Use of Risk Assessment Instruments to Predict Violence and Antisocial Behaviour in 73 Samples Involving 24,827 People: Systematic Review and Meta-Analysis

Fazel, S., Singh, J. P., Doll, H., & Grann, M. (2012). The prediction of violence and antisocial behaviour: A systematic review and meta-analysis of the utility of risk assessment instruments in 73 samples involving 24,827 individuals. British Medical Journal, 345, e4692.

12 Pages Posted: 30 Jul 2014 Last revised: 31 Jul 2014

See all articles by Seena Fazel

Seena Fazel

University of Oxford - Department of Psychiatry

Jay Singh

Høgskolen i Molde; Global Institute of Forensic Research

Helen Doll

University of East Anglia (UEA)

Martin Grann

Karolinska Institutet

Date Written: 2012

Abstract

Objective: To investigate the predictive validity of tools commonly used to assess the risk of violence, sexual, and criminal behaviour.

Design: Systematic review and tabular meta-analysis of replication studies following PRISMA guidelines.

Data Sources: PsycINFO, Embase, Medline, and United States Criminal Justice Reference Service Abstracts.

Review Methods: We included replication studies from 1 January 1995 to 1 January 2011 if they provided contingency data for the offending outcome that the tools were designed to predict. We calculated the diagnostic odds ratio, sensitivity, specificity, area under the curve, positive predictive value, negative predictive value, the number needed to detain to prevent one offence, as well as a novel performance indicator — the number safely discharged. We investigated potential sources of heterogeneity using metaregression and subgroup analyses.

Results: Risk assessments were conducted on 73 samples comprising 24,847 participants from 13 countries, of whom 5879 (23.7%) offended over an average of 49.6 months. When used to predict violent offending, risk assessment tools produced low to moderate positive predictive values (median 41%, inte rquartile range 27-60%) and higher negative predictive values (91%, 81-95%), and a corresponding median number needed to detain of 2 (2-4) and number safely discharged of 10 (4-18). Instruments designed to predict violent offending performed better than those aimed at predicting sexual or general crime.

Conclusions: Although risk assessment tools are widely used in clinical and criminal justice settings, their predictive accuracy varies depending on how they are used. They seem to identify low risk individuals with high levels of accuracy, but their use as sole determinants of detention, sentencing, and release is not supported by the current evidence. Further research is needed to examine their contribution to treatment and management.

Keywords: risk assessment instruments, systematic review, meta-analysis

Suggested Citation

Fazel, Seena and Singh, Jay and Singh, Jay and Doll, Helen and Grann, Martin, Use of Risk Assessment Instruments to Predict Violence and Antisocial Behaviour in 73 Samples Involving 24,827 People: Systematic Review and Meta-Analysis (2012). Fazel, S., Singh, J. P., Doll, H., & Grann, M. (2012). The prediction of violence and antisocial behaviour: A systematic review and meta-analysis of the utility of risk assessment instruments in 73 samples involving 24,827 individuals. British Medical Journal, 345, e4692., Available at SSRN: https://ssrn.com/abstract=2473084

Seena Fazel

University of Oxford - Department of Psychiatry ( email )

Oxford
United Kingdom

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

Helen Doll

University of East Anglia (UEA) ( email )

Norwich Research Park
Norwich, Norfolk NR4 7TJ
United Kingdom

Martin Grann

Karolinska Institutet ( email )

Granits väg 4
Section for Integrative Physiology
Solna, Stockholm 17171
Sweden

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