Assessing Risk of Violence
Recent Research on Assessing Risk of Violence:
72 Studies Published in 2012-2019
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Resources for Therapists & Therapists-in-Training Who Are Stalked, Threatened, or Attacked by Patients
Psychological Assessment of Torture Survivors: Essential Steps, Avoidable Errors, and Helpful Resource
Deposition & Cross-Examination Questions on Tests & Psychometrics
10 Fallacies in Psychological Assessment.
Responsibilities in Providing Psychological Test Feedback to Clients
I gathered the following 72 citations and excerpts from recent (i.e., published or in-press in peer-reviewed journals in 2012-2019) studies to make it easier for clinicians, researchers, and others to keep abreast of the evolving research relevant to assessing the risk of violence:
Abbiati, M., et al. (2018). "Predicting physically violent misconduct in prison: A comparison of four risk assessment instruments." Behavioral Sciences & the Law: No Pagination Specified-No Pagination Specified.
Excerpt: "Violence in correctional facilities is an important issue for both prisoners and prison staff. Risk assessment instruments have demonstrated their accuracy in predicting the risk of (re) offending and institutional violence in psychiatric settings, but less is known about their ability to predict violent misconduct in prison. The present study applied four risk assessment instruments (Structured Assessment of Protective Factors for violence risk, Historical Clinical Risk Management-20, Psychopathy checklist – Revised, and Violent Risk Appraisal Guide) to 52 violent offenders in a Swiss prison in order to evaluate the instruments' predictive validities. Outcomes were instances of physically violent, other and any misconduct as recorded in prison files during the 12 months following the prisoners' assessments. Approximately 15% of offenders committed physically violent misconduct and approximately 42% committed any misconduct. The results show that mainly dynamic assessment tools are as good predictors of physically violent misconduct as mainly static assessment tools. Targeting dynamic factors could increase the effectiveness of interventions to reduce the risk of physical violence in prison."
Belfrage & Strand (2012). "Measuring the outcome of structured spousal violence risk assessments using the B-SAFER: Risk in relation to recidivism and intervention." Behavioral Sciences & the Law 30(4): 420-430.
Excerpt: "216 risk assessments conducted by law enforcement officers in a suburb of Stockholm using the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) were followed up and correlated to both recidivism and type of protective actions implemented by the police. The results showed high recidivism rates across all risk categories, except in the highest risk group, where the recidivism rate was significantly lower. This finding suggests a poor, and even negative, predictive power of the police risk assessments: the higher the police-assessed risk, the lower the recidivism rate. However, it was clear that the police did very little, or nothing, in cases not assessed as high risk. All resources appear to have been directed to the high-risk cases, which seems to have had a preventive effect."
Belfrage et al. (2012). "Assessment and management of risk for intimate partner violence by police officers using the Spousal Assault Risk Assessment Guide." Law and Human Behavior 36(1): 60-67.
Excerpt: "SARA risk assessments had significant predictive validity with respect to risk management recommendations made by police, as well as with recidivism as indexed by subsequent contacts with police. Risk management mediated the association between risk assessment and recidivism: High levels of intervention were associated with decreased recidivism in high risk cases, but with increased recidivism in low risk cases."
Benezech et al. (2012). "Project for the comprehensive diagnosis and prognostic assessment of physical dangerousness: The 12-p questionnaire." Annales Médico-Psychologiques 170(2): 136-138.
Excerpt: "This article critically reviews the theory, methodology, and empirical evidence pertaining to the various approaches employed by mental health professionals in expert testimony regarding the probability of future violence for people within the jurisprudence system. Many professionals rely on unstructured clinical assessment, which allows the evaluator to fully capitalize on their clinical experience but is vulnerable to cognitive and situational biases that negatively affect the validity and reliability of the evaluation. In contrast, actuarial assessment involves statistical estimation of violence risk based on certain combinations of criminogenic variables derived from prospective analysis of recidivism in various offender groups. Structured professional judgment relies on professional expertise with a structured checklist application, and thus attempts to minimize the limitations of unstructured clinical and actuarial assessment while retaining the strengths of each. Although an improvement on unstructured assessment, structured applications have significant limitations, highlighting the importance of a multimethod approach to violence risk assessment."
Brown & Langrish (2012). "Evaluation of a risk assessment tool to predict violent behaviour by patients detained in a psychiatric intensive care unit." Journal of Psychiatric Intensive Care 8(1): 35-41.
Excerpt: "Violent behaviour during the previous two weeks was a significant predictor of subsequent violence. Drug use was a negative predictor. None of the other variables tested were predictive of violent behaviour.... A complicated risk assessment tool probably adds little to the process of predicting acutely violent behaviour in PICU patients."
Brugman, S., et al. (2016). "Cognitive predictors of violent incidents in forensic psychiatric inpatients." Psychiatry Research. Published online in advance of print publication.
Excerpt: "Generalized linear mixed model analyses showed that increased attention towards threat and aggression, difficulty recognizing sad faces and factor 2 of the PCL-R predicted the sum of violent incidents. Specifically, verbal aggression was predicted by increased attention towards threat and aggression, difficulty to recognize sad and happy faces, and PCL-R factor 2; physical aggression by decreased response inhibition, higher PCL-R factor 2 and lower PCL-R factor 1 scores; and aggression against property by difficulty recognizing angry faces. Findings indicate that cognitive tasks could be valuable in predicting aggression, thereby extending current knowledge on dynamic factors predicting aggressive behavior in forensic patients."
Cale &Lussier (2012). "Merging developmental and criminal career perspectives: Implications for risk assessment and risk prediction of violent/sexual recidivism in adult sexual aggressors of women." Sexual Abuse: Journal of Research and Treatment 24(2): 107-132.
Excerpt: "The current study was based on a sample of 204 convicted sexual aggressors of women incarcerated in the province of Quebec, Canada between April 1994 and June 2000.... For an average follow-up period of approximately 4 years, the violent/sexual recidivism rate for the sample was 23.7%. The results provided support for the inclusion of both developmental and criminal career indicators for the prediction of violent/sexual recidivism. More specifically, recidivists were characterized by an early onset antisocial trajectory and a pattern of escalation of antisocial behavior between childhood and adolescence."
