Evaluating the validity of anger regulation problems, interpersonal style, and disturbed mental state for predicting inpatient violence

Research has been conducted to try to identify risk factors to help predict which patients will be violent during psychiatric hospitalization. Despite the relatively large amount of research conducted, it is difficult to draw any firm conclusions, as the studies vary considerably in study design, methods used, and choice of outcome measures. Studies also tend to focus on risk prediction, even though risk management is the primary aim of clinical practice in mental health services and few studies have focused on a theoretical basis for understanding violence. This study assessed the predictive validity of brief assessment scales in a sample of 94 forensic inpatients who had been inpatient for a median of 521 days, to test the hypotheses that anger regulation problems, interpersonal style, and disturbed mental state would be linked to increased violence risk in a forensic hospital during a hospital stay. The outcome variables for this study were physical violence against another and/or clear threats of physical violence. The results of this study provide support for the hypotheses, and this remained the case after controlling for age, gender, length of stay, and presence of major mental disorder. The findings should not only assist clinicians with assessment and management of risk but also support the reconceptualizing of risk prediction research to reflect the task of clinical risk management.     

The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients

Considerable research has attempted to delineate the demographic and clinical characteristics of high-risk psychiatric patients and identify salient modifiable aspects of aggression prone environments. Recently, there has also been increased interest in the development and testing of structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. Although some of these methods show acceptable predictive validity, their ability to inform day-to-day treatment and management decisions is limited. The current research was designed to identify existing and novel risk factors that would assist staff to identify and manage the risk for aggression in psychiatric inpatient populations. Results showed that assessments supported by structured risk measures were more accurate than unaided clinical judgements based only on nurses' clinical experience and knowledge of the patient alone. Seven test items emerged that were maximally effective at identifying acute psychiatric patients at risk for engaging in inpatient violence within 24 hours; these items have been combined in the development of the Dynamic Appraisal of Situational Aggression. Empirical analyses and clinical experience support the efficacy of the instrument in assisting clinical staff in the identification and management of inpatient aggression.     

Subjective Social Status and Well-Being: The Role of Referent Abstraction

Subjective social status (SSS) has been shown to predict well-being and mental health, above and beyond objective social status (OSS). However, little is known about the factors that moderate this relationship. Two studies explored whether the link between SSS and well-being varied depending upon the referent used for comparison in SSS judgments. Participants judged their well-being and SSS in comparison to referents that varied in abstraction. A confirmatory factor analysis on SSS judgments yielded two factors: (a) SSS perceptions toward global referents and (b) SSS perceptions toward local referents. SSS relative to a global referent was a better predictor of depression (Studies 1 and 2), life satisfaction (Studies 1 and 2), and self-esteem (Study 2) than SSS relative to a local referent. These findings have theoretical implications for understanding how people differentiate between local vs. global referents and practical implications for status-related health disparities.     

Observed staff engagement predicts postive relationships and well-being in a physical activity-based program for low-income youth

Positive youth development (PYD) programs aim to support long-term well-being in young people by building their strengths and assets. PYD program staff are pivotal in achieving this goal, as positive staff-youth interactions are associated with well-being in youth. Much of this research relies on youth perceptions of interactions with staff. A better understanding of how observed staff behaviors are associated with youth outcomes would provide guidance for developing interventions regarding effective staff behaviors. This study examined associations between observed staff behaviors and youths' perceptions of their relationships with staff and well-being. Participants were recruited from a summer physical activity-based PYD program for underserved youth. Staff (N = 24, 16 women, 8 men) were observed by researchers to evaluate their engagement, interaction, safety, and support behaviors. Youth from diverse backgrounds (N = 394; 47% girls, 53% boys; M_age = 10.20; 44% Latino/a) completed measures of their perceptions of relationships with staff (mutual respect, autonomy support, and care), and well-being (hope, self-esteem, and social competence) at the end of the program. Structural equation modeling indicated that observed staff engagement positively predicted youth perceptions of their relationships with staff and well-being. Youth perceptions of positive social relationships with staff also positively predicted their well-being. Staff who create opportunities for youth to reflect and respond to program activities are perceived as valuing, making genuine connections, and considering the opinions and feelings of youth. Developing ways to enable staff to build relationships with youth that include these features is an important avenue for future research.     

