Jeremy W. Coid

The Efficacy of Violence Prediction: A Meta-Analytic Comparison of Nine Risk Assessment Tools

Actuarial risk assessment tools are used extensively to predict future violence, but previous studies comparing their predictive accuracies have produced inconsistent findings as a result of various methodological issues. We conducted meta-analyses of the effect sizes of 9 commonly used risk assessment tools and their subscales to compare their predictive efficacies for violence. The effect sizes were extracted from 28 original reports published between 1999 and 2008, which assessed the predictive accuracy of more than one tool. We used a within-subject design to improve statistical power and multilevel regression models to disentangle random effects of variation between studies and tools and to adjust for study features. All 9 tools and their subscales predicted violence at about the same moderate level of predictive efficacy with the exception of Psychopathy Checklist--Revised (PCL-R) Factor 1, which predicted violence only at chance level among men. Approximately 25% of the total variance was due to differences between tools, whereas approximately 85% of heterogeneity between studies was explained by methodological features (age, length of follow-up, different types of violent outcome, sex, and sex-related interactions). Sex-differentiated efficacy was found for a small number of the tools. If the intention is only to predict future violence, then the 9 tools are essentially interchangeable; the selection of which tool to use in practice should depend on what other functions the tool can perform rather than on its efficacy in predicting violence. The moderate level of predictive accuracy of these tools suggests that they should not be used solely for some criminal justice decision making that requires a very high level of accuracy such as preventive detention.

Relation between childhood sexual and physical abuse and risk of revictimisation in women: a cross-sectional survey

BACKGROUND Women who are physically and sexually abused in childhood are at increased risk of victimisation in adulthood. Research has concentrated on sexual revictimisation, and has not included investigation of other abusive experiences, nor examination of prevalence and effects of abuse on adult revictimisation. We aimed to examine the relation between childhood trauma and adult revictimisation, and identify confounding factors. METHODS We did a cross-sectional survey of 2592 women who were attending primary care practices in east London, UK, with self-administered anonymous questionnaires. We included questions on physical and sexual abuse in childhood; on domestic violence, rape, indecent assault, and other traumatic experiences in adulthood; and on alcohol and other drug abuse. We analysed associations between childhood and adulthood abuse with multiple logistic regression. FINDINGS 1207 (55%) of 2192 eligible women were recruited and completed the questionnaire. Abusive experiences co-occurred in both childhood and adulthood. Repetition and severity of childhood abuse were independently associated with specific types of adult revictimisation. Unwanted sexual intercourse (<16 years) was associated with domestic violence in adulthood (odds ratio 3.54; 95% CI 1.52-8.25) and with rape (2.84; 1.09-7.35); and severe beatings by parents or carers with domestic violence (3.58; 2.06-6.20), rape (2.70; 1.27-5.74), and other trauma (3.85; 2.23-6.63). INTERPRETATION Childhood abuse substantially increases risk of revictimisation in adulthood. Women who have experienced multiple childhood abuse are at most risk of adult revictimisation. Identification of women who have undergone childhood abuse is a prerequisite for prevention of further abuse.

Identifying domestic violence: cross sectional study in primary care

Abstract Objectives: To measure the prevalence of domestic violence among women attending general practice; test the association between experience of domestic violence and demographic factors; evaluate the extent of recording of domestic violence in records held by general practices; and assess acceptability to women of screening for domestic violence by general practitioners or practice nurses. Design: Self administered questionnaire survey. Review of medical records. Setting: General practices in Hackney, London. Participants: 1207 women (>15 years) attending selected practices. Main outcome measures: Prevalence of domestic violence against women. Association between demographic factors and domestic violence reported in questionnaire. Comparison of recording of domestic violence in medical records with that reported in questionnaire. Attitudes of women towards being questioned about domestic violence by general practitioners or practice nurses. Results: 425/1035 women (41%, 95% confidence interval 38% to 44%) had ever experienced physical violence from a partner or former partner and 160/949 (17%, 14% to 19%) had experienced it within the past year. Pregnancy in the past year was associated with an increased risk of current violence (adjusted odds ratio 2.11, 1.39 to 3.19). Physical violence was recorded in the medical records of 15/90 (17%) women who reported it on the questionnaire. At least 202/1010 (20%) women objected to screening for domestic violence. Conclusions: With the high prevalence of domestic violence, health professionals should maintain a high level of awareness of the possibility of domestic violence, especially affecting pregnant women, but the case for screening is not yet convincing. What is already known on this topic Domestic violence is associated with a wide range of health and social problems for women and their children Women experiencing violence are often not identified by health professionals in hospital settings Professional organisations and politicians are promoting a policy of screening for domestic violence What this study adds Over a third of women attending general practices had experienced physical violence from a male partner or former partner Most women who had experienced physical violence were not identified by general practitioners, according to data extracted from their medical records Women pregnant in the previous year were at high risk for current physical violence A substantial minority of women object to routine questioning about domestic violence