Camp, J. P., et al. (2013). "Psychopathic predators? Getting specific about the relation between psychopathy and violence." Journal of Consulting and Clinical Psychology 81(3): 467-480.
Excerpt: "First, the PPI manifested incremental validity in predicting future violence over the PCL–R (but not vice versa)—and most of its predictive power derived solely from impulsive antisociality. Second, impulsive antisociality—not interpersonal and affective traits specific to psychopathy—were uniquely associated with instrumental lifetime patterns of past violence. The latter psychopathic traits are narrowly associated with deficits in motivation for violence (e.g., lack of fear or lack of provocation)…. These findings and their consistency with some past research led us to advise against making broad generalizations about the relation between psychopathy and violence."
Chan, K. L. (2012). "Predicting the risk of intimate partner violence: The Chinese Risk Assessment Tool for Victims." Journal of Family Violence 27(2): 157-164.
Excerpt: "The CRAT-V had a sensitivity of 74.0 %, a specificity of 68.3 %, an overall accuracy of 68.7 %, and an area under the receiver operating characteristic (ROC) curve of 0.75 when administered on the second half of sample.... The CRAT-V may serve as a straightforward, systematic, and easy-to-administer instrument tailor-made for Chinese populations for the assessment of risk of IPV victimization against women."
Cornell et al. (2012). "A randomized controlled study of the Virginia Student Threat Assessment Guidelines in kindergarten through grade 12." School Psychology Review 41(1): 100-115.
Excerpt: "The students [who had made threats] attended 40 schools randomly assigned to use the Virginia Student Threat Assessment Guidelines or follow a business-as-usual disciplinary approach in a control group.... Implementation fidelity was associated with decreased long-term suspension.... These results provide strong empirical support for the use of student threat assessment in primary and secondary schools."
Day, A., et al. (2014). "Intimate partner violence in prisoners: Toward effective assessment and intervention." Aggression and Violent Behavior 19(5): 579-583.
Excerpt: "Unique and complex victim related issues that arise during incarceration and post-release are not adequately recognized in current correctional assessment and case management systems."
Dayan, K., et al. (2013). "Validation of Spouse Violence Risk Assessment Inventory for police purposes." Journal of Family Violence 28(8): 811-821.
Excerpt: " The Spouse Violence Risk Assessment Inventory (SVRA-I) is a new scale developed by the Israeli police to measure the likelihood of male perpetrators repeating violent behavior toward their partners.... The inventory was found to be a valid and efficient tool for predicting recidivism of intimate partner violence (IPV)."
de Girolamo, G., et al. (2016). "Monitoring and predicting the risk of violence in residential facilities. No difference between patients with history or with no history of violence." Journal of Psychiatric Research 80: 5-13.
Excerpt: " The bi-monthly monitoring during the 1-year follow-up did not show any statistically significant differences in aggressive behaviour rates between the two groups. The subscale explaining most of the MOAS total score was aggression against objects, although verbal aggression was the most common pattern. Furthermore, verbal aggression was significantly associated with aggression against objects and physical aggression…. Patients with a history of violence in RFs, where treatment and clinical supervision are available, do not show higher rates of aggressiveness compared to patients with no lifetime history of violence. Since verbal aggression is associated with more severe forms of aggression, prompt intervention is warranted to reduce the risk of escalation."
Doyle &Logan (2012). "Operationalizing the assessment and management of violence risk in the short-term." Behavioral Sciences & the Law 30(4): 406-419.
Excerpt: "The Short-Term Assessment of Risk and Treatability (START) is a brief clinical guide for the dynamic assessment of risks, strengths and treatability. It focuses on short-term risks and the characteristics of the individual that, if changed, might lead to an increase or decrease in risk."
Faccini & Saide (2012). "Assessment of written threats and inappropriate communications by persons with an intellectual disability." American Journal of Forensic Psychology 30(4): 43-61.
Excerpt: "The forensic method of assessing steps along the 'path to intended violence' was found to be applicable in analyzing the written threats or inappropriate communications. This approach was effective in helping to derive a threat risk level for violence."
Farkas & Tsukayama (2012). "An integrative approach to threat assessment andmanagement: Security and mental health response to a threatening client." Work: Journal of Prevention, Assessment & Rehabilitation 42(1): 9-14.
Excerpt: "This case study illustrates such an intervention in a complex situation involving a social service agency and its client. Following a curtailment of services and an arrest, the client developed an escalating homicidal anger toward the agency administrator. Once a Tarasoff warning was received, the agency contacted a security company who organized a threat assessment and management plan involving interdisciplinary collaboration. Information developed in the course of the assessment was presented to prosecutors, who facilitated the client's arrest and involuntary psychiatric commitment until he was judged to be no longer dangerous. This case ultimately involved an integration of the services of security, law enforcement, mental health professionals, prosecutors, the courts and the state mental health system in leading to a successful diversion of the client from a path of intended violence."
Fazel, S., et al. (2016). "Prediction of violent reoffending on release from prison: Derivation and external validation of a scalable tool." The Lancet Psychiatry 3(6): 535-543.
Excerpt: "We identified a cohort of 47 326 prisoners released in Sweden between 2001 and 2009, with 11 263 incidents of violent reoffending during this period. We developed a 14-item derivation model to predict violent reoffending and tested it in an external validation (assigning 37 100 individuals to the derivation sample and 10 226 to the validation sample). The model showed good measures of discrimination (Harrell's c-index 0·74) and calibration. For risk of violent reoffending at 1 year, sensitivity was 76% (95% CI 73–79) and specificity was 61% (95% CI 60–62). Positive and negative predictive values were 21% (95% CI 19–22) and 95% (95% CI 94–96), respectively. At 2 years, sensitivity was 67% (95% CI 64–69) and specificity was 70% (95% CI 69–72). Positive and negative predictive values were 37% (95% CI 35–39) and 89% (95% CI 88–90), respectively. Of individuals with a predicted risk of violent reoffending of 50% or more, 88% had drug and alcohol use disorders. We used the model to generate a simple, web-based, risk calculator (OxRec) that is free to use."
