Am J Psychiatry 1993; 150:1374-1379
Copyright © 1993 by American Psychiatric Association
Short-term clinical prediction of assaultive behavior: artifacts of research methods
LJ Apperson, EP Mulvey and CW Lidz
Department of Psychiatry, Duke University Medical Center, Durham, N.C.
OBJECTIVE: The apparent accuracy of predictions of assaultive behavior in
psychiatric inpatients varies substantially, depending on the method used
to study the prediction. The authors explored the effects of different
measures and sampling strategies on short-term clinical predictions of
dangerousness. METHOD: The index subjects were patients who were rated by
intake clinicians as potentially highly assaultive on the ward (N = 32) and
patients who were involuntarily committed on grounds of danger to others (N
= 32). The respective comparison groups comprised patients predicted by
clinicians not to be assaultive (N = 32) and patients committed for reasons
other than danger to others (N = 40). The text of unit meetings and data
from chart reviews were used to determine the occurrence and dates of
violent acts, seclusions for violent acts or threats, and violent threats.
RESULTS: There was a significant difference in the rate of inpatient
violence between the subjects rated at admission as potentially assaultive
(75.0%) and patients rated as not potentially assaultive (12.5%), but the
difference in the rates of violence between the patients who were (56.0%)
and were not (42.0%) involuntarily committed as dangerous to others was not
significant. Most of the violent acts occurred relatively late in the
hospitalization, but seclusions occurred almost exclusively in the initial
stages of hospitalization. CONCLUSIONS: The reported accuracy of clinical
predictions of assaultive behavior is markedly affected by the choice of
sampling strategy, comparison group, outcome measures, and follow-up
period. Including seclusion and violent threats in the outcome variable
appears to lead to deceptive findings.
