title: Dynamic relationship between multiple START assessments and violent incidents over time: a prospective cohort study.
abstract: BACKGROUND
  Dynamic risk factors need to be assessed repeatedly over time rather than at a single time point to examine the relationship with violence. This predictive validity study sought to examine the degree of dynamic change in risk assessed in a group of mentally disordered offenders and the relationship between change and the occurrence of violence.
  
  
  METHODS
  Routine structured assessments of Strengths and Vulnerabilities on the Short-Term Assessment of Risk and Treatability (START) instrument (n = 475) were linked prospectively with 275 violent incidents using logistic regression in a sample of 50 patients.
  
  
  RESULTS
  Stability within patients estimated using the intra-class correlation coefficient was high (>.80) for both Strengths and Vulnerabilities. In the overall sample, a 10 point increase in START Vulnerabilities score was associated with a three-fold increased risk of violence (OR = 3.1; 95% CI, 1.47-7.46) but there was no association for Strengths score (OR = 0.91, 95% CI, 0.34-2.47). When examined within patients, both Vulnerabilities (OR = 1.77, 95% CI, 0.56-5.54) and Strengths (OR = 2.26, 95% CI, 0.38-13.42) were associated with an increased risk of violence but in both cases precision was low due to reduced sample sizes.
  
  
  CONCLUSIONS
  Risk factors which are considered to have the capacity to fluctuate dynamically did not do so substantially in this group of mentally disordered offenders. When fluctuations did occur there was some tentative evidence that they are associated with violent outcomes and could guide the use of prevention measures.
authors.forename: Richard
authors.initials: R
authors.lastname: Whittington
authors.forename: Johan Håkon
authors.initials: JH
authors.lastname: Bjørngaard
authors.forename: Andrew
authors.initials: A
authors.lastname: Brown
authors.forename: Rajan
authors.initials: R
authors.lastname: Nathan
authors.forename: Stephen
authors.initials: S
authors.lastname: Noblett
authors.forename: Beverley
authors.initials: B
authors.lastname: Quinn
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D057237:Criminals / Q000523:psychology* / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult