CORRELATES OF ACCURACY IN THE ASSESSMENT OF PSYCHIATRIC-INPATIENTS RISK OF VIOLENCE

Objective: The authors evaluated characteristics of patients whom clin icians accurately assessed as being at high or lour risk for violence and patients for whom clinicians overestimated or underestimated the r isk. Method: At admission, physicians estimated the probability that e ach of 226 psychiatric inpatients would physically attack someone duri ng the first week of hospitalization. Nurses rated assaultive behavior in the hospital with the Overt Aggression Scale. Acute symptoms were rated with the Brief Psychiatric Rating Scale. Results: For the group as a whole, assessed levels of risk were substantially related to late r physical aggression (sensitivity=67%, specificity=69%). Multinomial legit analysis showed that patients with psychotic disorders such as s chizophrenia, organic psychotic conditions, and mania were more likely to be accurately assessed by clinicians as being at high risk (true p ositives) than to be true negatives or false positives. A recent histo ry of violence was associated with higher estimated risk but did not d istinguish true positives from false positives. An admission mental st atus characterized by low levels of hostility, uncooperativeness, and suspiciousness and high levels of depression, guilt, and anxiety diffe rentiated true negative patients from others, but symptom profiles did not differ among true positives, false positives, and false negatives . Clinical judgments emphasizing gender and race/ethnicity were associ ated with predictive errors: nonwhite and male patients tended to be f alse positives. Conclusions: While clinicians cart accurately classify the potential for violence in the majority of patients at admission, systematic errors characterize inaccurate assessments of the risk. Awa reness of these patterns may help improve assessment of the risk of vi olence in clinical practice.