Calibrating violence risk assessments for uncertainty
Psychiatrists and other mental health clinicians are often tasked with assessing patients’ risk of violence. Approaches to this vary and include both unstructured (based on individual clinicians’ judgement) and structured methods (based on formalised scoring and algorithms with varying scope for cli...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-04-01
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| Series: | General Psychiatry |
| Online Access: | https://gpsych.bmj.com/content/36/2/e100921.full |
| _version_ | 1797837457024090112 |
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| author | Michael H Connors Matthew M Large |
| author_facet | Michael H Connors Matthew M Large |
| author_sort | Michael H Connors |
| collection | DOAJ |
| description | Psychiatrists and other mental health clinicians are often tasked with assessing patients’ risk of violence. Approaches to this vary and include both unstructured (based on individual clinicians’ judgement) and structured methods (based on formalised scoring and algorithms with varying scope for clinicians’ judgement). The end result is usually a categorisation of risk, which may, in turn, reference a probability estimate of violence over a certain time period. Research over recent decades has made considerable improvements in refining structured approaches and categorising patients’ risk classifications at a group level. The ability, however, to apply these findings clinically to predict the outcomes of individual patients remains contested. In this article, we review methods of assessing violence risk and empirical findings on their predictive validity. We note, in particular, limitations in calibration (accuracy at predicting absolute risk) as distinct from discrimination (accuracy at separating patients by outcome). We also consider clinical applications of these findings, including challenges applying statistics to individual patients, and broader conceptual issues in distinguishing risk and uncertainty. Based on this, we argue that there remain significant limits to assessing violence risk for individuals and that this requires careful consideration in clinical and legal contexts. |
| first_indexed | 2024-04-09T15:26:05Z |
| format | Article |
| id | doaj.art-9f38166de7804f488adf8f47399902a5 |
| institution | Directory Open Access Journal |
| issn | 2517-729X |
| language | English |
| last_indexed | 2024-04-09T15:26:05Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | General Psychiatry |
| spelling | doaj.art-9f38166de7804f488adf8f47399902a52023-04-28T18:30:06ZengBMJ Publishing GroupGeneral Psychiatry2517-729X2023-04-0136210.1136/gpsych-2022-100921Calibrating violence risk assessments for uncertaintyMichael H Connors0Matthew M Large11 Sydney Medical School, The University of Sydney, Sydney, New South Wales, AustraliaSchool of Psychiatry, University of New South Wales, Sydney, New South Wales, AustraliaPsychiatrists and other mental health clinicians are often tasked with assessing patients’ risk of violence. Approaches to this vary and include both unstructured (based on individual clinicians’ judgement) and structured methods (based on formalised scoring and algorithms with varying scope for clinicians’ judgement). The end result is usually a categorisation of risk, which may, in turn, reference a probability estimate of violence over a certain time period. Research over recent decades has made considerable improvements in refining structured approaches and categorising patients’ risk classifications at a group level. The ability, however, to apply these findings clinically to predict the outcomes of individual patients remains contested. In this article, we review methods of assessing violence risk and empirical findings on their predictive validity. We note, in particular, limitations in calibration (accuracy at predicting absolute risk) as distinct from discrimination (accuracy at separating patients by outcome). We also consider clinical applications of these findings, including challenges applying statistics to individual patients, and broader conceptual issues in distinguishing risk and uncertainty. Based on this, we argue that there remain significant limits to assessing violence risk for individuals and that this requires careful consideration in clinical and legal contexts.https://gpsych.bmj.com/content/36/2/e100921.full |
| spellingShingle | Michael H Connors Matthew M Large Calibrating violence risk assessments for uncertainty General Psychiatry |
| title | Calibrating violence risk assessments for uncertainty |
| title_full | Calibrating violence risk assessments for uncertainty |
| title_fullStr | Calibrating violence risk assessments for uncertainty |
| title_full_unstemmed | Calibrating violence risk assessments for uncertainty |
| title_short | Calibrating violence risk assessments for uncertainty |
| title_sort | calibrating violence risk assessments for uncertainty |
| url | https://gpsych.bmj.com/content/36/2/e100921.full |
| work_keys_str_mv | AT michaelhconnors calibratingviolenceriskassessmentsforuncertainty AT matthewmlarge calibratingviolenceriskassessmentsforuncertainty |