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Research ArticleRegular Article

Clinical Decision-making About Inpatient Violence Risk at Admission to a Public-Sector Acute Psychiatric Hospital

Virginia M. Newton, Eric B. Elbogen, Carrie L. Brown, Jennifer Snyder and Ann Louise Barrick
Journal of the American Academy of Psychiatry and the Law Online April 2012, 40 (2) 206-214;
Virginia M. Newton
PhD
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Eric B. Elbogen
PhD
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Carrie L. Brown
MD, MPH
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Jennifer Snyder
PhD
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Ann Louise Barrick
PhD
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    Table 1

    Bivariate Associations Comparing Violent Patients to Nonviolent Patients on Violence Risk Factors

    Risk FactorTotal With Factor n (%)Nonviolent Group (n = 132) n (%)Violent Group (n = 103) n (%)χ2p
    Dispositional factors
        Age younger than 35 years124 (52.8)63 (47.7)61 (59.2)3.068.08
        Race (white)110 (46.8)78 (59.1)32 (31.1)18.248<.001
        Male142 (60.4)85 (64.4)57 (55.3)1.983.159
        Married29 (12.3)23 (17.4)6 (5.8)7.195.007
        Below average intelligence52 (22.1)12 (9.1)40 (38.8)29.705<.001
        Poor judgment183 (77.9)91 (68.9)92 (89.3)13.947<.001
        Low insight170 (72.3)81 (61.4)89 (86.4)18.135<.001
        Chronic hostility32 (13.6)14 (10.6)18 (17.5)2.321.128
        Information on behavioral control available86 (36.6)52 (39.4)34 (33)1.016.313
    Historical factors
        High school or GED81 (34.5)55 (41.7)26 (25.2)6.909.009
        Past psychiatric history202 (86)101 (76.5)101 (98.1)22.245<.001
        Childhood abuse24 (10.2)18 (13.6)6 (5.8)3.85.05
        History of physical abuse41 (17.4)31 (23.5)10 (9.7)7.623.006
        History of sexual abuse30 (12.8)19 (14.4)11 (10.7).717.397
        Family history of mental illness74 (31.5)46 (34.8)28 (27.2)1.575.209
        History of employment84 (35.7)64 (48.5)20 (19.4)21.283<.001
        Violence history available at admission23 (9.8)8 (6.1)15 (14.6)4.737.03
        History of violent criminal offense, from online search34 (14.5)17 (12.9)17 (16.5).615.433
    Contextual factors
        Has a place to live102 (43.4)71 (53.8)31 (30.1)13.219<.001
        Supportive family or friends76 (32.3)50 (37.9)26 (25.2)4.222.04
        Disability support31 (13.2)13 (9.8)18 (17.5)2.939.086
    Clinical factors
        History of alcohol abuse89 (37.9)56 (42.4)33 (32)2.652.103
        History of substance abuse113 (48.1)72 (54.5)41 (39.8)5.035.025
        Auditory hallucinations49 (20.9)25 (18.9)24 (23.3).667.414
        Visual hallucinations29 (12.3)14 (10.6)15 (14.6).837.36
        Suicidal ideation33 (14)25 (18.9)8 (7.8)2.542.111
        Suicidal plan21 (8.9)16 (12.1)5 (4.9).936.333
        Ability to care for self160 (68.1)102 (77.3)58 (56.3)11.699.001
        Aggression/agitation65 (27.7)24 (18.2)41 (39.8)13.52<.001
        Labile mood54 (23)28 (21.2)26 (25.2).531.466
        Current treatment noncompliance48 (20.4)19 (14.4)29 (28.2)6.741.009
        Psychotic disorder118 (50.2)42 (31.8)76 (73.8)40.762<.001
        Bipolar disorder28 (11.9)14 (10.6)14 (13.6).492.483
        Personality disorder32 (13.6)21 (15.9)11 (10.7)1.345.246
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    Table 2

    Regression Coefficients for Variables Associated With Inpatient Violence

    VariableBSEWalddfpOR95% CI
    Age <35 years.965.3676.9071.00862.6241.278–5.389
    Male.932.3985.4861.01922.5381.164–5.534
    Low intelligence1.789.4913.3181.00035.9842.289–15.642
    Past psychiatric history2.411.8128.8121.00311.152.269–54.792
    Employment history−.882.3964.9771.0257.414.191–.898
    Has a place to live−.88.3795.391.0203.415.197–.872
    Aggression/agitation1.029.4016.5741.01032.7991.274–6.148
    Psychotic disorder2.344.44727.4951<.000110.4274.341–25.046
    Bipolar disorder1.934.56411.7551.00066.922.29–20.91
    • R2 = .5479; AUC = .881. χ2 = 123.5278; df = 9; p <.0001.

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    Table 3

    Regression Classification

    ObservedPredicted
    NonviolentViolent% Correct
    Nonviolent1122084.8
    Violent277673.8
    Overall percentage80.0
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Journal of the American Academy of Psychiatry and the Law Online: 40 (2)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 40, Issue 2
1 Apr 2012
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Clinical Decision-making About Inpatient Violence Risk at Admission to a Public-Sector Acute Psychiatric Hospital
Virginia M. Newton, Eric B. Elbogen, Carrie L. Brown, Jennifer Snyder, Ann Louise Barrick
Journal of the American Academy of Psychiatry and the Law Online Apr 2012, 40 (2) 206-214;

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Clinical Decision-making About Inpatient Violence Risk at Admission to a Public-Sector Acute Psychiatric Hospital
Virginia M. Newton, Eric B. Elbogen, Carrie L. Brown, Jennifer Snyder, Ann Louise Barrick
Journal of the American Academy of Psychiatry and the Law Online Apr 2012, 40 (2) 206-214;
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