Fazel et al. (2012). "Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24,827 people: Systematic review and meta-analysis." BMJ: British Medical Journal 345(7868): 1-12.
Excerpt: "Our principal finding was that there was heterogeneity in the performance of these measures depending on the purpose of the risk assessment. If used to inform treatment and management decisions, then these instruments performed moderately well in identifying those individuals at higher risk of violence and other forms of offending. However, if used as sole determinants of sentencing, and release or discharge decisions, these instruments are limited by their positive predictive values: 41% of people judged to be at moderate or high risk by violence risk assessment tools went on to violently offend, 23% of those judged to be at moderate or high risk by sexual risk assessment tools went on to sexually offend, and 52% of those judged to be at moderate or high risk by generic risk assessment tools went on to commit any offence. In samples with lower base rates than those that contributed to the review, such as in general psychiatry, positive predictive values will probably be even lower.25 However, negative predictive values were high, and suggest that these tools can effectively screen out individuals at low risk of future offending. Whether the cautious optimism13 that experts have described in relation to the ability to predict violence seems justified will depend on the use to which these instruments are put.... One implication of these findings is that, even after 30 years of development, the view that violence, sexual, or criminal risk can be predicted in most cases is not evidence based.... A second and related implication is that these tools are not sufficient on their own for the purposes of risk assessment. Another implication is that actuarial instruments focusing on historical risk factors perform no better than tools based on clinical judgment, a finding contrary to some previous reviews.21 73 Finally, our review suggests that these instruments should be used differently. Since they had higher negative predictive values, one potential approach would be to use them to screen out low risk individuals."
Gerbrandij, J., et al. (2018). "Evaluating risk assessment instruments for intimate partner stalking and intimate partner violence." Journal of Threat Assessment and Management 5(2): 103-118.
Excerpt: "Research indicates that most stalking victims are harassed by a prior intimate partner and that this group of victims is at a higher risk for violence than other stalking victims. Furthermore, many researchers found a relationship between prior intimate partner stalking (IPS) and intimate partner violence (IPV). The present study focused on identification of overlapping and unique risk factors among IPS and IPV offenders. This was done by examining the accuracy and utility of abridged versions of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) and the Guidelines for Stalking Assessment and Management (SAM) in a sample of 158 low-risk offenders charged with crimes targeting an intimate partner. Follow-up ranged from one to 8.5 years; outcome variables were renewed (or continued) stalking and violent reoffending. Receiver operating characteristic (ROC) curves indicated that both instruments had weak, nonsignificant predictive validity for both violent or stalking reoffending when considered in isolation. However, each instrument added significantly to the logistic regression model when predicting stalking recidivism when entered after the PCL:SV and relevant covariates, but neither improved predictive accuracy when added after the other was already in the model. Neither instrument added to logistic regression models predicting violent reoffending. Analysis of individual items revealed that items measuring distress and violations of supervision (SAM) and violations of court orders (B-SAFER) were the most consistent predictors of renewed stalking but not violence. The findings of this study question the utility of these tools for predicting violent reoffending but provide qualified support for the prediction of stalking."
Guy et al. (2012). "Assessing risk of violence using structured professional judgment guidelines." Journal of Forensic Psychology Practice 12(3): 270-283.
Excerpt: "Violence risk assessments are conducted routinely in psychiatric and correctional settings. One method with demonstrated reliability and validity for assessing risk of violence is the structured professional judgment (SPJ) model.... We provide an overview of the SPJ model and a brief review of the empirical literature supporting its use."
Harris, G. T. and M. E. Rice (2015). "Progress in violence risk assessment and communication: Hypothesis versus evidence." Behavioral Sciences & the Law 33(1): 128-145.
Excerpt: "We suggest that some authorities in the field have proposed quite valid and reasonable hypotheses with respect to several issues. Among these are the following: that accuracy will be improved by the adjustment or moderation of numerical scores based on clinical opinions about rare risk factors or other considerations pertaining to the applicability to the case at hand; that there is something fundamentally distinct about protective factors so that they are not merely the obverse of risk factors, such that optimal accuracy cannot be achieved without consideration of such protective factors; and that assessment of dynamic factors is required for optimal accuracy and furthermore interventions aimed at such dynamic factors can be expected to cause reductions in violence risk. We suggest here that, while these are generally reasonable hypotheses, they have been inappropriately presented to practitioners as empirically supported facts, and that practitioners' assessment and communication about violence risk run beyond that supported by the available evidence as a result.
Howard & Dixon (2012). "The construction and validation of the OASys Violence Predictor: Advancing violence risk assessment in the English and Welsh correctional services." Criminal Justice and Behavior 39(3): 287-307.
Excerpt: "The Offender Assessment System (OASys) is the risk assessment and management system routinely used in the National Offender Management Service (NOMS), the prison and probation service for England and Wales. This study describes the construction and validation of a new actuarial violence risk measure, the OASys Violence Predictor (OVP), using OASys and Police National Computer data.... OVP achieves significantly greater predictive validity than existing actuarial scores available within NOMS (the original OASys risk prediction score; the Offender Group Reconviction Scale, Version 3; and the V scale of the Risk Matrix 2000) on a later validation sample..."
Hurducas, C. C., et al. (2014). "Violence risk assessment tools: A systematic review of surveys." The International Journal of Forensic Mental Health 13(3): 181-192.
Excerpts: "The Psychopathy Checklist-Revised and the Historical, Clinical, Risk Management-20 were the most commonly used instruments by practitioners. No surveys investigated differences in assessment practices across professional disciplines or continents, and none examined the use or perceived usefulness of structured instruments in risk management or risk monitoring."
Ibabe, I., et al. (2013). "Risk factors for child-to-parent violence." Journal of Family Violence:
Excerpt: "Evidence was found in support of a social learning taking into account gender: boys were more likely to be physically aggressive toward the mother if she was also physically victimized by the father. Differences were found in the profiles of adolescents who behave violently toward their parents (inappropriate upbringing by mother, social maladjustment, and drug abuse) depending on gender."
