1
|
Zhong S, Wang J, Guo H, Zhou J, Wang X. A clinical risk prediction tool for identifying the risk of violent offending in severe mental illness: A retrospective case-control study. J Psychiatr Res 2023; 163:172-179. [PMID: 37210836 DOI: 10.1016/j.jpsychires.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/05/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Individuals with severe mental illness are at a higher risk of violence than the general population. However, there is a lack of available and simple tools to screen for the risk of violent offending in clinical settings. We aimed to develop an easy-to-use predictive tool to assist clinicians' decision-making to identify risk of violent offences in China. METHODS We identified 1157 patients with severe mental illness who committed violent offending and 1304 patients who were not suspected of violent offending in the matched living areas. We used stepwise regression and Lasso's method to screen for predictors, built a multivariate logistic regression model, and performed internal validation with the 10- fold cross-validation to develop the final prediction model. RESULTS The risk prediction model for violence in severe mental illness included age (beta coefficient (b) = 0.05), male sex (b = 2.03), education (b = 1.14), living in rural areas (b = 1.21), history of homeless (b = 0.62), history of previous aggression (b = 1.56), parental history of mental illness (b = 0.69), diagnosis of schizophrenia (b = 1.36), episodes (b = -2.23), duration of illness (b = 0.01). The area under curve for the predictive model for the risk of violence in severe mental illness was 0.93 (95% CI: 0.92-0.94). CONCLUSIONS In this study, we developed a predictive tool for violent offending in severe mental illness, containing 10 items that can be easily used by healthcare practitioners. The model was internally validated and has the potential for assessing the risk of violence in patients with severe mental illness in community routine care, although external validation is necessary.
Collapse
Affiliation(s)
- Shaoling Zhong
- Department of Psychiatry & National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan Province, 410011, China; Department of Community Mental Health, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510370, China
| | - Jun Wang
- Department of Clinical Psychology, The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, 214151, China
| | - Huijuan Guo
- Department of Psychiatry & National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan Province, 410011, China
| | - Jiansong Zhou
- Department of Psychiatry & National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan Province, 410011, China
| | - Xiaoping Wang
- Department of Psychiatry & National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital, Central South University, Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan Province, 410011, China.
| |
Collapse
|
2
|
Fazel S, Burghart M, Fanshawe T, Gil SD, Monahan J, Yu R. The predictive performance of criminal risk assessment tools used at sentencing: Systematic review of validation studies. JOURNAL OF CRIMINAL JUSTICE 2022; 81:101902. [PMID: 36530210 PMCID: PMC9755051 DOI: 10.1016/j.jcrimjus.2022.101902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 05/13/2023]
Abstract
Although risk assessment tools have been widely used to inform sentencing decisions, there is uncertainty about the extent and quality of evidence of their predictive performance when validated in new samples. Following PRISMA guidelines, we conducted a systematic review of validation studies of 11 commonly used risk assessment tools for sentencing. We identified 36 studies with 597,665 participants, among which were 27 independent validation studies with 177,711 individuals. Overall, the predictive performance of the included risk assessment tools was mixed, and ranged from poor to moderate. Tool performance was typically overestimated in studies with smaller sample sizes or studies in which tool developers were co-authors. Most studies only reported area under the curve (AUC), which ranged from 0.57 to 0.75 in independent studies with more than 500 participants. The majority did not report key performance measures, such as calibration and rates of false positives and negatives. In addition, most validation studies had a high risk of bias, partly due to inappropriate analytical approach used. We conclude that the research priority is for future investigations to address the key methodological shortcomings identified in this review, and policy makers should enable this research. More sufficiently powered independent validation studies are necessary.
Collapse
Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
- Corresponding author at: University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | | | - Thomas Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | | | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Validation and recalibration of OxMIV in predicting violent behaviour in patients with schizophrenia spectrum disorders. Sci Rep 2022; 12:461. [PMID: 35013451 PMCID: PMC8748785 DOI: 10.1038/s41598-021-04266-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/16/2021] [Indexed: 12/23/2022] Open
Abstract
Oxford Mental Illness and Violence (OxMIV) addresses the need in mental health services for a scalable, transparent and valid tool to predict violent behaviour in patients with severe mental illness. However, external validations are lacking. Therefore, we have used a Dutch sample of general psychiatric patients with schizophrenia spectrum disorders (N = 637) to evaluate the performance of OxMIV in predicting interpersonal violence over 3 years. The predictors and outcome were measured with standardized instruments and multiple sources of information. Patients were mostly male (n = 493, 77%) and, on average, 27 (SD = 7) years old. The outcome rate was 9% (n = 59). Discrimination, as measured by the area under the curve, was moderate at 0.67 (95% confidence interval 0.61–0.73). Calibration-in-the-large was adequate, with a ratio between predicted and observed events of 1.2 and a Brier score of 0.09. At the individual level, risks were systematically underestimated in the original model, which was remedied by recalibrating the intercept and slope of the model. Probability scores generated by the recalibrated model can be used as an adjunct to clinical decision-making in Dutch mental health services.