Debt, income and mental disorder in the general population

BACKGROUND The association between poor mental health and poverty is well known but its mechanism is not fully understood. This study tests the hypothesis that the association between low income and mental disorder is mediated by debt and its attendant financial hardship. METHOD The study is a cross-sectional nationally representative survey of private households in England, Scotland and Wales, which assessed 8580 participants aged 16-74 years living in general households. Psychosis, neurosis, alcohol abuse and drug abuse were identified by the Clinical Interview Schedule--Revised, the Schedule for Assessment in Neuropsychiatry (SCAN), the Alcohol Use Disorder Identification Test (AUDIT) and other measures. Detailed questions were asked about income, debt and financial hardship. RESULTS Those with low income were more likely to have mental disorder [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.68-2.59] but this relationship was attenuated after adjustment for debt (OR 1.58, 95% CI 1.25-1.97) and vanished when other sociodemographic variables were also controlled (OR 1.07, 95% CI 0.77-1.48). Of those with mental disorder, 23% were in debt (compared with 8% of those without disorder), and 10% had had a utility disconnected (compared with 3%). The more debts people had, the more likely they were to have some form of mental disorder, even after adjustment for income and other sociodemographic variables. People with six or more separate debts had a six-fold increase in mental disorder after adjustment for income (OR 6.0, 95% CI 3.5-10.3). CONCLUSIONS Both low income and debt are associated with mental illness, but the effect of income appears to be mediated largely by debt.

Raised Incidence Rates of All Psychoses Among Migrant Groups Findings From the East London First Episode Psychosis Study

CONTEXT Certain black and minority ethnic groups are at increased risk for psychoses. It is unknown whether risk for second- and later-generation black and minority ethnic groups in the United Kingdom is universally increased or varies by ethnicity, population structure, or diagnostic category. OBJECTIVES To examine whether excess risk in black and minority ethnic groups varies by generation status and to determine whether this is explained solely by an excess of broadly defined schizophrenia. DESIGN Population-based epidemiological survey of first-onset psychoses during a 2-year study period. SETTING Three inner-city boroughs in East London, England. Patients Four hundred eighty-four patients with first-episode psychosis aged 18 to 64 years. MAIN OUTCOME MEASURES Nonaffective or affective psychoses according to the DSM-IV. RESULTS Raised incidence of both nonaffective and affective psychoses were found for all of the black and minority ethnic subgroups compared with white British individuals. The risk of nonaffective psychoses for first and second generations varied by ethnicity (likelihood ratio test, P = .06). Only black Caribbean second-generation individuals were at significantly greater risk compared with their first-generation counterparts (incidence rate ratio, 2.2; 95% confidence interval, 1.1-4.2) [corrected]. No significant differences between first and second generations were observed in other ethnic groups. Asian women but not men of both generations were at increased risk for psychoses compared with white British individuals. Patterns were broadly upheld for the affective psychoses. CONCLUSIONS Both first- and second-generation immigrants were at elevated risk for both nonaffective and affective psychoses, but this varied by ethnicity. Our results suggest that given the same age structure, the risk of psychoses in first and second generations of the same ethnicity will be roughly equal. We suggest that socioenvironmental factors operate differentially by ethnicity but not generation status, even if the exact specification of these stressors differs across generations. Research should focus on differential rates of psychoses by ethnicity rather than between generations.

RAISED PLASMA METENKEPHALIN IN PATIENTS WHO HABITUALLY MUTILATE THEMSELVES

Mean plasma metenkephalin concentration was significantly higher in ten patients who habitually mutilated themselves than in matched, healthy controls. No differences were found in corticotropin, N-lipotropin or C-lipotropin (beta-endorphin). Plasma metenkephalin was raised only in the five patients receiving hospital treatment because of their behaviour disorder. It was not raised in those patients sufficiently well to have been discharged from hospital.

