School of Psychology and Humanities, University of Central Lancashire, Preston, UK.
Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.
Aggress Behav. 2024 May;50(3):e22150. doi: 10.1002/ab.22150.
Structured clinical risk assessments represent a preferred means of assessing levels of aggression risk at different times and in different individuals. Increasing attention has been given to capturing protective factors, with sound risk assessment critical to high-secure forensic mental health care. The aim was to assess the predictive value of the HCR-20 for aggression risk and the long-term care pilot version of the SAPROF (the SAPROF-LC-pilot) in a high-secure forensic mental health inpatient population and to determine the incremental value of protective over risk factors. Participants were adult males detained in a high secure forensic mental health service, with a primary diagnosis of schizophrenia and/or personality disorder. The focus was on examining hospital based aggression (self- and other-directed) at two time points; up to 6 months (T1) and between 7 and 12 months (T2). The HCR-20 and SAPROF-LC-pilot demonstrated good predictive validity but with variability across subscales and aggression types/periods. Historical factors of the HCR-20 and External factors of the SAPROF-LC-pilot failed to predict, aside from a medium effect at T1 for verbal aggression and self-harm, for Historical factors. There was evidence for protective factors adding to prediction over risk factors alone, with the integration of protective and risk factors into a risk judgement particularly helpful in improving prediction accuracy. Protective factors contributed to risk estimates and particularly if integrated with risk factors. Combining risk and protective factors has clear predictive advantages, ensuring that protective factors are not supplementary but important to the aggression assessment process.
结构化临床风险评估代表了在不同时间和不同个体评估攻击风险水平的首选方法。越来越多的人开始关注保护因素，而健全的风险评估对于高度安全的法医心理健康护理至关重要。目的是评估 HCR-20 对攻击风险的预测价值以及 SAPROF 的长期护理试点版本（SAPROF-LC-pilot）在高度安全的法医心理健康住院患者人群中的预测价值，并确定保护因素相对于风险因素的增量价值。参与者是被拘留在高度安全的法医心理健康服务机构的成年男性，主要诊断为精神分裂症和/或人格障碍。重点是在两个时间点检查医院内的攻击行为（自我和他人指向）：长达 6 个月（T1）和 7 至 12 个月（T2）之间。HCR-20 和 SAPROF-LC-pilot 表现出良好的预测有效性，但各子量表和攻击类型/期间存在差异。HCR-20 的历史因素和 SAPROF-LC-pilot 的外部因素除了 T1 时言语攻击和自残的中等效应外，无法预测。有证据表明保护因素可增加对风险因素的预测，将保护因素和风险因素整合到风险判断中特别有助于提高预测准确性。保护因素有助于风险估计，特别是如果与风险因素相结合。将风险和保护因素结合起来具有明显的预测优势，确保保护因素不是补充性的，而是对攻击评估过程很重要。
