title: Assessing the risk of imminent aggression in mentally ill young offenders.
abstract: OBJECTIVE
  Aggression in adolescents presents a significant problem for psychiatric units. The Dynamic Appraisal of Situational Aggression (DASA) is an empirically validated measure designed to appraise the risk of imminent aggression (within the next 24 hours) in adult patients. Our aim was to examine the predictive validity of the DASA: Youth Version (DASA:YV) with youth-specific items, in young offenders hospitalised with a mental illness.
  
  
  METHODS
  This prospective validation study involved 4440 DASA:YV ratings of mentally ill adolescents in a secure hospital. At 24 hours post-assessment, the nursing staff documented whether patients had behaved aggressively: physically, verbally or towards property. Predictive accuracy was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  The DASA:YV significantly predicted any imminent aggression (AUC = 0.754). Additional youth-specific items conferred a greater predictive yield, as compared to adult-derived items (p = 0.014).
  
  
  CONCLUSIONS
  It is possible to monitor the risk state of hospitalised mentally ill youth, so that heightened states can be detected early, thus facilitating interventions to reduce the risk of violence.
authors.affiliation: Consultant Forensic Psychiatrist, Adolescent Unit, The Forensic Hospital, Justice Health, New South Wales Health, Sydney, NSWConjoint Lecturer, Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSWForensic Mental Health Service Australian Capital Territory Health, Canberra, ACTVisiting Fellow, Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia johnkas@med.usyd.edu.au.
authors.forename: John
authors.initials: J
authors.lastname: Kasinathan
authors.affiliation: Clinical Nurse Consultant, Adolescent Unit and Justice Health, The Forensic Hospital, New South Wales Health, Sydney, NSW, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Marsland
authors.affiliation: Fellow in Mental Health Research, Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Batterham
authors.affiliation: Clinical Director Adolescent Mental Health, Justice Health, The Forensic Hospital, New South Wales Health, Sydney, NSWConjoint Lecturer, Faculty of Medicine, School of Psychiatry University of New South Wales, Sydney, NSW, Australia.
authors.forename: Claire
authors.initials: C
authors.lastname: Gaskin
authors.affiliation: Consultant Forensic Psychiatrist, Justice Health, The Forensic Hospital, New South Wales Health, Sydney, NSWConjoint Lecturer, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Adams
authors.affiliation: Principal Consultant Psychologist, Centre for Forensic Behavioural Science University of Swinburne, Melbourne, VICVictorian Institute of Forensic Mental Health, Melbourne, VIC, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Daffern
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000374:Aggression / Q000523:psychology*; D057237:Criminals / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D018570:Risk Assessment; D055815:Young Adult
keywords: aggression; appraisal methods; dynamic appraisal; mental illness; risk; violent behaviour; youth