Jung, S. and K. Buro (2017). "Appraising risk for intimate partner violence in a police context." Criminal Justice and Behavior 44(2): 240-260.
Excerpt: "The Ontario Domestic Assault Risk Assessment (ODARA) and a modified 14-item version of the Spousal Assault Risk Assessment Guide (SARA) demonstrated large effects in their ability to predict any reoffending or any violent reoffending and moderate predictive accuracy for IPV offending behaviors. The regionally used approach, Family Violence Investigative Report (FVIR), showed good predictive validity for any future offending but poorly predicted any of the violent-specific recidivism outcomes…. The ODARA was significantly better at predicting violence risk over the FVIR, but paired comparisons did not reveal statistical differences with the SARA."
Kebbell & Porter (2012). "An intelligence assessment framework for identifying individuals at risk of committing acts of violent extremism against the West." Security Journal 25(3): 212-228.
Excerpt: This article aims to review the potential of a risk assessment model for the purpose of counter-terrorism intelligence gathering, and discuss potential factors.... From a review of the available literature, a number of factors, mainly attitudinal, appear to be associated with increased risk of violent extremism including beliefs by violent extremists that they are retaliating, that potential victims are less than human, and that their actions are religiously justified. In addition, violent extremists isolate themselves from positive influences, have a capability for violence and typically access violent materials."
Kim et al. (2012). "Usefulness of Aggressive Behaviour Risk Assessment Tool for prospectively identifying violent patients in medical and surgical units." Journal of Advanced Nursing 68(2): 349-357.
Excerpt: "The sensitivity and specificity at the cut-off score of 1 were 70.9% and 89.3%, respectively. The Cohen's Kappa for inter-rater reliability was 0.647.... The Aggressive Risk Assessment Tool is a simple, easy-to-use assessment tool with acceptable inter-rater reliability, sensitivity and specificity that may be useful for prospectively identifying violent patients in medical-surgical units."
Klepfisz, G., et al. (2016). "Understanding dynamic risk factors for violence." Psychology, Crime & Law 22(1-2): 124-137.
Excerpt:" Recent years have seen a consensus emerge regarding the dynamic risk factors that are associated with future violence. These risk factors are now routinely assessed in structured violence risk assessment instruments. They provide a focus for treatment in structured group programmes. However, relatively little attention has been paid to risk-related theoretical issues, whether these dynamic risk factors are causally related or simply correlates of violent offending, or the extent to which they change as a consequence of treatment. More challenging is the lack of evidence to suggest that changes in these dynamic risk factors actually result in reductions in violent offending. In this paper we consider the meaning of the term dynamic risk, arguing that only those factors that, when changed, reduce the likelihood of violent recidivism, can be considered to be truly dynamic. We conclude that few of the violence risk factors commonly regarded as dynamic fulfil this requirement."
Kocak, M. (2012). "Threat assessment of terrorist organizations: The application of Q methodology." Journal of Risk Research 15(1): 85-105.
Excerpt: "The analysis has produced quantitative assessments (factor scores) for five types of terrorist organizations: ethno-separatist, provocative religious, intimidator religious, self-conscious religious, and communist. Factor scores, in this study, have been used to measure these types' characteristics and eventually have served to assess their threats, in the eyes of Turkish counterterrorism professionals."
Large et al. (2012). "Minority report on violence risk assessment." The Psychiatrist 36(1): 36.
Excerpt: "The false positive rate is a major problem with violence risk assessment in psychiatry and for mental health legislation that requires judgments about future harm. False positives waste resources, and lead to needless and unfair detention and excessive treatment. Moreover, there is no evidence that the application of risk assessment can offer adequate protection to the public. Risk assessment, as it is currently practiced in psychiatry, is so flawed that it should not be used as the basis for clinical decision-making or coercive treatment. Instead, treatment decisions should be made as they are in the rest of medicine, after discussing the risks and benefits of treatment with the patient or, in the case of those who lack capacity, be made in the patient's best interests, after discussion with a proxy decision maker."
Lewis, K., et al. (2013). "The Violence Risk Scale: Predictive validity and linking changes in risk with violent recidivism in a sample of high-risk offenders with psychopathic traits." Assessment 20(2): 150-164.
Excerpt: "The Violence Risk Scale (VRS) uses ratings of static and dynamic risk predictors to assess violence risk, identify targets for treatment, and assess changes in risk following treatment…. VRS scores significantly predicted violent recidivism. Measurements of risk reduction using dynamic VRS predictors were significantly correlated with reduction of violent recidivism after controlling for various potential confounds. The results suggest that, in a high-risk group of offenders with significant psychopathic traits, the VRS demonstrated predictive validity and the dynamic predictors can be used to assess treatment progress, which is linked to a specific criterion variable, thus, fulfilling the criteria for causal dynamic predictors set forth by Kraemer et al."
Lofthouse, R. E., et al. (2014). "How do static and dynamic risk factors work together to predict violent behaviour among offenders with an intellectual disability?" Journal of Intellectual Disability Research 58(2): 125-133.
Excerpt: "Research on risk assessment with offenders with an intellectual disability (ID) has largely focused on estimating the predictive accuracy of static or dynamic risk assessments, or a comparison of the two approaches. The aim of this study was to explore how static and dynamic risk variables may 'work together' to predict violent behaviour.... Static risk factors temporally preceded dynamic ones, and were shown to dominate both dynamic measures, while there was a non-zero relationship between the static and the two dynamic measures.... Dynamic and static risk factors appear to capture elements of the same underlying risk associated with violent behaviour in individuals with an ID."
Meloy et al. (2012). "The role of warning behaviors in threat assessment: An exploration and suggested typology." Behavioral Sciences & the Law 30(3): 256-279.
Excerpt: "A typology of eight warning behaviors for assessing the threat of intended violence is proposed: pathway, fixation, identification, novel aggression, energy burst, leakage, directly communicated threat, and last resort warning behaviors.
