The first step in the validation of a new screen for violence risk in acute psychiatry: The inpatient context.
BACKGROUND
Instruments for evaluating the risk of violence towards others have mostly been developed for assessment of risk for recidivism into violent crime in forensic psychiatry. In general psychiatry there is a considerable need for specialised, brief and structured assessment tools to inform risk decisions.


METHODS
The study aimed to validate a brief structured clinical risk assessment screen of inpatient violence (V-RISK-10), a 10-item structured clinical checklist with a good vignette-based interrater reliability (ICC=0.87). In this study it was used for risk assessment of a one-year sample of patients (N=1.017) admitted to two acute psychiatric units. Risk assessments at admission were compared to prospective records of aggressive and violent acts during the hospital stay.


RESULTS
Results showed a base rate for aggression of 9%. The predictive validity of the V-RISK-10 was estimated by Receiver Operating Characteristics (ROC). It yielded an area under the curve (AUC) of 0.83, with sensitivity/specificity of 0.81/0.73 and corresponding positive and negative predictive values (PPV/NPV) of 0.24/0.97. The screen was easy-to-use and showed a short completion time.


CONCLUSIONS
Despite promising results further validation studies are required before the V-RISK-10 is adopted into routine clinical practise.
Hartvig
P
P
Centre for Research and Education in Forensic Psychiatry, Ullevål University Hospital, Oslo, Norway. paal.hartvig@kompetanse-senteret.no
Roaldset
J O
JO
Moger
T A
TA
Ostberg
B
B
Bjørkly
S
S
D000208:Acute Disease; D000328:Adult; D000369:Aged, 80 and over; D003617:Dangerous Behavior; D005260:Female; D005555:Forensic Psychiatry / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000592:standards* / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D010552:Personality Assessment / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D014754:Violence / Q000517:prevention & control* / Q000706:statistics & numerical data; D055815:Young Adult