Ethnic differences in prediction of violence risk with the HCR-20 among psychiatric inpatients.
OBJECTIVE
This study examined ethnic differences in assessment of violence risk among psychiatric inpatients by using the Historical Clinical Risk Management-20 (HCR-20).


METHODS
The HCR-20 was administered to 169 consecutive psychiatric inpatients. Individual items and total scores on the HCR-20 were compared between patients of Asian-American (N=51), Euro-American (N=46), and Native-Hawaiian (N=38) heritage. Receiver operating characteristic (ROC) and stepwise regressions were calculated for each ethnic group with HCR-20 scores as predictor variables and violent event reports of significant threats and assaults as the outcome measure.


RESULTS
Similar rates of overall violence were found between ethnic groups, and the HCR-20 was found to have predictive validity as measured by ROC analysis. Differences in scores on individual HCR-20 items were found, including young age at first incident of violence, psychopathy, early maladjustment, personality disorder, and past supervision failure, as well as total HCR-20 score, with Asian Americans scoring lower (less risk) than Euro-Americans and Native Hawaiians. Stepwise multiple regressions indicated a different pattern of predictor variables for each ethnic group, with impulsivity salient for the Asian-American group, young age at first incident of violence salient for the Euro-American group, and young age at first incident of violence, relationship instability, and risk-management plans' lacking feasibility as salient predictors for the Native-Hawaiian group.


CONCLUSIONS
The findings provide preliminary support for the cross-cultural validity of the HCR-20 while at the same time identifying unique ethnic differences in prediction of violence risk among psychiatric inpatients.
Fujii
Daryl E M
DE
Hawaii State Hospital, 45-710 Keaahala Road, Kaneohe, Hawaii, USA. defujii@hsh.health.state.hi.us
Tokioka
Abe B
AB
Lichton
Alex I
AI
Hishinuma
Earl
E
D000328:Adult; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data*; D003415:Crime / Q000706:statistics & numerical data; D003431:Cross-Cultural Comparison; D005260:Female; D006254:Hawaii / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010552:Personality Assessment / Q000706:statistics & numerical data*; D044382:Population Groups / Q000706:statistics & numerical data*; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012308:Risk Management; D014754:Violence / Q000208:ethnology* / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*