Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services.
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Authors
Abidin, Zareena
Davoren, Mary
Naughton, Leena
Gibbons, Olivia
Nulty, Andrea
Kennedy, Harry G
Issue Date
2013-07-27
Type
Journal Article
Validation Study
Validation Study
Language
en
Keywords
Alternative Title
Abstract
The START and SAPROF are newly developed fourth generation structured professional judgement instruments assessing strengths and protective factors. The DUNDRUM-3 and DUNDRUM-4 also measure positive factors, programme completion and recovery in forensic settings.
We compared these instruments with other validated risk instruments (HCR-20, S-RAMM), a measure of psychopathology (PANSS) and global function (GAF). We prospectively tested whether any of these instruments predict violence or self harm in a secure hospital setting (n = 98) and whether they had true protective effects, interacting with and off-setting risk measures.
SAPROF and START-strengths had strong inverse (negative) correlations with the HCR-20 and S-RAMM. SAPROF correlated strongly with GAF (r = 0.745). In the prospective in-patient study, SAPROF predicted absence of violence, AUC = 0.847 and absence of self-harm AUC = 0.766. START-strengths predicted absence of violence AUC = 0.776, but did not predict absence of self-harm AUC = 0.644. The DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales also predicted in-patient violence (AUC 0.832 and 0.728 respectively), and both predicted in-patient self-harm (AUC 0.750 and 0.713 respectively). When adjusted for the HCR-20 total score however, SAPROF, START-S, DUNDRUM-3 and DUNDRUM-4 scores were not significantly different for those who were violent or for those who self harmed. The SAPROF had a significant interactive effect with the HCR-dynamic score. Item to outcome studies often showed a range of strengths of association with outcomes, which may be specific to the in-patient setting and patient group studied.
The START and SAPROF, DUNDRUM-3 and DUNDRUM-4 can be used to assess both reduced and increased risk of violence and self-harm in mentally ill in-patients in a secure setting. They were not consistently better than the GAF, HCR-20, S-RAMM, or PANSS when predicting adverse events. Only the SAPROF had an interactive effect with the HCR-20 risk assessment indicating a true protective effect but as structured professional judgement instruments all have additional content (items) complementary to existing risk assessments, useful for planning treatment and risk management.
We compared these instruments with other validated risk instruments (HCR-20, S-RAMM), a measure of psychopathology (PANSS) and global function (GAF). We prospectively tested whether any of these instruments predict violence or self harm in a secure hospital setting (n = 98) and whether they had true protective effects, interacting with and off-setting risk measures.
SAPROF and START-strengths had strong inverse (negative) correlations with the HCR-20 and S-RAMM. SAPROF correlated strongly with GAF (r = 0.745). In the prospective in-patient study, SAPROF predicted absence of violence, AUC = 0.847 and absence of self-harm AUC = 0.766. START-strengths predicted absence of violence AUC = 0.776, but did not predict absence of self-harm AUC = 0.644. The DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales also predicted in-patient violence (AUC 0.832 and 0.728 respectively), and both predicted in-patient self-harm (AUC 0.750 and 0.713 respectively). When adjusted for the HCR-20 total score however, SAPROF, START-S, DUNDRUM-3 and DUNDRUM-4 scores were not significantly different for those who were violent or for those who self harmed. The SAPROF had a significant interactive effect with the HCR-dynamic score. Item to outcome studies often showed a range of strengths of association with outcomes, which may be specific to the in-patient setting and patient group studied.
The START and SAPROF, DUNDRUM-3 and DUNDRUM-4 can be used to assess both reduced and increased risk of violence and self-harm in mentally ill in-patients in a secure setting. They were not consistently better than the GAF, HCR-20, S-RAMM, or PANSS when predicting adverse events. Only the SAPROF had an interactive effect with the HCR-20 risk assessment indicating a true protective effect but as structured professional judgement instruments all have additional content (items) complementary to existing risk assessments, useful for planning treatment and risk management.
Description
Citation
Abidin, Z., Davoren, M., Naughton, L., Gibbons, O., Nulty, A., & Kennedy, H. G. (2013). Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services. BMC psychiatry, 13, 197. https://doi.org/10.1186/1471-244X-13-197
Publisher
License
Journal
BMC psychiatry
Volume
13
Issue
PubMed ID
DOI
10.1186/1471-244X-13-197
10.1192/bjp.bp.105.021204
10.1192/bjp.177.4.303
10.1080/14999013.2002.10471173
10.1176/appi.ps.54.10.1372
10.1192/pb.25.6.208
10.1046/j.1365-2850.2002.00535.x
10.1001/archpsyc.1997.01830160065009
10.1111/j.2044-8333.1998.tb00354.x
10.1080/13811118.2011.539951
10.1177/0093854807311972
10.1002/bsl.737
10.1192/pb.bp.108.019794
10.1186/1756-0500-4-229
10.1186/1471-244X-12-80
10.1186/1471-244X-13-185
10.1186/1471-244X-11-43
10.1192/bjp.147.6.598
10.1093/schbul/13.2.261
10.3109/00048679709073793
10.1016/S0033-3182(95)71666-8
10.1080/10683160208401811
10.1080/14999013.2007.10471256
10.1097/00005053-200110000-00009
10.1016/S0899-9007(99)00293-2
10.1186/1756-0500-2-105
10.1080/14999013.2011.600230
10.1080/14999013.2011.600232
10.1192/apt.bp.111.010025
10.1192/bjp.bp.105.021204
10.1192/bjp.177.4.303
10.1080/14999013.2002.10471173
10.1176/appi.ps.54.10.1372
10.1192/pb.25.6.208
10.1046/j.1365-2850.2002.00535.x
10.1001/archpsyc.1997.01830160065009
10.1111/j.2044-8333.1998.tb00354.x
10.1080/13811118.2011.539951
10.1177/0093854807311972
10.1002/bsl.737
10.1192/pb.bp.108.019794
10.1186/1756-0500-4-229
10.1186/1471-244X-12-80
10.1186/1471-244X-13-185
10.1186/1471-244X-11-43
10.1192/bjp.147.6.598
10.1093/schbul/13.2.261
10.3109/00048679709073793
10.1016/S0033-3182(95)71666-8
10.1080/10683160208401811
10.1080/14999013.2007.10471256
10.1097/00005053-200110000-00009
10.1016/S0899-9007(99)00293-2
10.1186/1756-0500-2-105
10.1080/14999013.2011.600230
10.1080/14999013.2011.600232
10.1192/apt.bp.111.010025
ISSN
1471-244X