Anders Tengström

Psychopathy (PCL-R) predicts violent recidivism among criminal offenders with personality disorders in Sweden

Psychopathy as conceptualized with Hares Psychopathy Checklist Revised, PCL-R, has attracted much research during the 1990s. In the Scandinavian countries, few studies that empirically support the validity of North American risk assessment techniques in our regional context have been published. The purpose of this paper is to explore the predictive power of the PCL-R in a population of personality-disordered violent offenders subjected to forensic psychiatric evaluation in Sweden. Following release from prison (n = 172), discharge from forensic psychiatric treatment (n = 129), or probation (n = 51), a total of 352 individuals were followed for up to 8 years (mean = 3.7 years) with reconviction for violent crime as endpoint variable (base rate 34%). As the estimate of predictive power, the area under the curve of a receiver operating characteristic (AUC of ROC) analysis was calculated. For PCL-R scores to predict 2-year violent recidivism, AUC of ROC was .72 (95% CI: .66–.78). In addition, the personality dimension of psychopathy (Factor 1) and the behavioral component (Factor 2) both predicted 2-year recidivism significantly better than random: AUC of ROC .64 (95% CI: .57–.70) and .71 (95% CI: .65–.77), respectively. We conclude that psychopathy is probably as valid a predictor of violent recidivism in Swedish forensic settings as seen in previous North American studies.

Psychopathy (PCL-R) as a Predictor of Violent Recidivism Among Criminal Offenders with Schizophrenia

Hares Psychopathy Checklist-Revised (PCL-R) was used to test the hypothesis that psychopathy predicts violent recidivism in a cohort subjected to forensic psychiatric investigation and consisting of male violent offenders with schizophrenia (N = 202). Psychopathy was assessed with retrospective file-based ratings. Mean follow-up time after detainment was 51 months. Twenty-two percent of the offenders had a PCL-R score ≥26 (cutoff), and the base rate for violent recidivism (reconvictions) during follow-up was 21%. Survival analysis revealed that psychopathy was strongly associated to violent recidivism (log-rank = 17.71, df = 1, p < 0.0001). The area under the curve (AUC) of the receiver operating characteristics (ROC) of PCL-R total score to predict violent recidivism varied between different time frames from .64 to .75. Cox regression analyses revealed that other potential risk factors could not equally well or better explain violent recidivism in the cohort than psychopathy as measured by PCL-R.

Convergent validity of the Youth Psychopathic Traits Inventory (YPI): association with the Psychopathy Checklist: Youth Version (PCL:YV).

This study investigates the relationship between the self-report Youth Psychopathic Traits Inventory (YPI) and the clinician-rated Psychopathy Checklist: Youth Version (PCL:YV). A representative sample of 92 girls and 70 boys, 12 to 20 years of age (mean age, 17 years), who received services at a clinic for adolescents with substance misuse problems, was studied. Moderate correlations (r =.30—.51) were found between conceptually corresponding YPI and PCL:YV factor scores among both boys and girls, whereas correlations between individual subscales of the YPI and items of the PCL:YV were not as consistent. A cross-tabulation of groupings based on the three-factor models of the two instruments largely supported the categorical convergent validity of the YPI, particularly for low and high scorers. Although more studies with larger samples are needed, results indicate that the YPI is a cost-effective measure of psychopathic traits in adolescents in research settings.

Actuarial Assessment of Risk for Violence - Predictive Validity of the VRAG and the Historical Part of the HCR-20

This article explores the predictive validity of two actuarial risk assessment instruments among mentally disordered offenders in Sweden: the historical part (H-10) of a historical, clinical, and risk management factors instrument (HCR-20) and the Violence Risk Appraisal Guide (VRAG). Actuarial scores were obtained retrospectively in two populations: one group of violent offenders with personality disorders and one with violent offenders diagnosed with schizophrenia. The predictive accuracy was evaluated with receiver operating characteristic analysis using a violent reconviction within 2 years from release or discharge as the criterion variable. Both scales fared better in the group of personality-disordered offenders than in the group of offenders with schizophrenia, and the H-10 fared better than the VRAG in both offender groups. The study found that historical data maintain a robust predictive validity in a population of personality-disordered offenders, whereas clinical and risk management factors may be of greater importance in offender populations in which major mental disorders are prevalent.

