Proximal Risk Factors for Short-Term Community Violence Among Adults With Mental Illnesses.
Proximal Risk Factors for Short-Term Community Violence Among Adults With Mental Illnesses.
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DOI：
10.1176/appi.ps.201500259
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发表时间：
2016-07-01
期刊：
影响因子：
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通讯作者：
Van Dorn RA
中科院分区：
文献类型：
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作者：
Johnson KL;Desmarais SL;Grimm KJ;Tueller SJ;Swartz MS;Van Dorn RA
本研究考察了静态指标和近端临床相关指标在预测大型异质精神疾病成人短期社区暴力中的作用。数据汇集自5项成人精神疾病研究（N=4,484）。随访数据来自2579名参与者。分层线性回归评估了六个月时预测暴力风险的一系列变量簇的增量有效性：静态特征（年龄、性别、种族和初步诊断）、物质使用（基线时的酒精使用和药物使用）、临床功能（基线时的精神症状和最近住院）、最近的暴力行为和最近的受害行为。结果表明，模型的每一步预测都有所提高，表明近端指标对短期社区暴力的预测比静态特征更有贡献。当输入所有变量时，即使在控制了参与者特征的分析之后，当前的酒精使用情况、最近的暴力行为和最近的受害行为都是随后暴力行为的积极预测因素。本研究为评估和管理成年精神疾病患者短期暴力风险的三个近端、临床相关指标提供了经验证据：当前饮酒、近期暴力和近期受害。在临床实践中考虑这些指标，可能有助于识别有较高短期社区暴力风险的成年精神疾病患者。
This study examined the role of static indicators and proximal, clinically relevant indicators in the prediction of short-term community violence in a large, heterogeneous sample of adults with mental illnesses. Data were pooled from five studies of adults with mental illnesses (N=4,484). Follow-up data were available for 2,579 participants. A hierarchical linear regression assessed the incremental validity of a series of variable clusters in the prediction of violence risk at six months: static characteristics (age, sex, race-ethnicity, and primary diagnosis), substance use (alcohol use and drug use at baseline), clinical functioning (psychiatric symptoms at baseline and recent hospitalization), recent violence, and recent victimization. Results demonstrated improved prediction with each step of the model, indicating that proximal indicators contributed to the prediction of short-term community violence above and beyond static characteristics. When all variables were entered, current alcohol use, recent violence, and recent victimization were positive predictors of subsequent violence, even after the analysis controlled for participant characteristics. This study provides empirical evidence for three proximal, clinically relevant indicators in the assessment and management of short-term violence risk among adults with mental illnesses: current alcohol use, recent violence, and recent victimization. Consideration of these indicators in clinical practice may assist in the identification of adults with mental illnesses who are at heightened risk of short-term community violence.