Meloy, J. R., et al. (2013). "Workplace assessment of targeted violence risk: The development and reliability of the WAVR-21." Journal of Forensic Sciences 58(5): 1353-1358.
Excerpt: "A subgroup of psychologists who were coders produced an ICC of 0.76 for overall presence of risk factors. Some of the individual items had poor reliability for both clinical and statistical reasons. The WAVR-21 appears to improve the structuring and organizing of empirically based risk-relevant data and may enhance communication and decision making."
Messing, J. T., et al. (2017). "The lethality screen: The predictive validity of an intimate partner violence risk assessment for use by first responders." Journal of Interpersonal Violence 32(2): 205-226.
Excerpt: "These analyses provide evidence that the Lethality Screen has considerable sensitivity (92%-93%) and a high negative predictive value (93%-96%) for near lethal and severe violence. However, specificity was low (21%). The Lethality Screen also has good agreement with the DA and IPV survivors' perception of risk. The high sensitivity and low specificity should be considered carefully when determining whether the Lethality Screen is appropriate for particular areas of practice with IPV survivors and/or perpetrators."
Miller et al. (2012). "Reliability of risk assessment measures used in sexually violent predator proceedings." Psychological Assessment 24(4): 944-953.
Excerpt: "The field interrater reliability of three assessment tools frequently used by mental health professionals when evaluating sex offenders' risk for reoffending—the Psychopathy Checklist–Revised (PCL-R), the Minnesota Sex Offender Screening Tool–Revised (MnSOST-R) and the Static-99—was examined within the context of sexually violent predator program proceedings. Rater agreement was highest for the Static-99 (intraclass correlation coefficient [ICC?] = .78) and lowest for the PCL-R (ICC? = .60; MnSOST-R ICC? = .74), although all instruments demonstrated lower field reliability than that reported in their test manuals. Findings raise concerns about the reliability of risk assessment tools that are used to inform judgments of risk in high-stake sexually violent predator proceedings."
Mills, J. F. and A. L. Gray (2013). "Two-tiered violence risk estimates: A validation study of an integrated-actuarial risk assessment instrument." Psychological Services 10(4): 361-371.
Excerpt: "Results show the [Two-Tiered Violence Risk Estimates instrument (TTV)] to be highly correlated with the HCR-20 and LCSF. The base rate for violence over the follow-up period was 47.4%, and the TTV was equally predictive of violent recidivism relative to the HCR-20 and LCSF."
Mills, J. F. (2017). "Violence risk assessment: A brief review, current issues, and future directions." Canadian Psychology/Psychologie canadienne 58(1): 40-49.
Excerpt: "A little over 11 years ago, I was invited to look forward and anticipate what areas in violence risk assessment would see more study (Mills, 2005). The areas identified at that time related to (a) increased clarity on the similarities and differences between structured professional judgment and actuarial approaches to risk assessment and the associated implications, (b) advancing our understanding of risk communication and risk management, (c) including dynamic change in actuarial risk assessment, and (d) the need to recalibrate frequently used risk appraisal instruments. This brief look back at my looking forward includes what we have learned from meta-analytic studies and that a review of the progress in the 4 areas identified above lead directly or indirectly to the need for a much greater understanding in the area of criminal justice risk communication. In matters of risk communication, we need to be clear in what we say and we need to understand how it will be perceived and employed by those who hear that message."
Neufeld et al. (2012). "Predicting Inpatient Aggression Using the InterRAI Risk of Harm to Others Clinical Assessment Protocol : A Tool for Risk Assessment and Care Planning." J Behav Health Serv Res 39(4): 472-480.
Excerpt: "Approximately 10% of inpatients were at moderate risk of harm to others, and 2% were considered high risk. The pattern of survival curves revealed that within the first month of admission, approximately 10% of inpatients at high risk of harm to others displayed physical aggression. Patients at high risk were also two times more likely to display physical aggression."
Nichols-Hadeed et al. (2012). "Assessing Danger: What Judges Need To Know." Family Court Review 50(1): 150-158.
Excerpt: "Findings suggest judges are inadequately prepared to render decisions to improve victim safety in the absence of standardized risk assessments. The Danger Assessment provides an evidence-based solution to routinize intake interviews with victims petitioning the court."
O'Shea, L. E., et al. (2016). "Predictive validity of the HCR-20 for violent and non-violent sexual behaviour in a secure mental health service." Criminal Behaviour and Mental Health 26(5): 366-379.
Excerpt: "HCR-20 total score, clinical and risk management subscales, predicted violent and non-violent sexual behaviour. The negative predictive value of the HCR-20 for inappropriate sexual behaviour was over 90%."
Perillo, A. D., et al. (2014). "Examining the scope of questionable diagnostic reliability in Sexually Violent Predator (SVP) evaluations." International Journal of Law and Psychiatry 37(2): 190-197.
Excerpt: "Research has suggested questionable reliability of diagnosing mental abnormality during Sexually Violent Predator (SVP) evaluations, despite this being a necessary requirement for SVP commitment.... The current study includes data from 375 sex offenders referred for evaluation for SVP commitment in New Jersey. Clinicians...rendered a variety of diagnoses,most commonly Pedophilia. Results suggested questionable agreement across paraphilic and non-paraphilic diagnoses, although agreement was fair for diagnoses of Pedophilia.... Findings suggest questionable diagnostic reliability to be a widespread issue in SVP evaluations, present across a variety of diagnoses and across the general body of clinicians involved in evaluations."
Rettenberger, M. and R. Eher (2013). "Actuarial risk assessment in sexually motivated intimate-partner violence." Law and Human Behavior 37(2): 75-86.
