Rates of Violence in Patients Classified as High Risk by Structured Risk Assessment Instruments

Singh, J. P., Fazel, S., Gueorguieva, R., & Buchanan, A. (2014). Rates of violence in patients classified as “high risk” by risk assessment instruments. British Journal of Psychiatry, 204, 180-187.

9 Pages Posted: 31 Jul 2014

See all articles by Jay Singh

Jay Singh

Høgskolen i Molde; Global Institute of Forensic Research

Seena Fazel

University of Oxford - Department of Psychiatry

Ralitza Gueorguieva

Yale University

Alec Buchanan

Yale University - Department of Psychiatry

Date Written: 2014

Abstract

Background: Rates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.

Aims: To analyse the variation in rates of violence in individuals identified as high risk by SRAIs.

Method: A systematic search of databases (1995-2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.

Results: Information was collected on 13,045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.

Conclusions: After controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

Keywords: rates of violence, structured risk assessment instruments

Suggested Citation

Singh, Jay and Singh, Jay and Fazel, Seena and Gueorguieva, Ralitza and Buchanan, Alec, Rates of Violence in Patients Classified as High Risk by Structured Risk Assessment Instruments (2014). Singh, J. P., Fazel, S., Gueorguieva, R., & Buchanan, A. (2014). Rates of violence in patients classified as “high risk” by risk assessment instruments. British Journal of Psychiatry, 204, 180-187., Available at SSRN: https://ssrn.com/abstract=2473081

Jay Singh (Contact Author)

Høgskolen i Molde ( email )

Molde NO-6405
Norway

Global Institute of Forensic Research ( email )

11700 Plaza America Drive
Suite 810
Reston, VA 20190
United States

HOME PAGE: http://www.gifrinc.com

Seena Fazel

University of Oxford - Department of Psychiatry ( email )

Oxford
United Kingdom

Ralitza Gueorguieva

Yale University ( email )

493 College St
New Haven, CT CT 06520
United States

Alec Buchanan

Yale University - Department of Psychiatry ( email )

New Haven, CT 06520
United States

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