The predictive validity and temporal characteristics of the HCR-20v3 for inpatient violence in forensic inpatient settings. An international study

• Published in: Psychiatry research Vol. 339; p. 116079
• Main Authors: Picchioni, Marco, Ruiz, Rebecca, de Girolamo, Giovanni, Iozzino, Laura, Zamparini, Manuel, Wancata, Johannes, Unger, Annemarie, Heitzman, Janusz, Markewitz, Inga, Dressing, Harald, Large, Matthew M
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.09.2024
• Subjects: Adult; Aggression; Challenging behaviour; Female; Follow-Up Studies; Forensic psychiatry; Forensic Psychiatry - methods; Humans; Inpatients - statistics & numerical data; Male; Middle Aged; Predictive Value of Tests; Psychiatric Status Rating Scales - standards; Reproducibility of Results; Risk assessment; Risk Assessment - methods; Schizophrenia; Schizophrenia - diagnosis; Schizophrenic Psychology; Time Factors; Violence; Violence - psychology; Young Adult; Forensic psychiatry; Schizophrenia; Violence; Aggression; Challenging behaviour; Risk assessment
• ISSN: 0165-1781; 1872-7123; 1872-7123
• DOI: 10.1016/j.psychres.2024.116079

•Violence risk is increased in patients with schizophrenia.•Our understanding of the nature of that link is limited.•The HCR-20v3 represents one of the best structured ways of assessing that risk.•The HCR-20 should be re-evaluated every 6 months.•The HCR-20v3 is most effective at identifying those at low risk of violence. Aggression and violence are common day to day problems in psychiatric settings. However, the optimal means of assessing that risk remains unclear. In the context of that uncertainty many tools have evolved, among which the HCR-20 is one of the most globally accepted, though many questions remain about its performance, how and when it should be deployed and how it can be most effectively used. In this 12 month follow up study of 210 forensic psychiatric inpatients with a diagnosis of a schizophrenia spectrum disorder we explored these issues. We found that the performance of the HCR-20v3, especially its Total score, performed well up to 6 months after it was rated but its performance deteriorated after that. Repeating the HCR-20v3 at 6 months stabilised the risk assessment and led to improved performance in the second months over and above the first rating. The HCR-20v3 was good at identifying those subjects at low risk of violence over 6 months of follow up in a forensic inpatient setting. The real-world implications of this study are that the HCR-20v3 is an effective means of identifying patient at low risk of violence, but it should be reassessed every 6 months.