Risk and prediction of violent crime in forensic psychiatry

Christina Gustavson

Risk and prediction of violent crime in forensic psychiatry

Christina Gustavson

EpiHealth: Epidemiology for Health

Forskningsoutput: Avhandling › Doktorsavhandling (sammanläggning)

1405 Nedladdningar (Pure)

Sammanfattning

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.

Originalspråk	engelska
Kvalifikation	Doktor
Tilldelande institution
Handledare	Kerekes, Nóra, handledare, Extern person Nilsson, Thomas, handledare Anckarsäter, Henrik, handledare
Tilldelningsdatum	2010 dec. 9
Förlag	Lund University: Faculty of Medicine
ISBN (tryckt)	978-91-86671-36-5
Status	Published - 2010

Bibliografisk information

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

---

Ämnesklassifikation (UKÄ)

Psykiatri

FN:s Globala mål

Denna forskningsoutput relaterar till följande Globala mål

Tillgång till dokument

Christina_Gustavson

3 Artikel i vetenskaplig tidskrift

Platelet Monoamine Oxidase B Activity Did Not Predict Destructive Personality Traits or Violent Recidivism: A Prospective Study in Male Forensic Psychiatric Examinees.
Gustavson, C., Wass, C., Mansson, J.-E., Blennow, K., Forsman, A., Anckarsäter, H. & Nilsson, T., 2010, I: Neuropsychobiology. 61, 2, s. 87-96
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review
The precarious practice of forensic psychiatric risk assessments
Nilsson, T., Munthe, C., Gustavson, C., Forsman, A. & Anckarsäter, H., 2009, I: International Journal of Law and Psychiatry. 32, 6, s. 400-407
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review
Age at onset of substance abuse: a crucial covariate of psychopathic traits and aggression in adult offenders
Gustavson, C., Stahlberg, O., Sjodin, A.-K., Forsman, A., Nilsson, T. & Anckarsäter, H., 2007, I: Psychiatry Research. 153, 2, s. 195-198
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

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@phdthesis{69b5d7bc67c545b8a374211da0ee077d,

title = "Risk and prediction of violent crime in forensic psychiatry",

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.",

keywords = "violence, forensic risk assessment, risk factors, recidivism",

author = "Christina Gustavson",

note = "Defence details Date: 2010-12-09 Time: 13:00 Place: CRCs aula, UMAS, Malm{\"o} External reviewer(s) Name: Lindstr{\"o}m, Eva Title: Docent Affiliation: Department of Neuroscience, Uppsala University Uppsala, Sweden ---",

year = "2010",

language = "English",

isbn = "978-91-86671-36-5",

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type = "Doctoral Thesis (compilation)",

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TY - THES

T1 - Risk and prediction of violent crime in forensic psychiatry

AU - Gustavson, Christina

N1 - 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 ---

PY - 2010

Y1 - 2010

N2 - 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.

AB - 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.

KW - violence

KW - forensic risk assessment

KW - risk factors

KW - recidivism

M3 - Doctoral Thesis (compilation)

SN - 978-91-86671-36-5

T3 - Lund University Faculty of Medicine Doctoral Dissertation Series

PB - Lund University: Faculty of Medicine

ER -

Risk and prediction of violent crime in forensic psychiatry

Sammanfattning

Bibliografisk information

Ämnesklassifikation (UKÄ)

FN:s Globala mål

Tillgång till dokument

Fingeravtryck

Forskningsoutput

Platelet Monoamine Oxidase B Activity Did Not Predict Destructive Personality Traits or Violent Recidivism: A Prospective Study in Male Forensic Psychiatric Examinees.

The precarious practice of forensic psychiatric risk assessments

Age at onset of substance abuse: a crucial covariate of psychopathic traits and aggression in adult offenders

Citera det här