Excerpt: "Both instruments showed evidence for their reliability and predictive accuracy, supporting the cross-cultural transferability of these risk assessment instruments. For the prediction of domestic violence recidivism, [Ontario Domestic Assault Risk Assessment (ODARA)] and [Domestic Violence Risk Appraisal Guide (DVRAG)] yield good predictive accuracy (area under the receiver operating characteristic curve, AUC = .71), and for general criminal and general violent recidivism, both instruments exhibit moderate effect sizes (AUC = .66–.71). Also, the results provide evidence for the discriminant validity of the ODARA. When examining the association between individual ODARA items and recidivism, only a few items were found to be related to domestic violence recidivism. The integration of the Psychopathy Checklist–Revised (PCL-R) does not add any incremental predictive accuracy to the ODARA, suggesting that ODARA items capture antisocial and psychopathic traits sufficiently even in incarcerated high-risk offenders."
Rice, M. E., et al. (2013). "Validation of and Revision to the VRAG and SORAG: The Violence Risk Appraisal Guide—Revised (VRAG-R)." Psychological Assessment.
Excerpt: "we evaluated the accuracy of the VRAG in a sample of 1,261 offenders, fewer than half of whom were participants in the development sample, then developed and validated a revised and easier-to-score instrument (the VRAG-R). We examined the accuracy of both instruments over fixed durations of opportunity ranging from 6 months to 49 years and examined outcome measures pertaining to the overall number, severity, and imminence of violent recidivism. Both instruments were found to predict dichotomous violent recidivism overall and at various fixed follow-ups with high levels of predictive accuracy (receiver operating characteristic areas of approximately .75) and to significantly predict other violent outcomes."
Roaldset et al. (2012). "A multifaceted model for risk assessment of violent behaviour in acutely admitted psychiatric patients." Psychiatry Research.
Excerpt: "A recent study indicated that both low total cholesterol (TC) and the patients' own estimates about their risk of future violent behaviour, the Self-report Risk Scale (SRS), significantly predicted violent behaviour during hospital stay and the first 3 months after discharge from an acute psychiatric department. Our aim was to investigate whether combining three methods, a screening instrument for risk of violence (V-RISK-10), low TC and the SRS, into one multifaceted risk assessment model may enhance predictive validity.... Low TC, SRS and V-RISK-10 at admission were prospectively compared with recorded violence during hospital stay and the first 3 months after discharge. The multifaceted risk assessment model yielded a significant increase in explained variance beyond that of the V-RISK-10. AUC values were higher, but differences were not significant."
Rosenfeld, B., et al. (2017). "Determining When to Conduct a Violence Risk Assessment: Development and Initial Validation of the Fordham Risk Screening Tool (FRST)." Law and Human Behavior [online prior to print publication]
Excerpt: "The FRST showed a high degree of sensitivity (93%) in identifying patients subsequently deemed to be at high risk for violence (based on the Case Prioritization risk rating). The FRST also identified all of the patients (100%) rated high in potential for severe violence (based on the Serious Physical Harm Historical Clinical Risk Management-20, version 3, summary risk rating). Sensitivity was more modest when individuals rated as moderate risk were included as the criterion (rather than only those identified as high risk). Specificity was also moderate, screening out approximately half of all participants as not needing further risk assessment."
Roychowdhury, A. and G. Adshead (2014). "Violence risk assessment as a medical intervention: ethical tensions." The Psychiatric Bulletin 38(2): 75-82.
Excerpt: "Risk assessment differs from other medical interventions in that the welfare of the patient is not the immediate object of the intervention. However, improving the risk assessment process may reduce the chance of risk assessment itself being unjust."
Scurich & John (2012). "Prescriptive approaches to communicating the risk of violence in actuarial risk assessment." Psychology, Public Policy, and Law 18(1): 50-78.
Excerpt: "This article describes the substantive considerations before examining whether it is within the purview of expert witnesses to amalgamate the various components into a finalistic risk estimate. Based on existing commentary about the appropriate scope of mental health expert testimony, three approaches to communicating actuarial risk estimates are described and appraised. These approaches are as follows: describing risk factors and their relation to violence; describing the risk of an individual; and describing the risk of an individual in categorical terms. Ultimately, the most appropriate form to communicate actuarial estimates depends on the proper scope of expert testimony, the issue to be addressed, and to some degree the context in which such testimony is proffered."
Scurich et al. (2012). "Innumeracy and unpacking: Bridging the nomothetic/idiographic divide in violence risk assessment." Law and Human Behavior 36(6): 548-554.
Excerpt: "This study examines the related...question: 'When do people apply group-level risk estimates to the individual case?' We manipulated whether an actuarial risk estimate is 'unpacked'; that is, whether the risk factors on which the estimate is based are articulated. Our findings indicate that the degree of unpacking (e.g., listing six vs. three risk factors) increased the likelihood that jury-eligible citizens will apply an actuarial risk estimate in their decision to civilly commit a particular respondent. Unpacking also increased the perceived relevance of the group-level risk estimate to the individual case."
Shepherd, S. M. (2016). "Violence risk instruments may be culturally unsafe for use with indigenous patients." Australasian Psychiatry 24(6): 565-567.
Excerpt: "To realize equitable forensic assessment, it is necessary to ascertain whether there are cultural differences across risk factors for violence and that risk instruments are validated as culturally appropriate. Greater cross-cultural rigour in forensic mental health risk assessment, research and practice [is needed]."
Sinclair et al. (2012). "The Suicide (SPI) and Violence Potential indices (VPI) from the Personality Assessment Inventory: A preliminary exploration of validity in an outpatient psychiatric sample." Journal of Psychopathology and Behavioral Assessment 34(3): 423-431.
Excerpt: "Results generally supported the convergent and divergent validity of both SPI and VPI when evaluating groups with and without a history of suicide and violence risk, and effect sizes were moderate to large even after controlling for other covariates.... Consistent with prior research, SPI and VPI were found to be significantly elevated in groups demonstrating executive dysfunction."
Singh, J. P., et al. (2013). "Authorship bias in violence risk assessment? A systematic review and meta-analysis." PLoS ONE 8(9).
