Risk and prediction of violent crime in forensic psychiatry
(2010) In Lund University Faculty of Medicine Doctoral Dissertation Series 2010:120.- 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) - 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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1716669
- author
- Gustavson, Christina LU
- supervisor
- opponent
-
- Docent Lindström, Eva, Department of Neuroscience, Uppsala University Uppsala, Sweden
- organization
- publishing date
- 2010
- 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 13:00:00
- 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
- 2016-04-01 14:33:18
- date last changed
- 2025-10-21 13:04:05
@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}},
keywords = {{violence; forensic risk assessment; risk factors; recidivism}},
language = {{eng}},
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}},
url = {{https://lup.lub.lu.se/search/files/4035633/1716688.pdf}},
volume = {{2010:120}},
year = {{2010}},
}