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Articles   |    
Violent Behavior and Gender of Swedish Psychiatric Patients: A Prospective Clinical Study
Joakim Sturup, Ph.D.; John Monahan, Ph.D.; Marianne Kristiansson, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200266
View Author and Article Information

Dr. Sturup and Dr. Kristiansson are affiliated with the Division of Social and Forensic Psychiatry, Karolinska Institutet, Box 4044, 14104, Huddinge, Sweden (e-mail: joakim.sturup@ki.se). Dr. Monahan is with the University of Virginia School of Law, Charlottesville.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study was designed to investigate the base rate of violent behavior, the predictive validity of the Classification of Violence Risk (COVR) software, and specific risk factors for violence among nonforensically involved psychiatric patients in Sweden.

Methods  On discharge from two psychiatric hospitals in Stockholm, 331 patients were interviewed. Telephone interviews with the patients and supportive others, as well as data from a national criminal register, were used to measure violent behavior 20 weeks after discharge. After the baseline interview, patients were assigned to different risk groups by the COVR software. Predicted risk was compared with the occurrence of actual acts of violence during the follow-up.

Results  Gender differences in base rates of violent behavior among the general psychiatric population were not found during the 20 weeks of follow-up after discharge. Violent behavior was significantly predicted by young age of males and by level of anger, violent thoughts, and victimization of females. The predictive validity of the COVR software was comparable between females (area under the curve [AUC]=.78) and males (AUC=.76).

Conclusions  Violent behavior was uncommon for all patients. Although several risk factors were significantly associated with violence by each gender, the COVR software could predict violence equally well for both genders.

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Figure 1 Distribution of risk of violence, by risk category and gender, of 331 psychiatric patients in Swedena

aAssessed by Classification of Violence Risk software

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Table 1Sociodemographic and clinical characteristics of 331 psychiatric patients in Sweden
Table Footer Note

aICD-10 diagnostic codes are listed in parentheses.

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Table 2Risk factors for violent behavior 20 weeks after discharge of 158 male and 173 female psychiatric patients in Sweden
Table Footer Note

aNovaco Anger Scale

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Table 3Predictive validity indicators of violent behavior 20 weeks after discharge of 331 psychiatric patients in Sweden
Table Footer Note

aClassification of Violence Risk

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