Assessing the Predictive Validity of the HCR-20V3 in Gauging Civil Psychiatric Patients’

Short-term Violence RiskMeghan Banks, B.S.

Fordham University 2016

BackgroundAssessment and prevention of violence are critical in psychiatric care, management, and treatment.

Clinicians have to make decisions about their patients’ violence risk, especially when presented with behavioral emergencies that may require hospitalization.

Clinicians’ unaided judgment in assessing violence risk results in a greater likelihood of false positives.

Four commonly used violence screening measures: 1. Violence-Screening Checklist (VSC)2. Brøset Violence Checklist (BVC)3. Dynamic Appraisal of Situational Aggression (DASA)4. Historical-Clinical Risk Management Version 3 (HCR-20V3)

Present StudyThe present study assessed the predictive validity of the HCR-20V3 Summary Risk Ratings (SRRs) in gauging civil psychiatric patients’ violence risk:1. Addressed whether the HCR-20V3 Case Prioritization, Severe

Physical Harm, and Imminent Violence risk ratings would each be associated with aggression frequency and severity among civil psychiatric patients during a 3 month follow-up period.

2. Addressed whether Case Prioritization ratings would predict aggression occurrence, frequency, and severity.

3. Addressed whether Severe Physical Harm risk ratings would predict aggression severity.

4. Addressed whether Imminent Violence risk ratings would predict aggression frequency and severity.

Methods63 civil psychiatric patients admitted to an urban public hospital between February and December of 2013.

Aggression: 1 = present and 0 = not present.

Aggression frequency: number of aggressive acts committed.

Aggression Severity: 1 = minimal (e.g., verbal), 2 = moderate (threat with weapon), and 3 = severe (life threatening).

HCR-20V3 risk ratings were completed within 2 to 3 weeks after hospital admission based on medical record information and brief interviews with patients’ treatment teams.

1 = low risk, 2 = moderate risk, 3 = high risk.

Data regarding aggressive incidents was extracted from the hospital’s database.

ResultsTable 1

Cross-Tabulation of Aggression Occurrence by Case PrioritizationCase

PrioritizationYes No X2

Low 6 4 1.14Moderate 20 10

High 12 11Total 38 25

• There was a weak, positive, and non-significant correlation between aggression and Case Prioritization rating, rs (61) = .10 p = .46.

• Aggression occurrence did not significantly differ by low, moderate, and high risk patients on Case Prioritization, X2 (2, N = 63) = 1.14, p = .56.

ResultsThere were no significant differences in aggression frequency and severity between low, moderate, and high risk patients on Case Prioritization, F (2, 62) = 0.57, p = .57 and F (2, 62) = 0.71, p = .49, respectively.

There was not a significant difference in aggression severity between low, moderate, and high risk patients with regard to engaging in severe physical harm, F (2, 62) = 1.18, p = .32.

There was not a significant difference in aggression frequency between low, moderate, and high risk patients in engaging in imminent violence, F (2, 62) = 0.47, p = .63.

There was a significant difference in aggression severity between low, moderate, and high risk patients in engaging in imminent violence, F (2, 62) = 3.47, p = .03.

Positive significant association between aggression severity and risk of engaging in imminent violence, rs = .25, p .03.

ResultsCase Prioritization and Severe Physical Harm ratings had weak and non-significant predictive validity. Imminent Violence risk ratings had moderate predictive validity that approached significance, AUC = .63, p = .08.

ResultsTable 2

Aggression Frequency and Severity by Case PrioritizationCase Prioritization

Frequency Severity

Low 10 (M = 0.40, SD = 0.52)

10 (M = 0.90, SD = 1.20)

Moderate 30 (M = 1.27, SD = 1.05)

30 (M = 0.63, SD = 0.93)

High 23 (M = 1.00, SD = 1.41)

23 (M = 0.96, SD = 1.07)

ResultsTable 2

Means and Standard Deviations of Aggression Severity by Severe Physical Harm

Severe Physical Harm SeverityLow 33 (M = 0.67, SD = 0.99)

Moderate 25 (M = 0.84, SD = 1.07)High 5 (M = 1.40, SD = 0.89)

ResultsTable 4

Aggression Frequency and Severity by Imminent ViolenceImminent Violence Frequency Severity

Low 27 (M = 0.93, SD = 2.42)

27 (M = 0.59, SD = 0.93)

Moderate 28 (M = 0.93, SD = 2.16)

28 (M = 0.75, SD = 1.05)

High 8 (M = 1.75, SD = 1.83)

8 (M = 1.63, SD = 1.06)

DiscussionThe HCR-20V3 demonstrated limited predictive validity in gauging civil psychiatric patients’ violence risk. Although Imminent Violence SRR demonstrated moderate predictive validity with regard to severity of violence, it was still weakly associated with aggression. Although more than half of the sample committed at least one aggressive incident, severe aggression was not common.

LimitationsStudy’s definition of “violence”.Did not compare the predictive validity of other validated violence screening measures.Sample size and limited statistical power.

Unable to look at potentially important variables (i.e., diagnostic category).

Lack of variability in diagnosis. Allocation of primary and aggressive interventions to high risk patients.

ReferencesHowe, J., Rosenfeld, B., Foellmi, M., Stern, S., & Rotter, M. (2015). Application of the HCR-20 version 3 in civil psychiatric patients. Criminal Justice and Behavior, 43(3), 398-412.