The predictive validity and practical utility of structured schemes used to assess risk for aggression in psychiatric inpatient settings

There has been increased interest in structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. The most commonly utilized schemes are those previously developed to assess risk for prisoners being considered for release on parole and for forensic psychiatric patients being considered for discharge from the hospital to the community. Few structured schemes have been developed with the explicit aim of assessing risk for aggression in the inpatient setting. Recent research utilising a variety of risk assessment schemes has revealed reasonable predictive validity. This narrative review summarizes and appraises this expanding literature within the context of risk assessment decision making tasks typically undertaken by psychiatric unit staff. It is concluded that a number of structured risk assessments schemes do have acceptable predictive validity. Unfortunately, many of the schemes tested are compromised by a lack of practical utility, and only a few are capable of contributing to the entire range of risk assessment decision making tasks required. Options for the application of structured risk assessment schemes are raised.     

Psychopathy and the predictive validity of the PCL-R: an international perspective

Its controversial past notwithstanding, psychopathy has emerged as one of the most important clinical constructs in the criminal justice and mental health systems. One reason for the surge in theoretical and applied interest in the disorder is the development and widespread adoption of reliable and valid methods for its measurement. The Hare PCL-R provides researchers and clinicians with a common metric for the assessment of psychopathy, and has led to a surge in replicable and meaningful findings relevant to the issue of risk for recidivism and violence, among other things. Most of the research thus far has been based on North American samples of offenders and forensic psychiatric patients. We summarize this research and compare it with findings from several other countries, including England and Sweden. We conclude that the ability of the PCL-R to predict recidivism, violence, and treatment outcome has considerable cross-cultural generalizability, and that the PCL-R and its derivatives play a major role in the understanding and prediction of crime and violence.     

Short-term clinical risk assessment and management: Comparing the Brockville Risk Checklist and Hamilton Anatomy of Risk Management

The current article aims to examine the performance of two brief, dynamic risk measures – the Brockville Risk Checklist (BRC4) and one of two versions of the Hamilton Anatomy of Risk Management [HARM-FV and electronic HARM-FV (eHARM-FV)] – scored at regular clinical case conferences for forensic psychiatric patients in two different settings. The eHARM represents a first-in-class dynamic risk assessment tool using data analytics. Two studies are presented from two forensic psychiatric hospitals in Ontario, Canada. The first study compared the HARM-FV, scored by trained research staff, with the BRC4, scored concurrently by clinical teams, on 36 forensic inpatients. In the second study, trained research staff scored both the BRC4 and the eHARM-FV on 55 forensic inpatients. Both studies demonstrated that the BRC4 and both HARM-FV tools were moderately and positively correlated with each other, with higher agreement for similar domains and items. In both samples, the risk measures performed better at identifying individuals who engaged in repeated or more serious problematic behavior. The HARM-FV and eHARM-FV produced higher area under the curve values for subsequent behavior compared with the BRC4. All three tools were effective at detecting future aggression and adverse incidents. We did not directly compare the HARM-FV and eHARM-FV.     

A qualitative investigation of perceptions of violence risk factors in low-income African American children

Conducted a qualitative investigation to identify the perceptions of risk factors for violence in a sample of inner-city African American youth. Using ethnographic analyses, themes emerging from these data included concerns about the reciprocity between drugs and violence, familial quality of life issues, gender differences in the experience of violence and risk for violence, community safety concerns, and fears about managing peer relationships specific to violence. These data are interpreted relative to the risk factors the violence prevention literature has identified among youth residing in urban environments. Findings are discussed in terms of their potential contribution to generating hypotheses for the development of theory and effective violence prevention practice.     

Myths and stereotypes of actors involved in domestic violence: Implications for domestic violence culpability attributions

Stereotypes exist about actors involved in domestic violence, particularly women of color. It has been suggested that Black women are more aggressive and accustomed to violence than White women. Moreover, victim resistance, marital status, and perceiver’s sex have all been found to influence perceptions of domestic violence culpability. Since the 1970s, when domestic violence was acknowledged as a social problem, researchers have examined how the lay person’s perceptions of battered women and their batterers are influenced by extralegal factors. Although research on perceptions of domestic violence when White women and men are involved has increased dramatically in recent years, there is a dearth of research on perceptions of such violence when women and men of color are participants. The available findings on the influence of stereotypical notions concerning victims and batterers upon perceptions of domestic violence are examined. This review will provide the available evidence and suggest research areas where information is needed to more fully address the needs of people of color in understanding their own victimization and how actors in the legal system can guard against biased responding.     

