14.2 STUCTURED RISK ASSESSMENT IN PSYCHIATRY. (1st April 2018)

• Record Type: Journal Article
• Authors: Fazel, Seena; Wolf, Achim; Larsson, Henrik; Fanshawe, Thomas; Mallett, Susan
• Is Part Of: Schizophrenia bulletin. Volume 44(2018)Supplement 1
• Page Start: S23
• Page End: S24
• Publication Date: 2018-04-01
• Subjects: Schizophrenia -- Periodicals; Schizophrenia -- Research -- Periodicals; 616.898005
• DOI: 10.1093/schbul/sby014.055
• Languages: English
• ISSNs: 0586-7614

Abstract

Abstract: Background: Current approaches to stratify psychiatric patients into groups based on violence risk are limited by inconsistency, variable accuracy, and unscalability. Methods: Based on a national cohort of 75 158 Swedish individuals aged 15–65 with a diagnosis of severe mental illness (schizophrenic-spectrum and bipolar disorders) with 574 018 patient episodes, we developed predictive models for violent offending through linkage of population-based registers. First, a derivation model was developed to determine strength of pre-specified criminal history, socio-demographic, and clinical risk factors, and tested it in external validation. We measured discrimination and calibration for prediction of violent offending at 1 year using specified risk cut-offs. Results: A 16 item model was developed from criminal history, socio-demographic and clinical risk factors, which are mostly routinely collected. In external validation, the model showed good measures of discrimination (c-index 0.89) and calibration. For risk of violent offending at 1 year, using a 5% cut off, sensitivity was 64% and specificity was 94%. Positive and negative predictive values were 11% and 99%, respectively. The model was used to generate a simple web-based risk calculator (OxMIV). Discussion: We have developed a prediction score in a national cohort of patients with psychosis that can be used as an adjunct to decision making in clinical practice by identifying those who are at low risk of violent offending