SCHIZOPHRENIA AND CRIMINAL OFFENDING The Role of Psychopathy and Substance Use Disorders

This study investigated the associations of psychopathy and substance use disorders (SUDs) with criminal offending among 202 men with schizophrenia and 78 men with a primary diagnosis of psychopathy. Comparisons among six groups of offenders indicated that non–mentally ill offenders diagnosed with psychopathy committed the highest numbers of offenses per year at risk. Among offenders with schizophrenia, those with high psychopathy scores committed more crimes than those with low psychopathy scores. Among non–mentally ill offenders with psychopathy and schizophrenic offenders with high psychopathy scores, those with and without SUDs committed, on average, similar numbers of offenses. These findings suggest that among offenders with psychopathic traits, the traits, not substance abuse, are associated with criminal offending.

Long-term predictive validity of historical factors in two risk assessment instruments in a group of violent offenders with schizophrenia

The long-term predictive validity of the Violent Risk Appraisal Guide (VRAG) and the historical part (H-10) of the risk assessment device HCR-20 in predicting violent recidivism was investigated in a sample of (n =106) violent offenders with schizophrenia. An effort was made to validate the 9-bin categorization of different absolute risk to recidivate depending on the individual score on the VRAG. Scores on both devices were retrospectively obtained from various files and registers. Individuals were followed up after discharge from hospital for on average 86 (standard deviation=19.33) months. During follow-up 29% of the sample was reconvicted of a violent crime. Results indicated that both H-10 and VRAG had a moderate ability to predict violent recidivism and that H-10 had a slightly better accuracy. Most of the items in H-10 but only half of those in VRAG correlated significantly with violent recidivism. The 9-bin categorization of VRAG scores produced mixed results. In the Swedish sample there was a linear trend in which increased VRAG scores were associated with higher absolute risk to recidivate. However, the distribution of scores and the figures of absolute risk of recidivation were not replicated. It is concluded that historical factors seem to play an important role for the long-term prediction of future violence among a group of severely mentally ill individuals.

Heavy Episodic Drinking in Early Adolescence: Gender-Specific Risk and Protective Factors

This longitudinal study examined possible gender differences regarding risk and protective factors for heavy episodic drinking among 1,222 seventh-grade students (aged 13) in the City of Stockholm, Sweden, with follow-up 2 years later. Logistic regression analyses showed that several factors predicted heavy episodic drinking. The strongest predictors for boys’ heavy episodic drinking in the ninth grade were heavy episodic drinking (odds ratio [OR] = 5.30) and smoking in the seventh grade (OR = 5.80). Drinking peers (OR = 2.47) and smoking (OR = 2.44) in the seventh grade showed the strongest association for girls. Furthermore, high parental monitoring and having a secure attachment to parents may have a protective effect when risk factors are present. Our results lend support to prevention initiatives to strengthen the parent–child relation and focus on adolescents’ ability to resist peer pressure and of limiting parental provision of alcohol. The studys limitations are noted.

Extracting data in file-based forensic psychiatric research: Some methodological considerations

This article explores possibilities and problems of the use of file-based data in forensic psychiatric research. Attention is paid to methodological problems with regard to data quality, operationalization of information into variables, and procedures for reliable data extraction, including interrater reliability assessments. We report on experiences from an ongoing Swedish forensic psychiatric research project based on complete forensic psychiatric investigation records, the National Police Register and the National Hospital Discharge Register. We conclude that when forensic psychiatric investigation records and population-based registers are combined, various factors for research can be extracted reliably. However, contrary to expectations, several categories of variables could not be consistently extracted. Examples of both types of variables are provided.

Consulting for substance abuse: mental disorders among adolescents and their parents.

Studies conducted outside of Scandinavia indicate that most adolescents with substance misuse problems suffer from co-morbid mental disorders. The present study assessed the mental health of adolescents seeking help for substance misuse problems in a large Swedish city. Parents’ mental health was also examined. The sample included 97 girls with their 90 mothers and 52 fathers, and 81 boys with their 72 mothers and 37 fathers. The adolescents completed a diagnostic interview, either the Kiddie-SADs or the Structured Clinical Interview for DSM-IV (SCID) depending on their age. Their parents underwent diagnostic interviews with the SCID. Ninety per cent of the girls and 81% of the boys met criteria for at least one disorder other than substance misuse, and on average, they suffered from three other disorders, most of which had onset before substance misuse began. Almost 80% of the mothers and 67% of the fathers met criteria for at least one mental disorder other than alcohol and drug-related disorders. The findings concur with those reported from studies conducted in North America. The results suggest that in Sweden mental disorders are not being identified and effectively treated among some children and young adolescents who subsequently abuse alcohol and/or illicit drugs. Adolescents who consult for substance abuse problems require assessments and treatment by mental health professionals.

Multiple adverse outcomes over 30 years following adolescent substance misuse treatment

Objective:  To compare outcomes over 30 years experienced by individuals who as adolescents entered substance misuse treatment and a general population sample.