Excerpt: "We found a substantial and statistically significant authorship effect. Overall, studies authored by tool designers reported predictive validity findings around two times higher those of investigations reported by independent authors [emphasis added by Ken Pope] (DOR = 6.22 [95% CI = 4.68–8.26] in designers' studies vs. DOR = 3.08 [95% CI = 2.45–3.88] in independent studies). As there was evidence of an authorship effect, we also examined disclosure rates. None of the 25 studies where tool designers or translators were also study authors published a conflict of interest statement to that effect, despite a number of journals requiring that potential conflicts be disclosed."
Skeem, J. L., et al. (2013). "The utility of patients' self-perceptions of violence risk: Consider asking the person who may know best." Psychiatric Services 64(5): 410-415.
Excerpt: "Patients' self-perceptions of risk performed quite well in predicting serious violence (area under the curve [AUC] = .74, sensitivity = 50%), particularly compared with the ICT-CF (AUC = .59, sensitivity = 40%) and the MST (AUC = .66, sensitivity = 30%). Self-perceived risk also added significant incremental utility to these tools in predicting violence….. Patients' self-perceptions hold promise as a method for improving risk assessment in routine clinical settings. Assuming it replicates and generalizes beyond the research context, this finding encourages a shift away from unaided clinical judgment toward a feasible method of risk assessment built on patient collaboration."
Snook et al. (2012). "The Violent Crime Linkage Analysis System: A test of interrater reliability." Criminal Justice and Behavior 39(5): 607-619.
Excerpt: "The interrater reliability of an internationally renowned crime linkage system—the Violent Crime Linkage Analysis System (ViCLAS)—was tested.... Results showed a 30.77% level of agreement across the 106 variables examined. Agreement ranged from 2.36% for weapon variables to 62.87% for administration variables. Only 11 (10.38%) of the variables reached an acceptable level of agreement."
Sowden, J. N. and M. E. Olver (2017). "Use of the Violence Risk Scale—Sexual Offender Version and the Stable 2007 to assess dynamic sexual violence risk in a sample of treated sexual offenders." Psychological Assessment 29(3): 293-303.
Excerpt: "VRS-SO pre- and posttreatment dynamic scores demonstrated significant predictive accuracy for sexual, nonsexual violent, any violent (including sexual), and general recidivism, while Stable-2007 pre- and posttreatment scores were significantly associated with the latter 3 outcomes; these associations were maintained after controlling for the Static-99R (Helmus, Thornton, Hanson, & Babchishin, 2012). Finally, significant pre-post differences, amounting to approximately three quarters of a standard deviation, were found on Stable-2007 and VRS-SO scores. VRS-SO change scores were significantly associated with reductions in nonsexual violent, any violent, and general recidivism (but not sexual recidivism) after controlling for baseline risk or pretreatment score, while Stable-2007 change scores did not significantly predict reductions in any recidivism outcomes."
Stanley, N. and C. Humphreys (2014). "Multi-agency risk assessment and management for children and families experiencing domestic violence." Children and Youth Services Review 47(Part 1): 78-85.
Excerpt: "Four key themes structure our analysis of the challenges of risk assessment and management in this field: the question of who is the primary client and the focus of risk assessment; the issue of how the information to inform risk assessment is organised, including how it is collected, the tools that are employed, and the context in which information is collected; the position of the child, mother and father and whether risk is assessed and managed with them or to them; and the relationship between risk assessment and risk management, specifically whether risk management is restricted to families where levels of danger are identified as high or whether there are opportunities for support and safety planning for families where the risk is assessed as low."
Stansfield, R. and K. R. Williams (2014). "Predicting family violence recidivism using the DVSI-R: Integrating survival analysis and perpetrator characteristics." Criminal Justice and Behavior 41(2): 163-180.
Excerpt: "Survival analyses identified critical times after intake assessments when those who reoffended were at greatest risk and significant differences in timing of reoffending by gender and ethnicity."
Stockdale, K. C., et al. (2014). "The validity and reliability of the Violence Risk Scale–Youth Version in a diverse sample of violent young offenders." Criminal Justice and Behavior 41(1): 114-138.
Excerpt: "The Violence Risk Scale–Youth Version (VRS-YV; S. Wong, Lewis, Stockdale, & Gordon, 2004-2011) is a risk assessment and treatment planning tool for youths designed to assess violence risk, identify dynamic risk factors or treatment targets, and evaluate changes in risk from treatment or other change agents.... Exploratory factor analysis (EFA) identified three factors: Interpersonal Aggression, Antisocial Tendencies, and Family Problems. VRS-YV static, dynamic, and total scores significantly predicted violent and general recidivism, including youth and adult outcomes, with moderate to high accuracy (area under the curve [AUC] = .65-.77); however, results varied among ethnic/cultural, gender, and developmental subgroups. The VRS-YV also demonstrated strong convergent validity with two well-established youth forensic assessment tools."
Storey, J. E., et al. (2014). "Assessment and management of risk for intimate partner violence by police officers using the brief spousal assault form for the evaluation of risk." Criminal Justice and Behavior 41(2): 256-271.
Excerpt: "Total scores and overall risk ratings predicted recidivism (AUC [Area under the curve] = .70 and .69, respectively).... [A] pattern where management recommendations were associated with decreased recidivism in high risk perpetrators but increased recidivism in low risk perpetrators was found. Results validate the use of the B-SAFER by police and reveal mostly comparable findings between the B-SAFER and the Spousal Assault Risk Assessment Guide, as examined by Belfrage et al., but suggest that the B-SAFER may be better suited for police."
Storey, J. E. and S. Strand (2013). "Assessing violence risk among female IPV perpetrators: An examination of the B-SAFER." Journal of Aggression, Maltreatment & Trauma 22(9): 964-980.
Excerpt: "When compared to Belfrage and Strand (2008), who examined men arrested for IPV in the same sample, women possessed fewer risk factors. Risk factors were related to summary risk judgments, although differences existed between genders and risk judgments were not related to management recommendations. Results suggest that risk factors, in addition to those in the B-SAFER, are required to assess risk for female IPV."
Strub, D. S., et al. (2016). "Violence risk assessment of civil psychiatric patients with the HCR-20: Does gender matter?" The International Journal of Forensic Mental Health 15(1): 81-96.
