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Risk and prediction of violent crime in forensic psychiatry

Gustavson, Christina LU (2010) In Lund University, Faculty of Medicine Doctoral Dissertation Series 2010:120.
Abstract (Swedish)
Popular Abstract in Swedish

Syfte: Att undersöka den prediktiva precisionen hos ålder för missbruksdebut, MAO-B

aktiviteten i blod, samt olika kombinationer av kriminologiska och kliniska riskfaktorer med

avseende på återfall i våldsbrott hos tidigare våldsbrottsdömda i en prospektiv svensk

uppföljningsstudie.

Studiepopulation: Hundra våldsbrottslingar, konsekutivt intagna för rättspsykiatrisk

undersökning mellan 1998 och 2001 (index), gav sitt samtycke till medverkan i studien.

Metoder: Psykiatriska och psykologiska data insamlades vid index, inklusive debutålder för

kriminalitet och för missbruk samt MAO-B aktivitet i trombocyter. Information om

... (More)
Popular Abstract in Swedish

Syfte: Att undersöka den prediktiva precisionen hos ålder för missbruksdebut, MAO-B

aktiviteten i blod, samt olika kombinationer av kriminologiska och kliniska riskfaktorer med

avseende på återfall i våldsbrott hos tidigare våldsbrottsdömda i en prospektiv svensk

uppföljningsstudie.

Studiepopulation: Hundra våldsbrottslingar, konsekutivt intagna för rättspsykiatrisk

undersökning mellan 1998 och 2001 (index), gav sitt samtycke till medverkan i studien.

Metoder: Psykiatriska och psykologiska data insamlades vid index, inklusive debutålder för

kriminalitet och för missbruk samt MAO-B aktivitet i trombocyter. Information om

kriminologiska och kliniska riskfaktorer insamlades, inklusive resultat av skattningar med

bedömningsinstrument (PCL-R, HCR-20, LHA). Uppgifter om nya fällande domar

insamlades via officiella register efter närmare fem års uppföljningstid och analyserades i

relation till kriminologiska och kliniska riskfaktorer och till resultaten av riskbedömningarna.

Resultat: Tjugo förövare dömdes för nya våldsbrott under observationstiden. Ålder vid

missbruksdebuten, men inte MAO-B aktiviteten i trombocyter (oberoende av rökning),

korrelerade med riskfaktorer för våld och predicerade återfall i brott. Merparten

kriminologiska och kliniska riskfaktorer, som ålder vid första dom, antal tidigare

fängelsedomar, uppförandestörning i barndomen, missbruk och poäng på PCL-R, HCR-20

och LHA uppvisade modesta samband med återfall i våldsbrott och moderat prediktiv

förmåga med kurvor för arean under Receiver Operating Characteristics (ROC) mellan 0,72

och 0,76. Bara ålder vid den första domen och drogmissbruk bland förstagradssläktingar

förblev signifikanta prediktorer i multivariata modeller. Utveckling och användning av

riskbedömningsinstrument inom det rättspsykiatriska fältet analyserades utifrån en klinisk

utgångspunkt med särskilt avseende på förändringar över tid, etiska dilemman samt risken för

integritetskränkningar och felbeslut beroende på motstridiga förväntningar och

begreppsförvirring.

Slutsatser: Tidigt debuterande missbruk och fällande domar för tidigare brott är oberoende

riskfaktorer för upprepad våldsbrottslighet bland psykiskt störda lagöverträdare. Enkla

historiska riskfaktorer har samma prediktiva värde som komplexa riskbedömningsinstrument. (Less)
Abstract
Objective: To test the predictive accuracy for violent recidivism of the age at onset of

substance abuse, the platelet MAO-B activity, and various combinations of criminological

and clinical risk factors among violent offenders in a prospective Swedish follow-up study.

Subjects: One hundred violent offenders, consecutively admitted for forensic psychiatric

investigations between 1998 and 2001 (baseline).

Methods: Psychiatric and psychological data collection at baseline included age at onset of

criminal behaviour and substance abuse and measures of platelet MAO-B activity. Known

criminological and clinical risk factors were registered as well as ratings with the risk

... (More)
Objective: To test the predictive accuracy for violent recidivism of the age at onset of

substance abuse, the platelet MAO-B activity, and various combinations of criminological

and clinical risk factors among violent offenders in a prospective Swedish follow-up study.

Subjects: One hundred violent offenders, consecutively admitted for forensic psychiatric

investigations between 1998 and 2001 (baseline).

Methods: Psychiatric and psychological data collection at baseline included age at onset of

criminal behaviour and substance abuse and measures of platelet MAO-B activity. Known

criminological and clinical risk factors were registered as well as ratings with the risk

assessment instruments the Psychopathy Checklist-Revised (PCL-R), Historical, Clinical,

Risk Management (HCR-20), and Life History of Aggression (LHA). After a mean follow-up

time of almost five years, data on violent recidivism was obtained from official crime

registers and analysed in relation to the clinical and criminological risk factors and to the

results of the risk instruments.

