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Psychiatr Serv. 2009 Nov;60(11):1522-6. doi: 10.1176/

Assessing risk of future violence among forensic psychiatric inpatients with the Classification of Violence Risk (COVR).

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  • 1School of Psychology, Cardiff University, Park Place, Cardiff, Wales, United Kingdom.



Instruments are needed to help clinicians make decisions about a patient's risk of future violence in order to manage this risk, protect others, and allocate resources. One such actuarial instrument-the Classification of Violence Risk (COVR)-was developed from the MacArthur Violence Risk Assessment Study. The COVR has not been validated in a sample other than the one with which it was constructed or outside of the United States. The purpose of this study was to provide an independent validation of the COVR in a sample of forensic psychiatric inpatients in the United Kingdom.


The prospective study was conducted at four medium-security forensic psychiatric units over six months. Two risk assessment instruments were completed for 52 patients: the COVR and the Violence Risk Appraisal Guide (VRAG), a well-established actuarial instrument. Incidents of verbal aggression, physical aggression toward others, and aggression against property were documented for the next six months from nursing records. Predictive accuracy of the instruments was analyzed using both correlational techniques and signal detection theory.


COVR was a good predictor of both verbal and physical aggression. Its predictive ability was similar to that of the VRAG, although the VRAG was a better predictor of violence to property.


The study provides the first independent validation of the COVR and evidence of the usefulness of the COVR in predicting harmful behavior in forensic inpatient settings in the United Kingdom.

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