The relationship between confidence and accuracy in clinical assessment ofpsychiatric patients' potential for violence

The authors studied the relationship between confidence and accuracy in cli nical assessments of psychiatric patients' short-term risk of violence. At the time of entry to the hospital, physicians (N = 78) estimated the probab ility that each of 317 patients would physically attack other people during the first week of psychiatric hospitalization. The clinicians also indicat ed the degree of confidence they had in their estimates of violence potenti al Nurses rated the occurrence of inpatient physical assaults with the Over t Aggression Scale. The results showed that when clinicians had a high degr ee of confidence, their evaluations of risk of violence were strongly assoc iated with whether or not patients became violent. At moderate levels of co nfidence, clinicians' risk estimates had a lower but still substantial rela tionship with the later occurrence of violence. However when clinicians had low confidence, their assessments of potential for violence had little rel ationship to whether or not the patients became violent. The findings sugge st that the level of confidence that clinicians have in their evaluations i s an important moderator of the predictive validity of their assessments of patients' potential for violence.