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Clinical and risk management factors in risk prediction of mentally disordered offenders: more important than historical data? A retrospective study of 40 mentally disordered offenders assessed with the HCR-20 violence risk assessment scheme
Forensic Psychiatric Centre, Research Unit, Växjö, Sweden. (Center for Criminological and Psychosocial Research)ORCID iD: 0000-0002-8285-0935
Forensic Psychiatric Centre, Research Unit, Växjö, Sweden; Karolinska Institute, Stockholm, Sweden.
Sundsvall Forensic Psychiatric Hospital, Sundsvall, Sweden.
Department of Psychiatry, University of Lund, Sweden.
1999 (English)In: Legal and Criminological Psychology, ISSN 1355-3259, E-ISSN 2044-8333, Vol. 4, no 1, 67-76 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The predictive validity of the risk prediction instrument HCR-20 was studied.

Methods: Two matched groups of discharged forensic psychiatric patients, one who had recidivated into violent criminality and the other not, were assessed with the HCR-20. This was done retrospective and blind to the outcome.

Results: The results show an overall high predictive validity (AUC =.80). However, historical data had none, or a low, validity while clinical and risk management data had a very high validity.

Conclusions: One of the most interesting findings in this study is that clinical and risk management factors came out as more predictive of future violence than historical factors, which is very much contrary to findings in past research. We think that one has to bear in mind that both clinical and risk management factors are heavily influenced by historical information. Thus, historical data are probably as important as is generally shown in follow-up studies of violence in various offender groups. However, using the HCR-20, which allows systematic and reliable coding or clinical and risk management factors, seems to make it possible to use these factors more successfully than has been hitherto possible.

Place, publisher, year, edition, pages
Elsevier, 1999. Vol. 4, no 1, 67-76 p.
National Category
URN: urn:nbn:se:oru:diva-54046DOI: 10.1348/135532599167798ScopusID: 2-s2.0-0033042516OAI: oai:DiVA.org:oru-54046DiVA: diva2:1057710
Available from: 2016-12-19 Created: 2016-12-19 Last updated: 2017-01-11Bibliographically approved
In thesis
1. Violence risk assessment in male and female mentally disordered offenders: differences and similarities
Open this publication in new window or tab >>Violence risk assessment in male and female mentally disordered offenders: differences and similarities
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

When assessing the risk of violence, increasing interest has been shown in bringing science and practice closer together. Moving from clinical intuition in the first generation of risk assessment via actuarial scales in the second generation to the structured professional judgments where risk assessments are today produces better, more valid results when assessing the risk of violence. One of the best predictors of violence is gender. Approximately 10% of the violent criminality can be attributed to women; even so, it is increasing, especially among young women. It is therefore important to examine risk assessments from a gender perspective. Another important factor when assessing the risk of violence is psychopathy and there are indications that there might be gender differences in this diagnosis. Thus, a special interest has been focused on psychopathy in this thesis. The purpose with this work is to explore the similarities and differences in assessing risk for violence in male and female mentally disordered offenders, while the overall aim is to validate the violence risk assessment instrument HCR-20 for Swedish offender populations. The risk assessments for all six studies in this thesis were made by trained personnel using the HCR-20 instrument, where psychopathy was diagnosed with the screening version of the Psychopathy Checklist (PCL:SV). The study populations were both male and female mentally disordered offenders in either the correctional or the forensic setting.

The findings show that both the validity and the reliability of the HCR-20 and the PCL:SV were good and the clinical and risk management subscales were found to have better predictive validity than the historical scale. Another finding was that there were more similarities than differences between genders in the HCR-20, while the opposite applied to the PCL:SV, where the antisocial behavior was performed in a different manner. Moreover, it was found that the gender of the assessor might be a factor to take into account when assessing the risk of violence in women, where the recommendation was that at least one assessor should be female. The conclusions were that the HCR-20 and the PCL:SV can be used In Swedish offender populations with valid results. For female offenders, there are differences in the antisocial behavior that is assessed in order to diagnose psychopathy and these differences tend to underestimate psychopathy among female offenders. Furthermore, the gender of the assessor might be of greater importance than has previously been realized. The overall conclusion was that this thesis supports the structural professional judgment method of making risk assessments in order to prevent violence in the community.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2006. 76 p.
Mid Sweden University Doctoral Thesis, ISSN 1652-893X ; 9
Risk assessment, HCR-20, psychopathy, PCL:SV, female offenders, mentally disordered offenders, antisocial behavior, violent recidivism
National Category
urn:nbn:se:oru:diva-54118 (URN)91-85317-21-7 (ISBN)
Public defence
2006-12-04, Campus Sundsvall, Sundsvall, 10:00 (English)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2016-12-20Bibliographically approved

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