Risk assessment of imminent violence in acute psychiatry: a step towards an extended model

ABSTRACT

Aggression occurs frequently in mental health care settings, and studies have reported that 17% to 31% of patients admitted to acute psychiatric wards commit violence. Inpatients’ fluctuating mental states and behaviour patterns reinforce the need for an assessment instrument to predict potential violence in a timely manner. This naturalistic prospective inpatient study investigated whether an extended short-term risk assessment model that combines (a) short-term risk assessment with the Broset Violence Checklist (BVC), (b) patient’s own prediction of violence with the Self-Report Risk Scale (SRS) and (c) single items from the Violence Risk Screening 10 (V-RISK-10) provides better short-term predictive accuracy for violence than the BVC alone. All patients admitted to a psychiatric emergency hospital in Norway during one year were included (N = 508). Stepwise multivariate generalised linear mixed model analyses were conducted. When adjusting for repeated measurements, the results indicated that an extended model for short-term risk assessment, consisting of the BVC, SRS and Item 2 Previous and/or current threats from the V-RISK-10 explained more variance of imminent violence, compared to the BVC alone. Further studies are recommended to investigate whether the extended model provides a clinically better short-term risk prediction of imminent violence, compared to the BVC alone.

KEYWORDS:

• Acute psychiatry
• aggression
• repeated measurements
• risk assessment
• violence

Author contributions

ØL made a substantial contribution to concept and design, acquisition of data, analysis and interpretation of data, drafting and revising the article for important intellectual content.

SV contributed to concept and design, drafting and revising the article for important intellectual content.

AF contributed to concept and design, drafting and revising the article for important intellectual content.

BMSE made a substantial contribution to acquisition of data, contributed to conception and design and revising the article for important intellectual content.

JOR contributed to acquisition of data, concept and design, and revising the article for important intellectual content.

NGP contributed to concept and design and revising the article for important intellectual content.

SKBV contributed to concept and design and analysis and interpretation of data and made a substantial contribution to drafting and revising the article for important intellectual content.

Acknowledgments

We gratefully appreciate the statistical support of Professor Emeritus Petter Laake of the University of Oslo, Faculty of Medicine, Department of Biostatistics. The participation of the practitioners and administrative staff at the Acute Psychiatric Department of Oslo University Hospital, Ullevål, was gratefully acknowledged, and we especially appreciate co-ordinator Kate Storm for her support during the data collection. We also acknowledge support from the Head of the Department, Thorbjørn Harald Sundin, and from the Head of the Division of Mental Health and Addiction, Marit Bjartveit.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical statements

The application was processed and the research approved by the Regional Committee for Medical and Health Research Ethics (REK Sør-Øst B) in Norway on 11 January 2012 (Protocol reference: 2011/2555/REK sør-øst B). The approval granted exemption from requesting patients’ informed consent to participate but required all patients to be informed about their participation and right to withdraw. The project was also approved by the Privacy Department of Oslo University Hospital (E-phorte No. 2011/22,191).

The authors report no conflicts of interest. The authors are responsible for the content and writing of the paper.