Sexual violence perceptions among Christian college students

Sexual violence is a persistent problem, both nationally and globally, with college females having an elevated risk over their non-college peers. However, there have been limited studies exploring the beliefs that specific sub-populations, such as religious groups, have about sexual violence. A central objective of this study was to provide a better understanding of student needs in order to assist administrators and student service professionals as they offer support for students in Christian higher education settings. This study was a comprehensive, exploratory survey into the attitudes and perceptions of rape myth acceptance, sexism, authoritarianism, violence, and safety, as well as occurrence of sexual violence, among Christian college students at a mid-Atlantic Christian university was conducted. The results demonstrate which concepts relate to or were predicted by students’ rape myth acceptance, as well as ascertaining similarities and differences between secular and religious colleges. Recommendations for universities, program developers, and researchers are discussed.     

Integrating research and practice in federal law enforcement: Secret Service applications of behavioral science expertise to protect the President

This paper discusses specific behavioral research needs by law enforcement and justice systems to guide forensic decision-making in areas of targeted violence. Continuing incidents of stalking, workplace violence, and threats to public figures underscore the importance of developing empirically based risk assessment and intervention strategies. Reviewing briefly the relevant literatures in these areas, this paper describes deficits in these literatures and the absence of a model for integrating research and practice in applied settings. The U.S. Secret Service Behavioral Research Program is explored as one example of how behavioral science expertise may be integrated with law enforcement responsibilities. Considerations associated with building behavioral research capacities in applied settings are examined in the context of differences in professional orientation, values, and access to information. Specific research directions to improve understanding of targeted violence are recommended along with suggestions for ways in which the psychology-law field may facilitate integration of research into practice. © 1998 John Wiley & Sons, Ltd.     

Evolving judgments of terror risks: foresight, hindsight, and emotion: a reanalysis

The authors examined the evolution of cognitive and emotional responses to terror risks for a nationally representative sample of Americans between late 2001 and late 2002. Respondents' risk judgments changed in ways consistent with their reported personal experiences. However, they did not recognize these changes, producing hindsight bias in memories for their judgments. An intensive debiasing procedure failed to restore a foresightful perspective. A fear-inducing manipulation increased risk estimates, whereas an anger-inducing manipulation reduced them-both in predictions (as previously observed) and in memories and judgments of past risks. Thus, priming emotions shaped not only perceptions of an abstract future but also perceptions of a concrete past. These results suggest how psychological research can help to ensure an informed public.     

Staff members' feelings toward psychiatric patients related to their own and the patient's self-image and gender

The relation between staff members' feelings toward a patient and their own and the patient's self-image in different gender combination groups was studied. Staff at 16 psychiatric treatment homes for patients with severe psychopathology reported their feelings toward their patients on a number of occasions. At the start of treatment, both staff members and patients rated their self-images using the Structural Analysis of Social Behavior (SASB). Male staff seemed less influenced by the patient, with their feelings relating mainly to aspects of their own self-image, while the feelings of the female staff were more related to the patient's self-image. The patient's diagnosis was less important for a staff member's feelings than that member's self-image. Generally, the relation between feelings and self-image was stronger for negative feelings. The results point to the importance of understanding more about the influence of staff members' self-structure on their negative feelings toward their patients and how this relates to both the staff member's and patient's gender.     

Evolving judgments of terror risks: foresight, hindsight, and emotion

The authors examined the evolution of cognitive and emotional responses to terror risks for a nationally representative sample of Americans between late 2001 and late 2002. Respondents' risk judgments changed in ways consistent with their reported personal experiences. However, they did not recognize these changes, producing hindsight bias in memories for their judgments. An intensive debiasing procedure failed to restore a foresightful perspective. A fear-inducing manipulation increased risk estimates, whereas an anger-inducing manipulation reduced them-both in predictions (as previously observed) and in memories and judgments of past risks. Thus, priming emotions shaped not only perceptions of an abstract future but also perceptions of a concrete past. These results suggest how psychological research can help to ensure an informed public.     

Nature,extent, and causes of bullying among personality‐disordered patients in a high‐secure hospital

The present study explored the perceptions and experiences of the nature, extent and causes of bullying among personality‐disordered patients, with a subsidiary aim of exploring differences in perceptions between staff and patients. The sample was selected from the Personality Disorder Unit of a high secure hospital. The total sample consisted of 60 participants, 30 patients and 30 staff. Participants engaged in a semi‐structured interview based on that developed by Brookes [1993] and modified by Ireland and Archer [1996] and Ireland [2002a]. The interview assessed their perceptions and experiences of patient‐to‐patient bullying. One fifth of patients and staff reported that they had seen a patient being bullied in the previous week. One‐fifth of patients reported that they had been bullied in the previous week and less than one tenth reported that they had bullied others. The most frequent types of bullying reported were theft‐related, verbal abuse, being made to do chores, physical assaults and intimidation. One fifth of the sample reported that sexual abuse took place. Victims were generally perceived to be ‘easy targets’ that were vulnerable, either physically or emotionally. Staff identified a wider range of victim types than patients. The results highlight how patient‐to‐patient bullying does occur and is an important issue worthy of further research. A number of similarities were found between the current findings and those of prison‐based research suggesting that both hospitals and prisons share a number of environmental similarities that help to explain why bullying takes placed in secure forensic settings. Aggr. Behav. 30:229–242, 2004. © 2004 Wiley‐Liss, Inc.     