Collapse
|
4
|
Beaudry G, Canal-Rivero M, Ou J, Matharu J, Fazel S, Yu R. Evaluating the Risk of Suicide and Violence in Severe Mental Illness: A Feasibility Study of Two Risk Assessment Tools (OxMIS and OxMIV) in General Psychiatric Settings. Front Psychiatry 2022; 13:871213. [PMID: 35845463 PMCID: PMC9280292 DOI: 10.3389/fpsyt.2022.871213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Two OxRisk risk assessment tools, the Oxford Mental Illness and Suicide (OxMIS) and the Oxford Mental Illness and Violence (OxMIV), were developed and validated using national linked registries in Sweden, to assess suicide and violence risk in individuals with severe mental illness (schizophrenia-spectrum disorders and bipolar disorders). In this study, we aim to examine the feasibility and acceptability of the tools in three different clinical services. METHOD We employed a two-step mixed-methods approach, by combining quantitative analyses of risk scores of 147 individual patients, and thematic analyses of qualitative data. First, 38 clinicians were asked to use OxMIS and OxMIV when conducting their routine risk assessments in patients with severe mental illness. The risk scores for each patient (which provide a probability of the outcome over 12 months) were then compared to the unstructured clinical risk assessment made by the treating clinician. Second, we carried out semi-structured interviews with the clinicians on the acceptability and utility of the tools. Thematic analysis was conducted on the qualitative data to identify common themes, in terms of the utility, accuracy, and acceptability of the tools. The investigations were undertaken in three general adult psychiatric clinics located in the cities of Barcelona and Sevilla (Spain), and Changsha (China). RESULTS Median risk probabilities over 12 months for OxMIS were 1.0% in the Spanish patient sample and 1.9% in the Chinese sample. For OxMIV, they were 0.7% (Spanish) and 0.8% (Chinese). In the thematic analysis, clinicians described the tools as easy to use, and thought that the risk score improved risk management. Potential additions to predictors were suggested, including family history and the patient's support network. Concordance rates of risk estimates between the tools and clinicians was high for violence (94.4%; 68/72) and moderate for suicide (50.0%; 36/72). CONCLUSION Both OxMIS and OxMIV are feasible and practical in different general adult psychiatric settings. Clinicians interviewed found that both tools provide a useful structured approach to estimate the risk of suicide and violence. Risk scores from OxMIS and OxMIV can also be used to assist clinical decision-making for future management.
Collapse
Affiliation(s)
- Gabrielle Beaudry
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Manuel Canal-Rivero
- Hospital Universitario Virgen del Rocío, Seville, Spain.,CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Jianjun Ou
- Hunan Key Laboratory of Psychiatry and Mental Health, National Clinical Research Center for Mental Disorders, Institute of Mental Health, National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Jaskiran Matharu
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
5
|
Fiedorowicz JG, Merranko JA, Iyengar S, Hower H, Gill MK, Yen S, Goldstein TR, Strober M, Hafeman D, Keller MB, Goldstein BI, Diler RS, Hunt JI, Birmaher BB. Validation of the youth mood recurrences risk calculator in an adult sample with bipolar disorder. J Affect Disord 2021; 295:1482-1488. [PMID: 34563392 DOI: 10.1016/j.jad.2021.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/12/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The ability to predict an individual's risk of mood episode recurrence can facilitate personalized medicine in bipolar disorder (BD). We sought to externally validate, in an adult sample, a risk calculator of mood episode recurrence developed in youth/young adults with BD from the Course and Outcome of Bipolar Youth (COBY) study. METHODS Adult participants from the National Institute of Mental Health Collaborative Depression Study (CDS; N=258; mean(SD) age=35.5(12.0) years; mean follow-up=24.9 years) were utilized as a sample to validate the youth COBY risk calculator for onset of depressive, manic, or any mood episodes. RESULTS In this older validation sample, the risk calculator predicted recurrence of any episode over 1, 2, 3, or 5-year follow-up intervals, with Area Under the Curves (AUCs) approximating 0.77. The AUC for prediction of depressive episodes was about 0.81 for each of the time windows, which was higher than for manic or hypomanic episodes (AUC=0.72). While the risk calculator was well-calibrated across the range of risk scores, it systematically underestimated risk in the CDS sample by about 20%. The length of current remission was a highly significant predictor of recurrence risk in the CDS sample. LIMITATIONS Predominantly self-reported White samples may limit generalizability; the risk calculator does not assess more proximal risk (e.g., 1 month). CONCLUSIONS Risk of mood episode recurrence can be predicted with good accuracy in youth and adults with BD in remission. The risk calculators may help identify higher risk BD subgroups for treatment and research.
