Psychiatric symptoms and community violence among high-risk patients: A test of the relationship at the weekly level

Department of Pediatrics, The Ohio State University, Columbus, Ohio, United States
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 11/2006; 74(5):967-79. DOI: 10.1037/0022-006X.74.5.967
Source: PubMed


Given the availability of violence risk assessment tools, clinicians are now better able to identify high-risk patients. Once these patients have been identified, clinicians must monitor risk state and intervene when necessary to prevent harm. Clinical practice is dominated by the assumption that increases in psychiatric symptoms elevate risk of imminent violence. This intensive study of patients (N = 132) at high risk for community violence is the first to evaluate prospectively the temporal relation between symptoms and violence. Symptoms were assessed with the Brief Symptom Inventory and threat/control override (TCO) scales. Results indicate that a high-risk patient with increased anger in 1 week is significantly more likely to be involved in serious violence in the following week. This was not true of other symptom constellations (anxiety, depression, TCO) or general psychological distress. The authors found no evidence that increases in the latter symptoms during 1 week provide an independent foundation for expecting violence during the following week.

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    • "Anger dysregulation is part of a broad range of clinical disorders (DiGiuseppe & Tafrate, 2007; Novaco, 2010), and its relevance for clinical and forensic populations centrally concerns it being a dynamic risk factor for violence. Studies with multiple control variables show anger to be related to the violent behavior of psychiatric patients before, during, and after hospitalization (Doyle & Dolan, 2006a, 2006b; McNiel, Eisner, & Binder, 2003; Monahan et al., 2001; Novaco & Taylor, 2004; Skeem et al., 2006; Swogger et al., 2012) and to physical aggression within institutions by incarcerated adults (Wang & Diamond, 1999). Anger is not only an important clinical need, it also bears on the therapeutic milieu and on the well-being of clinical and custodial staff. "
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    ABSTRACT: Anger has high prevalence in clinical and forensic settings, and it is associated with aggressive behavior and ward atmosphere on psychiatric units. Dysregulated anger is a clinical problem in Danish mental health care systems, but no anger assessment instruments have been validated in Danish. Because the Novaco Anger Scale and Provocation Inventory (NAS-PI) has been extensively validated with different clinical populations and lends itself to clinical case formulation, it was selected for translation and evaluation in the present multistudy project. Psychometric properties of the NAS-PI were investigated with samples of 477 nonclinical, 250 clinical, 167 male prisoner, and 64 male forensic participants. Anger prevalence and its relationship with other anger measures, anxiety/depression, and aggression were examined. NAS-PI was found to have high reliability, concurrent validity, and discriminant validity, and its scores discriminated the samples. High scores in the offender group demonstrated the feasibility of obtaining self-report assessments of anger with this population. Retrospective and prospective validity of the NAS were tested with the forensic patient sample regarding physically aggressive behavior in hospital. Regression analyses showed that higher scores on NAS increase the risk of having acted aggressively in the past and of acting aggressively in the future. © The Author(s) 2015.
    Assessment 05/2015; DOI:10.1177/1073191115583713 · 3.29 Impact Factor
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    • "Anger has long been associated with aggression and violence from both a theoretical perspective and as demonstrated through empirical evidence (Craig, 1982; Novaco, 2003; Novaco & Jarvis, 2002). Recent studies have shown anger to be related to physical aggression in inpatient settings (Doyle & Dolan, 2006a; McDermott, Quanbeck, Busse, Yastro, & Scott, 2008) as well as in the community (Doyle, Carter, Shaw, & Dolan, 2012; Doyle & Dolan, 2006b; Monahan et al., 2001; Skeem et al., 2006). As a result, the assessment of anger has increased in forensic psychiatric and correctional settings, and treatment programs targeting anger have been developed in hopes of reducing violence (see e.g., Haddock et al., 2009). "
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    ABSTRACT: We used archival data to examine the predictive validity of a prerelease violence risk assessment battery over 6 years at a forensic hospital (N = 230, 100% male, 63.0% African American, 34.3% Caucasian). Examining “real-world” forensic decision making is important for illuminating potential areas for improvement. The battery included the Historical-Clinical-Risk Management-20, Psychopathy Checklist-Revised, Schedule of Imagined Violence, and Novaco Anger Scale and Provocation Inventory. Three outcome “recidivism” variables included contact violence, contact and threatened violence, and any reason for hospital return. Results indicated measures of general violence risk and psychopathy were highly correlated but weakly associated with reports of imagined violence and a measure of anger. Measures of imagined violence and anger were correlated with one another. Unexpectedly, Receiver Operating Characteristic curve analyses revealed that none of the scales or subscales predicted recidivism better than chance. Multiple regression indicated the battery failed to account for recidivism outcomes. We conclude by discussing three possible explanations, including timing of assessments, controlled versus field studies, and recidivism base rates.
    Criminal Justice and Behavior 03/2015; 42(9). DOI:10.1177/0093854815572252 · 1.71 Impact Factor
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    • "However, anger is also a " fundamental and functional human emotion " that is a robust dynamic risk factor for violence among both general offenders and psychiatric inpatients (Gardner, Lidz, Mulvey, & Shaw, 1996; Novaco, 1994; Novaco, 2011a, p. 661a; Novaco, 2011b). In an intensive study of 132 psychiatric patients at high risk for community violence, Skeem et al. (2006) found that anger robustly predicted violence, unlike symptoms that were more unique to serious mental illness (e.g., delusions). In short, approaching anger as a symptom of mental illness runs the risk of pathologizing a normal emotional state (Novaco, 2011a). "
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    ABSTRACT: Although offenders with mental illness are overrepresented in the criminal justice system, psychiatric symptoms relate weakly to criminal behavior at the group level. In this study of 143 offenders with mental illness, we use data from intensive interviews and record reviews to examine how often and how consistently symptoms lead directly to criminal behavior. First, crimes rarely were directly motivated by symptoms, particularly when the definition of symptoms excluded externalizing features that are not unique to Axis I illness. Specifically, of the 429 crimes coded, 4% related directly to psychosis, 3% related directly to depression, and 10% related directly to bipolar disorder (including impulsivity). Second, within offenders, crimes varied in the degree to which they were directly motivated by symptoms. These findings suggest that programs will be most effective in reducing recidivism if they expand beyond psychiatric symptoms to address strong variable risk factors for crime like antisocial traits. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Law and Human Behavior 04/2014; 38(5). DOI:10.1037/lhb0000075 · 2.16 Impact Factor
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