The Utility of Patients' Self-Perceptions of Violence Risk: Consider Asking the Person Who May Know Best
Department of Psychiatry
Medical Subject Headings
Violence; Risk Assessment; Self Concept; Diagnostic Self Evaluation
Behavioral Disciplines and Activities | Mental and Social Health | Psychiatry | Psychiatry and Psychology
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.
Skeem, Jennifer L.; Manchak, Sarah M.; Lidz, Charles W.; and Mulvey, Edward P., "The Utility of Patients' Self-Perceptions of Violence Risk: Consider Asking the Person Who May Know Best" (2013). Psychiatry Publications and Presentations. 621.