Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes

Abstract

Background Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future – Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class. Method A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure. Results Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge. Discussion Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.

Transgressive incidents targeted on staff in forensic psychiatric healthcare: a latent class analysis

“…However, not all forensic psychiatric patients have the same risk factors for recidivism, as they constitute a heterogeneous group with diverse characteristics and psychopathologies ( 15 ). Patient psychopathology may influence aggression, with pathways to aggressive behavior varying depending on psychopathology ( 16 , 17 ).…”

“…Patient psychopathology may influence aggression, with pathways to aggressive behavior varying depending on psychopathology ( 16 , 17 ). Dynamic risk factors for inpatient aggression exhibit different patterns across different patient groups ( 15 , 18 , 19 ). For instance, aggression in schizophrenic patients often results from active psychotic symptoms and is reactive (e.g., following the denial of a request) ( 9 ), while patients with personality disorders may engage in aggression more frequently for instrumental purposes (e.g., to obtain tangibles) ( 20 ).…”