This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Charles W. Lidz, PhD; Edward P. Mulvey, PhD; William Gardner, PhD

JAMA. 1993;269(8):1007-1011.

Abstract
Objective.
—To assess the accuracy of clinicians in predicting violence in mental patients. Specifically, to determine if clinicians can predict violence when variation in rates of violence attributable to age, race, and sex is controlled.

Design.
—Two samples of psychiatric patients, matched on age, race, sex, and admission status, were followed up in the community during a 6-month period. One group included individuals assessed by psychiatric emergency department clinicians as likely to be violent to another person during the follow-up period; the other was a comparison group. Patients provided self-reports of violent incidents, and a "collateral," ie, an individual with detailed knowledge of the patient's life, provided this same information. Official records were also reviewed.

Setting.
—Patients were recruited in the emergency department of a metropolitan psychiatric hospital. Patients and collaterals were interviewed in their homes or in public places in the community.

Patients or Other Participants.
—A consecutive sample of individuals coming into a psychiatric emergency department during daylight and evening shifts was obtained. A total of 2452 patients were approached for consent and 1948 consented. A final sample of 357 patients whom clinicians assessed as likely to be violent and their matched comparison patients were included.

Main Outcome Measures.
—Patients', collaterals', and official records' reports of incidents in which the patient laid hands on another person or threatened someone with a weapon.

Results.
—Violence during the follow-up period was reported in approximately 45% of the cases: 36% in the comparison group and 53% in the cases predicted to be violent. Overall clinical accuracy was significantly better than chance, but predictions of female patients' violence were not better than chance.

Conclusions.
—The level of patient violence reported using self-reports and collateral reports was higher than has been obtained using other methods. Clinical judgment adds to predictive accuracy, but overall accuracy was modest and particularly low for female patients.

(JAMA. 1993;269:1007-1011)

Author Affiliations
From the Department of Psychiatry, University of Pittsburgh (Pa) School of Medicine.

Footnotes
Reprint requests to Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213 (Dr Lidz).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Does Gender Moderate the Predictive Utility of the Level of Service Inventory--Revised (LSI-R) for Serious Violent Offenders?
Manchak et al.
Criminal Justice and Behavior 2009;36:425-442.
ABSTRACT  

Risk of Violence by Psychiatric Patients: Beyond the "Actuarial Versus Clinical" Assessment Debate
Buchanan
Psychiatr. Serv. 2008;59:184-190.
ABSTRACT | FULL TEXT  

Preventing the Unpredicted: Managing Violence Risk in Mental Health Care
Swanson
Psychiatr. Serv. 2008;59:191-193.
ABSTRACT | FULL TEXT  

Violence in women with psychosis in the community: prospective study
DEAN et al.
Br. J. Psychiatry 2006;188:264-270.
ABSTRACT | FULL TEXT  

Monahan et al.
Psychiatr. Serv. 2006;57:143-143.
FULL TEXT  

Monahan et al.
Psychiatr. Serv. 2006;57:143-143.
FULL TEXT  

Prediction of violent behaviour: Professionals' appraisal
Louw et al.
Criminal Justice 2005;5:379-406.
ABSTRACT  

Identifying Subtypes of Civil Psychiatric Patients at High Risk for Violence
Skeem et al.
Criminal Justice and Behavior 2004;31:392-437.
ABSTRACT  

Emergency Psychiatry: How Should Emergency Psychiatrists Respond to School Violence?
Glick et al.
Psychiatr. Serv. 2004;55:223-224.
FULL TEXT  

Mental Disorder and Violence: Personality Dimensions and Clinical Features
Nestor
Am. J. Psychiatry 2002;159:1973-1978.
ABSTRACT | FULL TEXT  

A Prevention-Based Paradigm for Violence Risk Assessment: Clinical and Research Applications
Douglas and Kropp
Criminal Justice and Behavior 2002;29:617-658.
ABSTRACT  

The Prediction of Criminal Recidivism in Juveniles: A Meta-Analysis
COTTLE et al.
Criminal Justice and Behavior 2001;28:367-394.
ABSTRACT  

Violence in the Community as a Predictor of Violence in the Hospital
Dinakar and Sobel
Psychiatr. Serv. 2001;52 :240-241.
FULL TEXT  

The Relationship Between Command Hallucinations and Violence
McNiel et al.
Psychiatr. Serv. 2000;51:1288-1292.
ABSTRACT | FULL TEXT  

Violence risk prediction: Clinical and actuarial measures and the role of the Psychopathy Checklist
DOLAN and DOYLE
Br. J. Psychiatry 2000;177:303-311.
ABSTRACT | FULL TEXT  

The Relationship Between Patients' Gender and Violence Leading to Staff Injuries
Lam et al.
Psychiatr. Serv. 2000;51:1167-1170.
ABSTRACT | FULL TEXT  

Assessing the risk of violence in patients
Shaw
BMJ 2000;320:1088-1089.
FULL TEXT  

Developing a clinically useful actuarial tool for assessing violence risk
MONAHAN et al.
Br. J. Psychiatry 2000;176:312-319.
ABSTRACT | FULL TEXT  

Actuarial Assessment of Risk for Violence: Predictive Validity of the VRAG and the Historical Part of the HCR-20
GRANN et al.
Criminal Justice and Behavior 2000;27:97-114.
ABSTRACT  

Life-Threatening Psychiatric Emergencies in the Elderly: Overview
Tueth and Zuberi
J Geriatr Psychiatry Neurol 1999;12:60-66.
ABSTRACT  

Test of Family of Origin Structural Models of Male Verbal and Physical Aggression
JULIAN et al.
Journal of Family Issues 1999;20:397-423.
ABSTRACT  

Criminal Victimization of Persons With Severe Mental Illness
Hiday et al.
Psychiatr. Serv. 1999;50:62-68.
ABSTRACT | FULL TEXT  

Inpatient and Postdischarge Aggression in Mentally Disordered Offenders: The Role of Psychopathy
HEILBRUN et al.
J Interpers Violence 1998;13:514-527.
ABSTRACT  

Violence by People Discharged From Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods
Steadman et al.
Arch Gen Psychiatry 1998;55:393-401.
ABSTRACT | FULL TEXT  

Guidelines for Managing Domestic Abuse When Male and Female Partners Are Patients of the Same Physician
Ferris et al.
JAMA 1997;278:851-857.
ABSTRACT  

The Influence of Gender and Mental State on Police Decisions in Domestic Assault Cases
FINN and STALANS
Criminal Justice and Behavior 1997;24:157-176.
ABSTRACT  

Batterer Programs: What We Know and Need to Know
GONDOLF
J Interpers Violence 1997;12:83-98.
ABSTRACT  

A Prospective Follow-up Study of Alcoholic Violent Offenders and Fire Setters
Virkkunen et al.
Arch Gen Psychiatry 1996;53:523-529.
ABSTRACT  

Commentary: Dangerous patients or dangerous diseases?
Taylor and Monahan
BMJ 1996;312:967-969.
FULL TEXT  

Violence Prediction: The Past Twenty and the Next Twenty Years
MONAHAN
Criminal Justice and Behavior 1996;23:107-120.
ABSTRACT  

Book Reviews
Monahan
Criminal Justice and Behavior 1995;22:446-447.