TABLE 4. Selected Studies Demonstrating Validity of Clinical Risk Factors in Risk Assessment

Study Major findings

Lidz, Mulvey, and Gardner (1993) Clinical predictions significantly above chance for males (63% sensitive, 60% specificity), but not for females; clinical prediction better than chance even when clinicians not predicting on basis of history, age, or gender
McNeil and Binder (1994) Five-item scale including clinical, historical, and demographic factors (Violence Screening Checklist or VSC) resulted in 57% sensitivity, 70% specificity
Mossman (1994) In meta-analysis of 58 data sets, 47 demonstrated better than chance validity of clinical prediction of violence, with combined AUC = 0.73
Mulvey and Lidz (1998) Clinicians generally right in predicting seriousness and location of violence, but overestimate role of medication noncompliance and SA; clinicians tend to focus on conditions they can address with treatment
Arango et al. (1999) Inpatient violence related to clinical variables, not sociodemographic variables or psychiatric history; model based on uncooperativeness, poor judgment, poor insight into psychotic symptoms, and violence in week prior to admission achieved 80% positive predictive power (PPP)
Hoptman et al. (1999) Psychiatrists' prediction of assault in maximum security forensic facility achieved 54% sensitivity, 79% specificity, and 71% correct classification
Skeem, Mulvey, and Lidz (2000) Clinicians moderately accurate in predicting violent behavior (55% PPP) based on alcohol use, but do not discriminate well between drinkers who are/are not violent
McNeil et al. (2003) VSC and clinical scale of HCR-20 significantly associated with inpatient assault
Gray et al. (2003) Brief Psychiatric Rating Scale best predictor of physical aggression over 3 months among patients admitted to inpatient service, followed by "HCR-15" (i.e., no "R")