Prevalence and correlates of psychopathic traits in the household population of Great Britain

There are no previous surveys of psychopathy and psychopathic traits in representative general population samples using standardized instruments. This study aimed to measure prevalence and correlates of psychopathic traits, based on a two-phase survey using the Psychopathy Checklist: Screening Version (PCL: SV) in 638 individuals, 16-74 years, in households in England, Wales and Scotland. The weighted prevalence of psychopathy was 0.6% (95% CI: 0.2-1.6) at a cut score of 13, similar to the noncriminal/nonpsychiatric sample described in the manual of the PCL: SV. Psychopathy scores correlated with: younger age, male gender; suicide attempts, violent behavior, imprisonment and homelessness; drug dependence; histrionic, borderline and adult antisocial personality disorders; panic and obsessive-compulsive disorders. This survey demonstrated that, as measured by the PCL: SV, psychopathy is rare, affecting less than 1% of the household population, although it is prevalent among prisoners, homeless persons, and psychiatric admissions. There is a half-normal distribution of psychopathic traits in the general population, with the majority having no traits, a significant proportion with non-zero values, and a severe subgroup of persons with multiple associated social and behavioral problems. This distribution has implications for research into the etiology of psychopathy and its implications for society.

Development of adolescence-limited, late-onset, and persistent offenders from age 8 to age 48

This article investigates the life success at ages 32 and 48 of four categories of males: nonoffenders, adolescence-limited offenders (convicted only at ages 10-20), late-onset offenders (convicted only at ages 21-50), and persistent offenders (convicted at both ages 10-20 and 21-50). In the Cambridge Study in Delinquent Development, 411 South London males have been followed up from age 8 to 48 in repeated personal interviews. There was considerable continuity in offending over time. Persistent offenders had the longest criminal careers (averaging 18.4 years), and most of them had convictions for violence. Persistent offenders were leading the most unsuccessful lives at ages 32 and 48, although all categories of males became more successful with age. By age 48, the life success of adolescence-limited offenders was similar to that of nonoffenders. The most important risk factors at ages 8-18 that predicted which offenders would persist after age 21 were heavy drinking at age 18, hyperactivity at ages 12-14, and low popularity and harsh discipline at ages 8-10. The most important risk factors that predicted which nonoffenders would onset after age 21 were poor housing and low nonverbal IQ at ages 8-10, high neuroticism at age 16, and anti-establishment attitudes and motoring convictions at age 18. It was suggested that nervousness and neuroticism may have protected children at risk from offending in adolescence and the teenage years.

Psychiatric and social aspects of suicidal behaviour in prisons

BACKGROUND Suicidal behaviour and completed suicide are serious problems within British prisons, leading to significant morbidity and mortality, and are the focus of major efforts towards their prevention. AIM To explore the demographic, social and psychiatric correlates of suicidal behaviour in prisons in England and Wales and their relationship with health service use; and to develop a combined psychosocial model of risk. METHOD This report analyses the prevalence of suicidal ideation and suicide attempts in the ONS National Prison Survey, and their association with the presence of psychiatric disorders, personality disorder, substance abuse and social risk factors. These data were compared with data from the second national survey of psychiatric morbidity in adults living at home. In both surveys, a two-phase interviewing procedure was used, covering general health, health service use, assessment of psychiatric disorders, life events, social supports, suicidal behaviour, activities of daily living, sociodemographic data, substance abuse and intelligence. RESULTS Suicidal thoughts and suicide attempts were commoner in prisons than in the general population and these were significantly associated with higher rates of psychosis, neurosis and personality disorder in prisons. In addition, demographic and factors such as being young, single, white, leaving school early and experiencing poor social support and significant social adversity were important risk factors for suicidal thoughts. Crucially, there was no separate category of people at suicidal risk who did not have psychiatric disorders. CONCLUSIONS The high rates of suicidal behaviour in prisons cannot be addressed without adequate attention to the high rates of psychiatric disorder and vulnerability factors in prisoners.

Psychopathy and the dimensions of personality disorder in violent offenders

Abstract The relationship of factors of personality disorder to psychopathy was investigated to determine whether psychopathy is more appropriately construed as a dimension of personality disorder rather than as one of several discrete categories of personality disorder. Comparisons were also made of the associations of personality disorders and psychopathy with measures of established personality dimensions, criminality and lifetime psychopathology. Male violent offenders detained in English prisons and a maximum security psychiatric hospital (N=167) were assessed with the Structured Clinical Interview for DSM-III Axis II disorders (SCID-II) and the Hare Psychopathy Checklist-Revised (PCL-R). Factor analysis of personality disorder measures yielded four factors identified as impulsivity, detachment, sensitivity and compulsivity. The first three factors were related to measures of the personality dimensions of agreeableness, extraversion and neuroticism, respectively. The PCL-R correlated highly with the impulsivity factor. Both had significant associations with violent and nonviolent criminality, but relationships to psychopathology were limited to substance abuse history. The results replicate previous findings on the dimensional structure of personality disorders and support a dimensional conception of psychopathy.