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OtherREGULAR ARTICLE

Hindsight Bias Among Psychiatrists

H. W. LeBourgeois, Debra A. Pinals, Valerie Williams and Paul S. Appelbaum
Journal of the American Academy of Psychiatry and the Law Online March 2007, 35 (1) 67-73;
H. W. LeBourgeois III
Dr. LeBourgeois is Director, Forensic Psychiatry Fellowship Program and Assistant Professor of Psychiatry, Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA. Dr. Pinals is Director, Forensic Psychiatry Fellowship Program and Associate Professor of Psychiatry, Law and Psychiatry Program, and Ms. Williams is a Research Instructor, Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Dr. Appelbaum is Professor and Director, Division of Psychiatry, Law and Ethics, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
MD
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Debra A. Pinals
Dr. LeBourgeois is Director, Forensic Psychiatry Fellowship Program and Assistant Professor of Psychiatry, Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA. Dr. Pinals is Director, Forensic Psychiatry Fellowship Program and Associate Professor of Psychiatry, Law and Psychiatry Program, and Ms. Williams is a Research Instructor, Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Dr. Appelbaum is Professor and Director, Division of Psychiatry, Law and Ethics, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
MD
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Valerie Williams
Dr. LeBourgeois is Director, Forensic Psychiatry Fellowship Program and Assistant Professor of Psychiatry, Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA. Dr. Pinals is Director, Forensic Psychiatry Fellowship Program and Associate Professor of Psychiatry, Law and Psychiatry Program, and Ms. Williams is a Research Instructor, Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Dr. Appelbaum is Professor and Director, Division of Psychiatry, Law and Ethics, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
MA, MS
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Paul S. Appelbaum
Dr. LeBourgeois is Director, Forensic Psychiatry Fellowship Program and Assistant Professor of Psychiatry, Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA. Dr. Pinals is Director, Forensic Psychiatry Fellowship Program and Associate Professor of Psychiatry, Law and Psychiatry Program, and Ms. Williams is a Research Instructor, Center for Mental Health Services Research, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Dr. Appelbaum is Professor and Director, Division of Psychiatry, Law and Ethics, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
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Tables

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    Table 1

    Background Characteristics of Study Sample

    Background CharacteristicsStudy GroupTotal(n = 235)p*
    Hindsight (n = 114)Control (n = 121)
    Male (%)70.272.771.5.665
    Years since completion of residency (%)
        0–1040.427.333.6
        11–2021.127.324.3.054
        21–3024.624.024.3
        >3014.021.517.9
    Membership status, %
        APA only53.547.950.6.393
        AAPL46.552.149.4
    Median percentage of time spent on clinical work (IQR†)70 (50)80 (50)80 (50).411
    Median percentage of time spent on forensic psychiatry work (IQR†)10 (30)10 (45)10 (40).111
    Practices in a geographic area with a population of ≥1 million (%)41.246.343.8.435
    • ↵* Chi-square test used for nominal measures and Mann-Whitney test for ordinal measures.

    • ↵† Interquartile range is the difference between the 75th and the 25th percentiles and is a robust estimator of a distribution's dispersion or spread.

    • View popup
    Table 2

    Background Characteristics by Organization Affiliation

    Background CharacteristicsStudy GroupTotal(n = 235)p
    APA-only(n = 119)AAPL(n = 116)
    Male (%)68.175.071.5.239
    Years since completion of residency (%)
        0–1036.131.033.6
        11–2021.027.624.3.665
        21–3026.122.424.3
        >3016.819.017.9
    Median percentage of time spent on clinical work (IQR)90 (50)70 (50)80 (50).000
    Median percentage of time spent on forensic psychiatry work (IQR)0 (10)20 (40)10 (40).000
    Practices in a geographic area with a population of ≥1 million (%)38.749.143.8.105
    • Data are as described in Table 1.

    • View popup
    Table 3.

    Suicide and Violence Risk and Standard of Care Assessment Results by Study Group

    Study GroupTotalp*
    HindsightControl
    Risk assessment rating†
        Mean suicide risk rating (SD)(n = 114)(n = 117)(n = 231).000
    4.9 (1.04)4.2 (1.16)4.6 (1.2)
        Mean violence risk rating (SD)(n = 112)(n = 115)(n = 227).008
    4.0 (1.12)3.6 (1.16)3.8 (1.2))
    Met standard of care‡
        Suicide (%)(n = 114)(n = 117)(n = 231).113
    49.159.054.1
        Violence (%)(n = 112)(n = 115)(n = 227).251
    67.073.970.5
    • ↵* ANOVA was used for continuous measures and the chi-square test for nominal measures.

    • ↵† Higher rating represents higher perceived risk on a seven-point Likert scale.

    • ↵‡ Responded “yes.”

    • View popup
    Table 4

    Suicide and Violence Risk and Standard of Care Assessment Results by Study Group and AAPL Status

    Study Groupp*
    HindsightControl
    Risk assessment rating†
        Mean suicide risk rating (SD)
            APA only(n = 61)(n = 57).000
    5.0 (1.1)4.0 (1.3)
            AAPL(n = 53)(n = 60).118
    4.8 (1.0)4.5 (1.0)
        Mean violence risk rating (SD)
            APA-only(n = 60)(n = 57).011
    3.9 (1.2)3.4 (1.1)
            AAPL(n = 52)(n = 58).173
    4.1 (1.1)3.8 (1.2)
    Met standard of care‡
        Suicide (%)
            APA-only(n = 61)(n = 57).092
    45.961.4
            AAPL(n = 53)(n = 60).683
    52.856.7
        Violence (%)
            APA-only(n = 60)(n = 57).068
    70.084.2
            AAPL(n = 52)(n = 58).971
    63.563.8
    • Data are as described in Table 3.

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Journal of the American Academy of Psychiatry and the Law Online: 35 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 35, Issue 1
March 2007
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Hindsight Bias Among Psychiatrists
H. W. LeBourgeois, Debra A. Pinals, Valerie Williams, Paul S. Appelbaum
Journal of the American Academy of Psychiatry and the Law Online Mar 2007, 35 (1) 67-73;

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Hindsight Bias Among Psychiatrists
H. W. LeBourgeois, Debra A. Pinals, Valerie Williams, Paul S. Appelbaum
Journal of the American Academy of Psychiatry and the Law Online Mar 2007, 35 (1) 67-73;
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