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Am J Psychiatry 1991; 148:1317-1321
Copyright © 1991 by American Psychiatric Association
Clinical assessment of the risk of violence among psychiatric inpatients
DE McNiel and RL Binder
Department of Psychiatry, University of California, School of Medicine, San Francisco.
OBJECTIVE: The authors evaluated the reliability and validity of a
probabilistic approach to clinical assessment of short-term risk of
violence. METHOD: At admission, nurses and physicians independently rated
the probability that each of 149 psychiatric patients would physically
attack someone during the first week of hospitalization on a
university-based locked inpatient unit. Ward behavior was measured with the
Overt Aggression Scale. RESULTS: There was a moderate level of agreement
between nurses' and physicians' assessments of risk. Ratings of ward
behavior showed an increase in the proportion of assaultive patients as the
level of estimated risk of violence increased. Although the overall rate of
assaults was overpredicted, there was a close correspondence between
clinical estimates of patients' chances of becoming violent and the
proportion of patients within each risk level who later displayed some type
of inpatient aggression. CONCLUSIONS: The reliability and validity of
short-term estimates of the risk of violence among acutely disturbed
inpatients may be higher than past violence research has suggested. These
findings provide preliminary support for the utility of a probabilistic
approach to assessment of the risk of violence.
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