Psychiatric assessments for predicting violence are ineffective

November 12, 2015

In a study published in PLOS One the team have proposed an entirely new approach to risk assessment for future violence. Previous approaches have relied on looking at risk factors that happen to be linked to, but may not cause, violence, for example, being young, male, of lower social class, with previous violent convictions.

The new approach is instead based on identifying risk factors that have a clear causal link to violence, and include symptoms of major mental disorder, the patient's living condition, and whether they are taking medication.

Over 300 risk assessment instruments are currently used by psychiatrists, psychologists, and probation officers to assess the risks of violence and sexual offending among psychiatric patients, prisoners, and the general population. The authors say that producing risk assessment instruments has become an 'industry' and new ones are being produced annually.

QMUL researchers found that none of these instruments have any advantage over those produced before and that their best predictions for future violence are incorrect 30 per cent of the time.

First author Professor Jeremy Coid from QMUL's Wolfson Institute of Preventative Medicine said: "Researchers have become too obsessed with predicting whether a patient will be violent in the future, rather than looking for the causes of why they become violent. While it is helpful to know that a patient has a high or low risk of being violent if you release them from hospital, this is not going to tell you what you should do to stop them being violent."

"It is more important to know which factors are causally related because these are the factors that must be the targets for future treatments and management interventions if the aim is to prevent violence happening in the future."

In the study, 409 male and female patients who were discharged from medium secure services in England and Wales were followed up after release into the community. They received assessments with two 'state-of-the-art' assessment instruments prior to release into the community, then after six and 12 months following discharge. Information on violence was gathered via individual case notes and a search of the police national computer.

The team's analysis suggests that the standard risk factors were poor in identifying who would be violent and who would not.

When the researchers used a causal approach to confirm which risk and protective factors resulted in violence, the findings were very different. Symptoms of major mental disorder, the patients' living condition, and whether they were taking medication, were highly important factors. The effects of violent thoughts, being in an unstable life situation, being under stress and unable to cope were also three to four times stronger using the causal model than using the traditional predictive approach.

Professor Jeremy Coid added: "The future direction should be to identify risk factors that have causal relationships with violent behaviour and not those which predict violent behaviour. Risk factors, such as being young, male, of lower social class, with many previous violent convictions, may be good predictors, however, none of these factors are truly causal."
-end-
The study was funded by the UK National Institute for Health Research (NIHR).

Notes for editors:

'Identifying Causal Risk Factors for Violence among Discharged Patients' by Jeremy W. Coid, Constantinos Kallis, Mike Doyle, Jenny Shaw, Simone Ullrich. PLOS One

About QMUL

Queen Mary University of London (QMUL) is one of the UK's leading universities, and one of the largest institutions in the University of London, with 20,260 students from more than 150 countries.

A member of the Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research -- in the most recent national assessment of the quality of research, we were placed ninth in the UK (REF 2014).

We also offer something no other university can: a stunning self-contained residential campus in London's East End. As well as our home at Mile End, we have campuses at Whitechapel, Charterhouse Square and West Smithfield dedicated to the study of medicine, and a base for legal studies at Lincoln's Inn Fields.We have a rich history in London with roots in Europe's first public hospital, St Barts; England's first medical school, The London; one of the first colleges to provide higher education to women, Westfield College; and the Victorian philanthropic project, the People's Palace at Mile End. Today, as well as retaining these close connections to our local community, we are known for our international activities, and have research and teaching partnerships with leading universities around the world. This includes two very successful and long-standing joint partnerships with the Beijing University of Posts and Telecommunications, and Nanchang University.

QMUL has an annual turnover of £350m, a research income worth £100m, and generates employment and output worth £700m to the UK economy each year.

Queen Mary University of London

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