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The Utility of Patients’ Self-Perceptions of Violence Risk: Consider Asking the Person Who May Know Best
Jennifer L. Skeem, Ph.D.; Sarah M. Manchak, Ph.D.; Charles W. Lidz, Ph.D.; Edward P. Mulvey, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.001312012
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Dr. Skeem is affiliated with the Department of Psychology and Social Behavior, School of Social Ecology, University of California, Irvine, 3311 Social Ecology II, Irvine, CA 92697 (e-mail: skeem@uci.edu).
Dr. Manchak is with the School of Criminal Justice, University of Cincinnati, Cincinnati, Ohio.
Dr. Lidz is with the Department of Psychiatry, University of Massachusetts Medical School, Worcester.
Dr. Mulvey is with the Department of Psychiatry, University of Pittsburgh School of Medicine, and with the Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, both in Pittsburgh, Pennsylvania.

Copyright © 2013 by the American Psychiatric Association


Objective  The authors compared the predictive accuracy of two risk assessment methods that are feasible to use in routine clinical settings: brief risk assessment tools and patients’ self-perceptions of risk.

Methods  In 2002–2003, clinical interviewers met with 86 high-risk inpatients with co-occurring mental and substance use disorders (excluding schizophrenia) to carefully elicit the patients’ global rating of their risk of behaving violently and to complete two brief risk assessment tools—the Clinically Feasible Iterative Classification Tree (ICT-CF) and the Modified Screening Tool (MST). Two months after discharge, patients were reinterviewed in the community to assess their involvement in violence.

Results  Patients’ self-perceptions of risk performed quite well in predicting serious violence (area under the curve [AUC]=.74, sensitivity=50%), particularly compared with the ICT-CF (AUC=.59, sensitivity=40%) and the MST (AUC=.66, sensitivity=30%). Self-perceived risk also added significant incremental utility to these tools in predicting violence.

Conclusions  Patients’ self-perceptions hold promise as a method for improving risk assessment in routine clinical settings. Assuming it replicates and generalizes beyond the research context, this finding encourages a shift away from unaided clinical judgment toward a feasible method of risk assessment built on patient collaboration.

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Table 1Utility of patients’ self-perception and of brief assessment tools in predicting violence after discharge
Table Footer Note

a AUC, area under the curve

Table Footer Note

b PPV, positive predictive value

Table Footer Note

c NPV, negative predictive value

Table Footer Note

d MST, Modified Screening Tool (7,10)

Table Footer Note

e ICT-CF, Clinically Feasible Iterative Classification Tree (4)



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