Results: Twenty subjects were reconvicted for violent crimes during follow-up. The age at

onset of substance abuse, but not the MAO-B activity (regardless of smoking habits),

correlated with risk factors for violence and predicted criminal recidivism. Most

criminological and clinical risk factors, such as age at first conviction, number of convictions,

history of conduct disorder, substance abuse, and scores on the PCL-R, HCR-20, and LHA,

demonstrated modest correlations with violent recidivism and moderate predictive ability

with areas under the Receiver Operating Characteristics (ROC) curves between 0.72 and

0.76. Only age at first conviction and a history of substance abuse among primary relatives

remained significant predictors in multivariate models. The development and use of forensic

psychiatric risk assessments were analysed from a clinical point of view, considering changes

over time, ethical dilemmas, and risk for integrity violations and misunderstandings due to

divergent expectations and interpretations of terminology.

Conclusions: Early-onset substance abuse and age at first conviction are independent risk

factors for recidivistic violence in forensic psychiatry. Simple historical risk factors

describing behaviour have as good predictive accuracy as complex clinical risk assessment

instruments. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Docent Lindström, Eva, Department of Neuroscience, Uppsala University Uppsala, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
violence, forensic risk assessment, risk factors, recidivism
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
volume
2010:120
pages
46 pages
publisher
Lund University, Faculty of Medicine
defense location
CRCs aula, UMAS, Malmö
defense date
2010-12-09 13:00
ISSN
1652-8220
ISBN
978-91-86671-36-5
language
English
LU publication?
yes
id
69b5d7bc-67c5-45b8-a374-211da0ee077d (old id 1716669)
date added to LUP
2010-11-17 10:46:34
date last changed
2018-05-29 11:30:26
@phdthesis{69b5d7bc-67c5-45b8-a374-211da0ee077d,
  abstract     = {Objective: To test the predictive accuracy for violent recidivism of the age at onset of<br/><br>
substance abuse, the platelet MAO-B activity, and various combinations of criminological<br/><br>
and clinical risk factors among violent offenders in a prospective Swedish follow-up study.<br/><br>
Subjects: One hundred violent offenders, consecutively admitted for forensic psychiatric<br/><br>
investigations between 1998 and 2001 (baseline).<br/><br>
Methods: Psychiatric and psychological data collection at baseline included age at onset of<br/><br>
criminal behaviour and substance abuse and measures of platelet MAO-B activity. Known<br/><br>
criminological and clinical risk factors were registered as well as ratings with the risk<br/><br>
assessment instruments the Psychopathy Checklist-Revised (PCL-R), Historical, Clinical,<br/><br>
Risk Management (HCR-20), and Life History of Aggression (LHA). After a mean follow-up<br/><br>
time of almost five years, data on violent recidivism was obtained from official crime<br/><br>
registers and analysed in relation to the clinical and criminological risk factors and to the<br/><br>
results of the risk instruments.<br/><br>
Results: Twenty subjects were reconvicted for violent crimes during follow-up. The age at<br/><br>
onset of substance abuse, but not the MAO-B activity (regardless of smoking habits),<br/><br>
correlated with risk factors for violence and predicted criminal recidivism. Most<br/><br>
criminological and clinical risk factors, such as age at first conviction, number of convictions,<br/><br>
history of conduct disorder, substance abuse, and scores on the PCL-R, HCR-20, and LHA,<br/><br>
demonstrated modest correlations with violent recidivism and moderate predictive ability<br/><br>
with areas under the Receiver Operating Characteristics (ROC) curves between 0.72 and<br/><br>
0.76. Only age at first conviction and a history of substance abuse among primary relatives<br/><br>
remained significant predictors in multivariate models. The development and use of forensic<br/><br>
psychiatric risk assessments were analysed from a clinical point of view, considering changes<br/><br>
over time, ethical dilemmas, and risk for integrity violations and misunderstandings due to<br/><br>
divergent expectations and interpretations of terminology.<br/><br>
Conclusions: Early-onset substance abuse and age at first conviction are independent risk<br/><br>
factors for recidivistic violence in forensic psychiatry. Simple historical risk factors<br/><br>
describing behaviour have as good predictive accuracy as complex clinical risk assessment<br/><br>
instruments.},
  author       = {Gustavson, Christina},
  isbn         = {978-91-86671-36-5},
  issn         = {1652-8220},
  keyword      = {violence,forensic risk assessment,risk factors,recidivism},
  language     = {eng},
  pages        = {46},
  publisher    = {Lund University, Faculty of Medicine},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine Doctoral Dissertation Series},
  title        = {Risk and prediction of violent crime in forensic psychiatry},
  volume       = {2010:120},
  year         = {2010},
}