Predicting physically violent misconduct in prison: A comparison of four risk assessment instruments

Violence in correctional facilities is an important issue for both prisoners and prison staff. Risk assessment instruments have demonstrated their accuracy in predicting the risk of (re) offending and institutional violence in psychiatric settings, but less is known about their ability to predict violent misconduct in prison. The present study applied four risk assessment instruments (Structured Assessment of Protective Factors for violence risk, Historical Clinical Risk Management‐20, Psychopathy checklist – Revised, and Violent Risk Appraisal Guide) to 52 violent offenders in a Swiss prison in order to evaluate the instruments' predictive validities. Outcomes were instances of physically violent, other and any misconduct as recorded in prison files during the 12 months following the prisoners' assessments. Approximately 15% of offenders committed physically violent misconduct and approximately 42% committed any misconduct. The results show that mainly dynamic assessment tools are as good predictors of physically violent misconduct as mainly static assessment tools. Targeting dynamic factors could increase the effectiveness of interventions to reduce the risk of physical violence in prison.     

The accuracy of risk assessment instruments in the prediction of impulsive versus predatory aggression

Actuarial violence risk assessments, many of which include the construct of psychopathy, have been shown to be superior to clinical judgment in the prediction of long-term risk of community violence and recidivism. While these instruments initially appeared to provide similarly accurate judgments of risk of institutional aggression, recent research has indicated that such assessments may be less robust in this setting. One explanation may lie in the types of aggression most frequently observed in each setting. Impulsive (or reactive/affective) is the type of physical aggression most commonly exhibited in psychiatric facilities. This research examines the relationship between risk assessments and aggression in an inpatient forensic setting, with such aggression categorized as impulsive, predatory or psychotic aggression. Consistent with previous research, impulsive aggression was the most frequent type observed (58%). Anger (as measured by the Novaco Anger Scale) and clinical issues (as measured by the HCR-20) were most associated with impulsive aggression, with AUC values of .73 and .71 respectively. In contrast, anger and psychopathy (as measured by the PCL-R) were more associated with predatory aggression, with AUC values of .95 and .84 respectively. Psychotic symptoms were highly associated with psychotically motivated aggression (AUC = .90). These results suggest that traditional violence risk assessments may have limited utility in predicting aggression in an institutional setting and that psychiatric symptoms and heightened affect are more relevant. Copyright © 2008 John Wiley & Sons, Ltd.     

Organizational tenure,work environment perceptions,and employee mental health

The mediating effect of organizational “time investments” on the relationship between work environment perceptions and mental health was explored in two work settings. Participants were 257 managerial-level employees in a line organization and 214 in a staff setting. Results support the hypothesis of greater “responsivity” to perceived organizational stimuli for longer tenured employees, but only in the line setting. The mixed findings in the staff organization suggest that other characteristics of the environment (e.g., systems function) and of its members (e.g., organizational versus occupational identification) need to be considered. Implications for the social responsibilities of organizations to their members are offered in conclusion.     

Family Functioning among Rural Teens and Caregivers: Interactive Influence on Teen Dating Violence

Multi-informant assessment of family functioning is considered best practice in research and clinical settings. However, in the area of teen dating violence, multi-informant assessment of family functioning has received limited attention. The current study investigated whether and to what extent caregiver and adolescent perceptions of family functioning interact in their influence on adolescent dating violence. Participants were 493 adolescents and their primary caregivers from a rural southeastern community in the United States. As hypothesized, a paired-samples t test showed that adolescents’ scores on the family functioning measure were significantly lower than their caregivers’ scores. Logistic regressions revealed that adolescents’ positive views of family functioning were significantly associated with a lower likelihood of dating violence victimization but not perpetration and that caregivers’ views on family functioning moderated the impact of adolescent-reported family functioning on both dating violence outcomes. Post hoc analyses showed that adolescents with negative perceptions of family environment were most likely to be victims and perpetrators of dating violence when their parents also reported more negative views of family environment. The article concludes with a discussion of how these findings can: (a) advance our understanding of the impact of family functioning on teen dating relationships and (b) inform practical efforts aimed at preventing dating aggression among teens.