影响的看法，使用主题分析对其进行了检验。
对 95 名从法医精神病院出院的患者进行了随访。FoVOx 评分中位数为两年内再次发生暴力犯罪的可能性为 7%。使用官方记录确认了 6 名出院患者（6%）为暴力累犯，其 FoVOx 风险类别分布与样本其余部分相似。FoVOx 在超过一半的情况下被临床医生认为是准确的，他们建议可以添加可修改的风险因素来提高可接受性。所有临床医生都认为 FoVOx 有用，在 20%的出院患者中，它将极大地改变患者的护理。总体而言，FoVOx 被认为会影响决策和风险管理，使用起来很实用，并且无需参考书面病例材料即可完成。
在法医精神病院中完成 FoVOx 可以补充当前在暴力风险评估和管理方面进行临床决策的方法。
