The accuracy of predictions of violence to others.
The accuracy of predictions of violence to others.
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DOI：
10.1001/jama.1993.03500080055032
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发表时间：
1993-02
期刊：
影响因子：
--
通讯作者：
C. Lidz;E. Mulvey;W. Gardner
中科院分区：
文献类型：
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作者：
C. Lidz;E. Mulvey;W. Gardner
目的评价临床医生预测精神病人暴力行为的准确性。具体来说，确定临床医生是否可以在控制年龄、种族和性别导致的暴力率变化的情况下预测暴力。设计在社区对年龄、种族、性别和入院情况相匹配的两例精神病患者进行为期6个月的随访。一组包括精神病急诊科临床医生在随访期间评估为可能对他人暴力的个体；另一组是对照组。患者提供了暴力事件的自我报告，而一个“附属品”，即一个对患者生活有详细了解的人，提供了同样的信息。还审查了官方记录。研究背景：在一家大都会精神病院的急诊科招募患者。在患者家中或社区公共场所对患者及其抵押品进行访谈。患者或其他参与者在白班和夜班期间连续获得进入精神科急诊科的个体样本。共接触2452例患者征求同意，1948例患者同意。最后的样本包括357名临床医生评估为可能有暴力倾向的患者及其匹配的对照患者。主要结果测量：患者、附属品和官方记录中关于患者对他人动手或用武器威胁他人的事件报告。结果：在随访期间，约45%的病例报告有暴力行为：对照组为36%，预计有暴力行为的病例为53%。总体临床准确性显著优于随机，但对女性患者暴力行为的预测不优于随机。结论采用自我报告和附带报告的患者暴力程度高于其他方法。临床判断增加了预测的准确性，但总体准确性一般，尤其是女性患者的准确性较低。
OBJECTIVE To assess the accuracy of clinicians in predicting violence in mental patients. Specifically, to determine if clinicians can predict violence when variation in rates of violence attributable to age, race, and sex is controlled. DESIGN Two samples of psychiatric patients, matched on age, race, sex, and admission status, were followed up in the community during a 6-month period. One group included individuals assessed by psychiatric emergency department clinicians as likely to be violent to another person during the follow-up period; the other was a comparison group. Patients provided self-reports of violent incidents, and a "collateral," ie, an individual with detailed knowledge of the patient's life, provided this same information. Official records were also reviewed. SETTING Patients were recruited in the emergency department of a metropolitan psychiatric hospital. Patients and collaterals were interviewed in their homes or in public places in the community. PATIENTS OR OTHER PARTICIPANTS A consecutive sample of individuals coming into a psychiatric emergency department during daylight and evening shifts was obtained. A total of 2452 patients were approached for consent and 1948 consented. A final sample of 357 patients whom clinicians assessed as likely to be violent and their matched comparison patients were included. MAIN OUTCOME MEASURES Patients', collaterals', and official records' reports of incidents in which the patient laid hands on another person or threatened someone with a weapon. RESULTS Violence during the follow-up period was reported in approximately 45% of the cases: 36% in the comparison group and 53% in the cases predicted to be violent. Overall clinical accuracy was significantly better than chance, but predictions of female patients' violence were not better than chance. CONCLUSIONS The level of patient violence reported using self-reports and collateral reports was higher than has been obtained using other methods. Clinical judgment adds to predictive accuracy, but overall accuracy was modest and particularly low for female patients.