Collapse
Affiliation(s)
- Jess G Fiedorowicz
- The Ottawa Hospital, Ottawa Hospital Research Institute, Department of Psychiatry, School of Public Health and Epidemiology, Brain and Mind Research Institute, University of Ottawa, 75 Laurier Ave. East, Ottawa, ON K1N 6N5, Canada.
| | - John A Merranko
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, 230 S. Bouquet St., Pittsburgh, PA 15213, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA; Department of Psychiatry, University of California San Diego, 4510 Executive Drive, Suite 315, San Diego, CA 92121, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Shirley Yen
- Departments of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Martin B Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Psychiatry, University of Miami, 1120 NW 14th St., Miami, FL 33136, USA
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Faculty of Medicine, 2075 Bayview Ave., FG-53, Toronto, ON M4N 3M5, Canada
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| | - Jeffrey I Hunt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Box G-BH, Providence, RI 02912, USA; Department of Psychiatry, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, USA
| | - Boris B Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, School of Medicine, University of Pittsburgh, 3811 O'Hara St., Pittsburgh, PA 15213, USA
| |
Collapse
|
6
|
Candidate symptomatic markers for predicting violence in schizophrenia: A cross-sectional study of 7711 patients in a Chinese population. Asian J Psychiatr 2021; 59:102645. [PMID: 33845298 DOI: 10.1016/j.ajp.2021.102645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Violent behaviour is an alarming problem among schizophrenia patients. The effects of historical, clinical, and pathological risk factors for violence have been investigated by multiple studies, but consensus has not been achieved. As psychotic symptoms are more direct and intuitive indicators for violence, identifying robustly associated symptoms is a crucial part of the future prediction and precise management of violent patients in clinics. This study aims to identify the psychotic symptoms correlated with violence among schizophrenia patients in a Chinese population. METHODS In this cross-sectional study, the medical records of 7711 schizophrenia patients (4711 in the discovery set and 3000 in the validation set) were collected from 1998 to 2010. Their psychotic symptoms were extracted, and the patients were divided into violent and non-violent groups. Multivariate logistic analysis was applied to identify symptoms associated with violence in the discovery set. RESULTS Eight psychotic symptoms were found to be significantly correlated with violence in schizophrenia. "Destruction of property", "verbal aggression" and "insomnia" increased the risk of violence, while "flat affect", "delusion of persecution", "auditory hallucination", "vagueness of thought" and "poverty of thought" decreased the risk of violence. The regression model was evaluated by receiver operating characteristic (ROC) analysis for its discriminatory performance, achieving area under curve (AUC) values of 0.887 in the discovery sample set and 0.824 in the validation sample set. CONCLUSIONS The correlated symptoms identified by this study can serve as future candidate predictors for violence in schizophrenia, paving the way for precise management of schizophrenia patients in clinics.
Collapse
|
7
|
Krebs J, Negatsch V, Berg C, Aigner A, Opitz-Welke A, Seidel P, Konrad N, Voulgaris A. Applicability of two violence risk assessment tools in a psychiatric prison hospital population. BEHAVIORAL SCIENCES & THE LAW 2020; 38:471-481. [PMID: 32633430 DOI: 10.1002/bsl.2474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, "FoVOx," and Mental Illness and Violence Tool, "OxMIV") were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)-for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80-0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry.
Collapse
Affiliation(s)
- Julia Krebs
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Institute of Forensic Psychiatry, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Germany
| | - Vincent Negatsch
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Institute of Forensic Psychiatry, Berlin, Germany
| | - Christine Berg
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Institute of Forensic Psychiatry, Berlin, Germany
| | - Annette Aigner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Annette Opitz-Welke
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Institute of Forensic Psychiatry, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Germany
| | - Peter Seidel
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Germany
| | - Norbert Konrad
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Institute of Forensic Psychiatry, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Germany
| | - Alexander Voulgaris
- Universitätsklinikum Hamburg-Eppendorf, Institute of Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| |
Collapse
|