ABSTRACT

Violence risk prediction in forensic mental health care settings is important in facilitating its management. Although not specifically developed for risk assessment, previous studies have demonstrated that the Health of the Nation Outcome Scales-Secure (HoNOS-secure) and its predecessor may have some predictive validity for violence. This retrospective cohort study examines the predictive validity of HoNOS-secure scores rated on admission in a medium-secure forensic psychiatric ward in New Zealand for inpatient violence in the short- to medium-term at 30 and 90 days respectively. A sample size of 33 eligible admissions was obtained within the study period (2005–2017), and incident reports were rated by two independent clinicians for the occurrence and level of inpatient violence. Poisson, negative binomial and Cox regression analyses were used to investigate HoNOS-secure predictivity for the occurrence of inpatient violence, number of violent events, and time to the first violent event respectively. Although the HoNOS-secure total and subscale scores were not found to be significant predictors, post hoc analysis at the item level demonstrated association of various items with violence. Future studies could consider pooling data from multiple study sites, extending follow-up periods and adopting a prospective design.

摘要

法医精神卫生保健机构中的暴力风险预测对于促进其管理非常重要。尽管不是专门为风险评估而开发的，但之前的研究已经证明，国家健康结果量表-安全（HoNOS-secure）及其前身可能对暴力具有一定的预测有效性。这项回顾性队列研究检验了新西兰中等安全法医精神病病房入院时评估的 HoNOS 安全评分对中短期住院暴力（分别为 30 天和 90 天）的预测有效性。研究期间（2005-2017）获得了 33 名符合条件的入院患者的样本量，事件报告由两名独立临床医生对住院暴力的发生和程度进行了评级。泊松，负二项式和 Cox 回归分析分别用于研究 HoNOS 对住院暴力发生、暴力事件数量和首次暴力事件时间的安全预测。尽管 HoNOS 安全总分和子量表分数未被发现是显着的预测因素，但项目级别的事后分析表明了各种项目与暴力的关联。未来的研究可以考虑汇集多个研究中心的数据、延长随访期并采用前瞻性设计。项目层面的事后分析表明，各种项目与暴力之间存在关联。未来的研究可以考虑汇集多个研究中心的数据、延长随访期并采用前瞻性设计。项目层面的事后分析表明，各种项目与暴力之间存在关联。未来的研究可以考虑汇集多个研究中心的数据、延长随访期并采用前瞻性设计。