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Eur Psychiatry. 2018 Jan;47:88-93. doi: 10.1016/j.eurpsy.2017.07.011. Epub 2017 Aug 4.

Prediction of violent crime on discharge from secure psychiatric hospitals: A clinical prediction rule (FoVOx).

Author information

1
Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, OX3 7JX Oxford, UK.
2
Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG Oxford, UK.
3
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden.
4
Oxford Health NHS Foundation Trust, OX3 7JX Oxford, UK.
5
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden; School of Medical Sciences, Örebro University, 701 82 Örebro, Sweden.
6
Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, OX3 7JX Oxford, UK. Electronic address: seena.fazel@psych.ox.ac.uk.

Abstract

BACKGROUND:

Current approaches to assess violence risk in secure hospitals are resource intensive, limited by accuracy and authorship bias and may have reached a performance ceiling. This study seeks to develop scalable predictive models for violent offending following discharge from secure psychiatric hospitals.

METHODS:

We identified all patients discharged from secure hospitals in Sweden between January 1, 1992 and December 31, 2013. Using multiple Cox regression, pre-specified criminal, sociodemographic, and clinical risk factors were included in a model that was tested for discrimination and calibration in the prediction of violent crime at 12 and 24 months post-discharge. Risk cut-offs were pre-specified at 5% (low vs. medium) and 20% (medium vs. high).

RESULTS:

We identified 2248 patients with 2933 discharges into community settings. We developed a 12-item model with good measures of calibration and discrimination (area under the curve=0.77 at 12 and 24 months). At 24 months post-discharge, using the 5% cut-off, sensitivity was 96% and specificity was 21%. Positive and negative predictive values were 19% and 97%, respectively. Using the 20% cut-off, sensitivity was 55%, specificity 83% and the positive and negative predictive values were 37% and 91%, respectively. The model was used to develop a free online tool (FoVOx).

INTERPRETATION:

We have developed a prediction score in a Swedish cohort of patients discharged from secure hospitals that can assist in clinical decision-making. Scalable predictive models for violence risk are possible in specific patient groups and can free up clinical time for treatment and management. Further evaluation in other countries is needed.

FUNDING:

Wellcome Trust (202836/Z/16/Z) and the Swedish Research Council. The funding sources had no involvement in writing of the manuscript or decision to submit or in data collection, analysis or interpretation or any aspect pertinent to the study.

KEYWORDS:

Clinical prediction; Crime; Forensic psychiatry; Psychometry and assessments in psychiatry; Risk assessment; Secure hospital; Violence

PMID:
29161680
PMCID:
PMC5797975
DOI:
10.1016/j.eurpsy.2017.07.011
[Indexed for MEDLINE]
Free PMC Article

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