The Utility of Patients’ Self-Perceptions of Violence Risk: Consider Asking the Person Who May Know Best

Skeem, Jennifer L.; Manchak, Sarah M.; Lidz, Charles W.; Mulvey, Edward P.

doi:10.1176/appi.ps.001312012

Cited by 45 publications

(39 citation statements)

References 39 publications

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“…As described later, an AUC analysis was used to identify the cut point for dichotomization, which was comparable to that used by Skeem et al (2010) in their study of self-perceived violence risk (i.e., into ratings of 0-2 and 3-5) and comparable to that applied by Lidz, Mulvey, and Gardner (1993) in their study of clinicians' concems about patients' violence dsk (i.e., ratings of 0-2 and 3-5).…”

Section: Methodsmentioning

confidence: 99%

“…Recently, Skeem, Manchak, Mulvey, and Lidz (2010) found that patients' self-perceptions of violence risk performed relatively well in predicting violence after hospital discharge. In this study, interviewers asked psychiatric inpatients about how concemed their therapist should be that they might be involved in violence during the 2 months after hospital discharge.…”

Section: A Way Forward? Self-perceptions Of Riskmentioning

confidence: 99%

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If you want to know, consider asking: How likely is it that patients will hurt themselves in the future?

Peterson

Skeem

Manchak

2011

Psychological Assessment

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Although self-harming behavior is a common and costly problem for psychiatric inpatients released from the hospital, standardized tools that assess patients' risk for self-harm are rarely used in clinical settings. In this study of dually diagnosed psychiatric inpatients (N = 147), we assessed the utility of patients' self-perceptions of risk in predicting self-harm in the community. Patients' self-perceptions of risk predicted self-harm 8 weeks after discharge from the hospital (Lag 1; area under the curve [AUC] = 0.75). Self-perceptions of risk at the 8-week interview also predicted self-harm 2 months later (Lag 2; AUC = 0.72). Self-perceived risk added predictive utility above and beyond scores on a measure of depression and seemed to capture changes in risk state over time. The results suggest that inpatients can accurately perceive their own risk and therefore may be important collaborators in the risk management process.

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Section: Methodsmentioning

confidence: 99%

Section: A Way Forward? Self-perceptions Of Riskmentioning

confidence: 99%

If you want to know, consider asking: How likely is it that patients will hurt themselves in the future?

Peterson

Skeem

Manchak

2011

Psychological Assessment

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“…A recent review article emphasized the importance of a multidisciplinary approach to violence risk assessments (Steinert & Whittington 2013), because different perspectives may provide a deeper and improved understanding of risk assessment. Despite this, service users' self-perception of risk has rarely been emphasized as useful in violence risk assessment, and only a few studies have addressed the topic (Roaldset & Bjørkly 2010;Skeem et al 2013). One group (Roaldset & Bjørkly 2010) developed a 'Self-report Risk Scale' (SRS), which significantly predicts occurrence of inpatient violent threats (AUC = 0.73, 95% confidence interval (CI) = 0.61-0.85, P < 0.001) and violent acts (AUC = 0.68, 95% CI = 0.55-0.81, P = 0.003).…”

Section: Violence Risk Assessments and Service Users' Selfperception mentioning

confidence: 99%

“…There is broad international research consensus that structured violence risk assessment instruments provide more accurate predictions of violence compared with clinical assessment (Singh et al 2016). Yet the most common method of violence risk assessment used in acute mental health units is unstructured clinical judgement (Daffern 2007;Doyle & Dolan 2002;Skeem et al 2013). Most structured risk assessment instruments achieve moderate accuracy with an area under the curve (AUC) value of 0.7 in comparison studies, suggesting a 'glass ceiling' effect beyond which few instruments can improve (Coid et al 2011;Yang et al 2010).…”

Section: Violence Risk Assessments and Service Users' Selfperception mentioning

confidence: 99%

Screening for risk of violence using service users’ self‐perceptions: A prospective study from an acute mental health unit

