Lidz C W, Mulvey E P, Gardner W
Department of Psychiatry, University of Pittsburgh School of Medicine, Pa.
JAMA. 1993 Feb 24;269(8):1007-11.
To assess the accuracy of clinicians in predicting violence in mental patients. Specifically, to determine if clinicians can predict violence when variation in rates of violence attributable to age, race, and sex is controlled.
Two samples of psychiatric patients, matched on age, race, sex, and admission status, were followed up in the community during a 6-month period. One group included individuals assessed by psychiatric emergency department clinicians as likely to be violent to another person during the follow-up period; the other was a comparison group. Patients provided self-reports of violent incidents, and a "collateral," ie, an individual with detailed knowledge of the patient's life, provided this same information. Official records were also reviewed.
Patients were recruited in the emergency department of a metropolitan psychiatric hospital. Patients and collaterals were interviewed in their homes or in public places in the community.
A consecutive sample of individuals coming into a psychiatric emergency department during daylight and evening shifts was obtained. A total of 2452 patients were approached for consent and 1948 consented. A final sample of 357 patients whom clinicians assessed as likely to be violent and their matched comparison patients were included.
Patients', collaterals', and official records' reports of incidents in which the patient laid hands on another person or threatened someone with a weapon.
Violence during the follow-up period was reported in approximately 45% of the cases: 36% in the comparison group and 53% in the cases predicted to be violent. Overall clinical accuracy was significantly better than chance, but predictions of female patients' violence were not better than chance.
The level of patient violence reported using self-reports and collateral reports was higher than has been obtained using other methods. Clinical judgment adds to predictive accuracy, but overall accuracy was modest and particularly low for female patients.
评估临床医生预测精神病患者暴力行为的准确性。具体而言，确定在控制了因年龄、种族和性别导致的暴力发生率差异后，临床医生是否能够预测暴力行为。
选取两组年龄、种族、性别和入院状态相匹配的精神病患者样本，在社区中进行为期6个月的随访。一组包括被精神科急诊科临床医生评估为在随访期间可能对他人实施暴力的个体；另一组为对照组。患者提供暴力事件的自我报告，同时有一名“旁证者”（即对患者生活有详细了解的人）提供相同信息。此外，还查阅了官方记录。
在一家大城市精神病医院的急诊科招募患者。患者和旁证者在其家中或社区公共场所接受访谈。
选取白天和夜间轮班期间进入精神科急诊科的连续样本个体。共接触了2452名患者以征求同意，其中1948名同意参与。最终样本包括357名被临床医生评估为可能实施暴力的患者及其匹配的对照患者。
患者、旁证者以及官方记录中关于患者对他人动手或用武器威胁他人事件的报告。
随访期间约45%的病例报告有暴力行为：对照组为36%，预计有暴力行为的病例组为53%。总体临床预测准确性显著高于随机猜测，但对女性患者暴力行为的预测并不优于随机猜测。
使用自我报告和旁证报告得出的患者暴力行为水平高于使用其他方法所获得的结果。临床判断提高了预测准确性，但总体准确性一般，对女性患者的准确性尤其低。
