Louise Hjort Nielsen

International Perspectives on the Practical Application of Violence Risk Assessment: A Global Survey of 44 Countries

Mental health professionals are routinely called upon to assess the risk of violence presented by their patients. Prior surveys of risk assessment methods have been largely circumscribed to individual countries and have not compared the practices of different professional disciplines. Therefore, a Web-based survey was developed to examine methods of violence risk assessment across six continents, and to compare the perceived utility of these methods by psychologists, psychiatrists, and nurses. The survey was translated into nine languages and distributed to members of 59 national and international organizations. Surveys were completed by 2135 respondents from 44 countries. Respondents in all six continents reported using instruments to assess, manage, and monitor violence risk, with over half of risk assessments in the past 12 months conducted using such an instrument. Respondents in Asia and South America reported conducting fewer structured assessments, and psychologists reported using instruments more than psychiatrists or nurses. Feedback regarding outcomes was not common: respondents who conducted structured risk assessments reported receiving feedback on accuracy in under 40% of cases, and those who used instruments to develop management plans reported feedback on whether plans were implemented in under 50% of cases. When information on the latter was obtained, risk management plans were not implemented in over a third of cases. Results suggest that violence risk assessment is a global phenomenon, as is the use of instruments to assist in this task. Improved feedback following risk assessments and the development of risk management plans could improve the efficacy of health services.

A Danish Model for Treating Victims of Rape and Sexual Assault: The Multidisciplinary Public Approach

Most centers for rape and sexual assault victims today build on the original principles proposed in Boston by Burgess and Holmstrom in the 1970s (Burgess, 2006; Burgess & Holmstrom, 1973). In line with technological advances, scientific developments, and societal changes, the standards of and the framework behind these centers must be assessed and developed further to accommodate the growing need for rape trauma services in Europe and worldwide. This article describes the experiences of a public Danish center for rape victims and proposes a management model for current and future rape victim centers.

Posttraumatic stress disorder among bereaved relatives of cancer patients.

The aim of this study was to assess post-traumatic stress disorder (PTSD) and predictors of PTSD in individuals who experienced the loss of a close relative to cancer. A total of 251 bereaved relatives ages 14 to 76 (M = 41.3, SD = 16.8) were recruited at a counseling service for cancer patients and their relatives. The prevalence of current probable PTSD was 40% in the bereaved sample. A hierarchical logistic regression analysis indicated that full-time employment, perceived control, and a secure attachment style moderated the risk for PTSD. Moreover, a long period of caretaking, high levels of somatization, and dissociation were all associated with an increased risk of PTSD.

A Cartoon-Based Measure of PTSD Symptomatology in Children Exposed to a Disaster

Research on childhood posttraumatic stress disorder (PTSD) is sparse. This is partly due to the limited availability of empirically validated measures for children who are insecure readers. The present study examined the reliability and validity of a cartoon-based measure of PTSD symptoms in children exposed to a disaster. Cartoons were generated on the basis of the literature and on the “Darryl” test, which was originally designed to assess community violence-related PTSD. Using a sample of 430 children, preliminary analyses demonstrated that the adapted version of the Darryl test had reasonable psychometric properties. Future validation of the measure as a screening tool is discussed.

Violence Risk Assessment Practices in Denmark: A Multidisciplinary National Survey

Abstract With a quadrupling of forensic psychiatric patients in Denmark over the past 20 years, focus on violence risk assessment practices across the country has increased. However, information is lacking regarding Danish risk assessment practice across professional disciplines and clinical settings; little is known about how violence risk assessments are conducted, which instruments are used for what purposes, and how mental health professionals rate their utility and costs. As part of a global survey exploring the application of violence risk assessment across 44 countries, the current study investigated Danish practice across several professional disciplines and settings in which forensic and high-risk mental health patients are assessed and treated. In total, 125 mental health professionals across the country completed the survey. The five instruments that respondents reported most commonly using for risk assessment, risk management planning and risk monitoring were Broset, HCR-20, the START, the PCL-R, and the PCL:SV. Whereas the HCR-20 was rated highest in usefulness for risk assessment, the START was rated most useful for risk management and risk monitoring. No significant differences in utility were observed across professional groups. Unstructured clinical judgments were reported to be faster but more expensive to conduct than using a risk assessment instrument. Implications for clinical practice are discussed.

Rape Crimes: Are Victims’ Acute Psychological Distress and Perceived Social Support Associated With Police Case Decision and Victim Willingness to Participate in the Investigation?:

This study examined level of acute psychological distress and perceived social support in 64 victims of rape and the association with police case decisions and victims’ willingness to participate in the investigation. The results of independent-sample t tests revealed that victims’ unwillingness to participate in the investigation was significantly associated with a higher level of psychological distress in the acute phase following the assault. The results suggest that victims of rape who disengage with the police investigation may do so because of a high level of acute psychological distress. Clinical implications are discussed.

Predicting charges and convictions for rape suspects in Denmark: characteristics associated with the notion of the ‘credible criminal’

ABSTRACT In recent years, focus on the high attrition rates and low conviction rates in sexual assault cases in Scandinavia has increased. Attrition refers to the dropout of cases through the criminal justice system. However, only limited research exists on the importance of suspect characteristics for the legal outcomes in these cases. The present study is the first in Scandinavia to investigate legal and extralegal suspect variables relating to charges and convictions in the criminal justice system regarding suspected offenders in rape and attempted rape cases. All reported cases of rape and attempted rape in the Eastern Jutland Police District from 2008 to 2010 with an identified rape suspect (N = 175) were analysed through binary logistic regression analyses to examine which variables might increase the likelihood of charges or convictions. Results show that suspects with one or more prior sexual assault charges were more likely to be charged and convicted of a rape offence. The results of the present study help improve the understanding of the judicial processing of cases of rape from a different perspective than the victims’ and partially lend support to the hypothesis of ‘the credible criminal’ in terms of investigative and prosecutorial decision-making in rape cases.

Positive or negative change in outlook on life following sexual assault and associations to PTSD severity

ABSTRACT In a sample of female victims of sexual assault (n = 122) this study examined the possibility of a positive or negative change in outlook on life 3 and 12 months following the assault and associations to posttraumatic stress disorder (PTSD). The majority of women reported a negative change or no change in outlook on life following the sexual assault. The group of women who reported a negative outlook on life 3 months following the sexual assault had a significant higher level of PTSD severity 12 months following the assault. More research is needed to enhance our understanding of the causal relationship between life changes and psychological distress following sexual assaults.