title: The utility of patients' self-perceptions of violence risk: consider asking the person who may know best.
abstract: OBJECTIVE The authors compared the predictive accuracy of two risk assessment methods that are feasible to use in routine clinical settings: brief risk assessment tools and patients' self-perceptions of risk. METHODS In 2002-2003, clinical interviewers met with 86 high-risk inpatients with co-occurring mental and substance use disorders (excluding schizophrenia) to carefully elicit the patients' global rating of their risk of behaving violently and to complete two brief risk assessment tools-the Clinically Feasible Iterative Classification Tree (ICT-CF) and the Modified Screening Tool (MST). Two months after discharge, patients were reinterviewed in the community to assess their involvement in violence. RESULTS Patients' self-perceptions of risk performed quite well in predicting serious violence (area under the curve [AUC]=.74, sensitivity=50%), particularly compared with the ICT-CF (AUC=.59, sensitivity=40%) and the MST (AUC=.66, sensitivity=30%). Self-perceived risk also added significant incremental utility to these tools in predicting violence. CONCLUSIONS Patients' self-perceptions hold promise as a method for improving risk assessment in routine clinical settings. Assuming it replicates and generalizes beyond the research context, this finding encourages a shift away from unaided clinical judgment toward a feasible method of risk assessment built on patient collaboration.
authors: Department of Psychology and Social Behavior, School of Social Ecology, University of California, Irvine, 3311 Social Ecology II, Irvine, CA 92697, USA. skeem@uci.edu
authors: Jennifer L
authors: JL
authors: Skeem
authors: Sarah M
authors: SM
authors: Manchak
authors: Charles W
authors: CW
authors: Lidz
authors: Edward P
authors: EP
authors: Mulvey
mesh_terms: D000328:Adult; D019540:Area Under Curve; D059026:Diagnostic Self Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019964:Mood Disorders / Q000523:psychology*; D018570:Risk Assessment / Q000379:methods; D012649:Self Concept; D019966:Substance-Related Disorders / Q000523:psychology*; D014754:Violence / Q000517:prevention & control* / Q000706:statistics & numerical data; D055815:Young Adult