Risk and prediction of violent crime in forensic psychiatry

Christina Gustavson

Research output: ThesisDoctoral Thesis (compilation)

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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
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.
Original languageEnglish
QualificationDoctor
Awarding Institution
Supervisors/Advisors
  • Kerekes, Nóra, Supervisor, External person
  • Nilsson, Thomas, Supervisor
  • Anckarsäter, Henrik, Supervisor
Award date2010 Dec 9
Publisher
ISBN (Print)978-91-86671-36-5
Publication statusPublished - 2010

Bibliographical note

Defence details

Date: 2010-12-09
Time: 13:00
Place: CRCs aula, UMAS, Malmö

External reviewer(s)

Name: Lindström, Eva
Title: Docent
Affiliation: Department of Neuroscience, Uppsala University Uppsala, Sweden

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Subject classification (UKÄ)

  • Psychiatry

Free keywords

  • violence
  • forensic risk assessment
  • risk factors
  • recidivism

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