Lockertsen

Procter

Vatnar

et al. 2017

Int J Mental Health Nurs

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Service users' self-perception of risk has rarely been emphasized in violence risk assessments. A recent review pointed to the importance of a multidisciplinary approach, because different perspectives may provide a deeper and improved understanding of risk assessment. The aim of this study was to investigate service users' perceptions of their own risk of committing violence, using a self-report risk scale, to determine the feasibility and efficacy of this potential violence risk marker during acute mental health hospitalization. All service users admitted to a psychiatric emergency hospital in Norway during one calendar year were included (N = 512). Nearly 80% self-reported no risk or low risk; only seven (1.4%) reported moderate risk or high risk. Service users who reported moderate risk, high risk, don't know, or won't answer were more likely to be violent (OR = 4.65, 95% CI = 2.79-7.74) compared with those who reported no risk or low risk. There was a significant gender interaction with higher OR for women on both univariate and multivariate analyses. Although the OR was higher for women, women's violence rate (11.0%) was almost half that of men (21.8%). For women, sensitivity and specificity were 0.55 and 0.88, respectively; corresponding values for men were 0.40 and 0.80. Inclusion of self-perception of violence risk is the first step towards service users' collaborative involvement in violence prediction; these results indicate that self-perception can contribute to violence risk assessments in acute mental health settings. Findings also indicate that there are gender differences in these assessments.

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“…In a recent paper, Skeem et al reported that patients’ self‐perceptions hold promise as a method for improving risk assessment of violence in routine clinical settings. She further stated that assuming it replicates and generalizes beyond the research context, this finding encourages a shift away from unaided clinical judgment toward a feasible method of risk assessment built on patient collaboration.…”

mentioning

confidence: 99%

Listen to the patient – what about patients’ perceptions of suicidal risk?

Roaldset

2016

Acta Psychiatr Scand

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In a recent and very appropriate editorial article, Nordentoft addresses the complexity and challenges of evaluations of the risk of suicidal behaviour with emphasis on psychiatric disorders and clinical practice (1). The article suggest that to improve suicide prevention in different psychiatric settings, staff should focus on clinical variables in order to detect immediate suicide risk, with a major focus on listening to the patient's suicidal thoughts and sense of worthlessness and other clinical manifestations of high risk of suicide. Moreover, the clinicians should listen carefully to signs and signals indicating unspoken risk of suicide.The headline of the editorial by Nordentoft is 'Listen to the patient'. In this context, one might add another aspect of the patient-related exploration of risk of suicide, exploring the patient's own perception about his or hers risk of suicidal behaviour. Despite the uncertainty of the honesty and insight behind patient's own perception of suicidal risk; for example by concealing suicidal ideation to prevent hospitalization (as Nordentoft states in the article), this topic has been an integrated part of clinical practice for years in many psychiatric milieus and settings.However, very few articles exploring the validity of patients own risk perceptions have been published. A study from an acute psychiatric department showed that patients' perceptions (at discharge) of moderate or higher suicidal risk were prospectively significant (P < 0.01) for suicidal behaviour during the first 3 months after discharge (2). Results indicated that the patient's risk perception added incremental validity to established clinical and psychosocial risk factors of suicide attempts.In a recent paper, Skeem et al. (3) reported that patients' self-perceptions hold promise as a method for improving risk assessment of violence in routine clinical settings. She further stated that assuming it replicates and generalizes beyond the research context, this finding encourages a shift away from unaided clinical judgment toward a feasible method of risk assessment built on patient collaboration.The sparse research in the field of 'patients' perception' do not yet allow for general evidence-based recommendations of incorporating this into the complex field of evaluation of suicide risk. However, patient collaboration and participation in decision-making procedures are important, and further investigations in this field should be encouraged. References 1. Nordentoft M. Listen to the patient: challenges in the evaluation of the risk of suicidal behaviour. Acta Psychiatr Scand 2016;133:255-256. 2. Roaldset JO, Bjørkly S. Patients' own statements of their future risk for violent and self-harm behaviour: a prospective inpatient and post-discharge follow-up study in an acute psychiatric unit. Psychiatry Res 2010;178:153-159. 3. Skeem JL, Manchak SM, Lidz CW, Mulvey EP. The utility of patients' self-perceptions of violence risk: consider asking the person who may know best. Psychiatr Serv 2013;64: 410-415.

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The Utility of Patients’ Self-Perceptions of Violence Risk: Consider Asking the Person Who May Know Best

Cited by 45 publications

References 39 publications

If you want to know, consider asking: How likely is it that patients will hurt themselves in the future?

If you want to know, consider asking: How likely is it that patients will hurt themselves in the future?

Screening for risk of violence using service users’ self‐perceptions: A prospective study from an acute mental health unit

Listen to the patient – what about patients’ perceptions of suicidal risk?

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