Excerpt: "Results indicated that the HCR-20 as well as its components predicted both the occurrence and imminence of violent outcomes and gender did not moderate those relationships. Exploratory analyses revealed gender differences in the baseline item and scale ratings. Additionally, the HCR-20 demonstrated an association with violent victimization."
Sutherland et al. (2012). "Sexual violence risk assessment: An investigation of the interrater reliability of professional judgments made using the risk for sexual violence protocol." The International Journal of Forensic Mental Health 11(2): 119-133.
Excerpt: "There was a good level of interrater reliability on Summary Judgments and Supervision Recommendations. Interrater reliability was highest when used by professionals who were highly trained in forensic risk assessment. On average, professionals with lower levels of specialist training agreed less with their colleagues and experts, and provided higher estimations of sexual violence risk. Lower levels of agreement were found in cases with moderate levels of complexity and risk. The RSVP can be used to make judgments of risk with adequate levels of interrater reliability. However, this is dependent on the training and expertise of professionals who use the tool.
Szmukler, G. (2012). "Risk assessment for suicide and violence is of extremely limited value in general psychiatric practice." Australian and New Zealand Journal of Psychiatry 46(2): 173-174.
Excerpt: "Rare events, such as suicide or serious violence, no matter how tragic they are or how much our society wishes us to prevent them are impossible to predict with a degree of accuracy that is clinically meaningful. In fact, using probably the best ever result for a risk instrument under research conditions, the percentage of high-risk patients who will commit an act of serious violence would be 3% for an incidence of violence of 1% in that population of patients."
Tapp, J. and E. Moore (2016). "Risk assessments for dating violence in mid to late adolescence and early adulthood." Criminal Behaviour and Mental Health 26(4): 278-292.
Excerpt: "Drawing on this evidence, we conclude that young people appear to be at greater risk of encountering dating violence if they have experienced violence in earlier attachment relationships; if their skills for coping with conflict and responding to coercion are limited and if the presence of peer influences reinforces offence supportive attitudes. The reliability and validity of existing intimate partner violence risk assessments that conceptually overlap with elements of dating violence risk warrant investigation to inform risk assessment developments in this field and, building on this, possible interventions to minimise future harm."
Tishler, Carl L.; Reiss, Natalie S.; Dundas, John. (2013). " The assessment and management of the violent patient in critical hospital settings." General Hospital Psychiatry, vol. 35, #2, 181-185.
Excerpt: Violence assessment and management topics should be included in trainings and continuing education for new and experienced ED clinicians. Didactic trainings should highlight different techniques for assessing and responding to violent behavior. Clinicians should practice multiple techniques in order to feel comfortable switching strategies in their 'treatment toolbox.' Since most clinicians fall back on familiar skills, it is especially important to design trainings where participants practice responses that expand their comfort zones."
Ullrich, S., et al. (2014). "Delusions, anger, and serious violence: New findings from the MacArthur Violence Risk Assessment Study." Schizophrenia Bulletin 40(5): 1174-1181.
Excert: "A 'prospective' model confirmed previous findings that delusions do not predict later violence. However, reanalysis, considering temporal proximity, indicated a relationship between specific delusions and outcome including: being spied upon..., being followed ..., being plotted against..., being under control of person/force..., thought insertion..., and having special gifts/powers.... All these delusions were associated with angry affect.... Inclusion of anger in the model significantly attenuated the main effects (except grandiose delusions), indicating an indirect pathway.... Temporal proximity is crucial when investigating relationships between delusions and violence. Anger due to delusions is the key factor in this pathway."
Viljoen, J. L., et al. (2018). "Do risk assessment tools help manage and reduce risk of violence and reoffending? A systematic review." Law and Human Behavior 42(3): 181-214.
Excerpt: "Although it is widely believed that risk assessment tools can help manage risk of violence and offending, it is unclear what evidence exists to support this view. As such, we conducted a systematic review and narrative synthesis. To identify studies, we searched 13 databases, reviewed reference lists, and contacted experts. Through this review, we identified 73 published and unpublished studies (N = 31,551 psychiatric patients and offenders, N = 10,002 professionals) that examined either professionals' risk management efforts following the use of a tool, or rates of violence or offending following the implementation of a tool. These studies included a variety of populations (e.g., adults, adolescents), tools, and study designs. The primary findings were as follows: (a) despite some promising findings, professionals do not consistently adhere to tools or apply them to guide their risk management efforts; (b) following the use of a tool, match to the risk principle is moderate and match to the needs principle is limited, as many needs remained unaddressed; (c) there is insufficient evidence to conclude that tools directly reduce violence or reoffending, as findings are mixed; and (d) tools appear to have a more beneficial impact on risk management when agencies use careful implementation procedures and provide staff with training and guidelines related to risk management. In sum, although risk assessment tools may be an important starting point, they do not guarantee effective treatment or risk management. However, certain strategies may bolster their utility."
Warren, J. I., et al. (2018). "Gender and violence risk assessment in prisons." Psychological Services 15(4): 543-552.
Excerpt: "Our study examines the association between Historical, Clinical, Risk Management-20: Version 2; Psychopathy Checklist–Revised; and Violence Risk Assessment Guide scores and violence perpetrated during incarceration by male and female inmates. Using a sample of 288 men and 183 women selected from prisons in 2 states, we used receiver operating characteristics analyses to assess the potential of these 3 measures to predict threatened, physical, or sexual prison violence measured in 2 ways: inmate self-report and formal institutional infractions. We found all 3 instruments to demonstrate moderate to good levels of predictive accuracy for both the male and female inmates, a finding that suggests that actuarial, structured professional judgment and personality measures perform in a broadly comparable manner in assessing institutional violence for both men and women. Our findings did vary on the basis of the way violence was measured: Women self-reported significantly higher levels of prison violence than was suggested by their institutional infractions, and the associative power of the instruments diminished substantially, particularly among the men, when institutional infractions alone were used in the analyses. These findings suggest that the 3 risk measures are likely to be gender neutral in their association with prison violence, albeit with gender-related differences in the frequency of violent behavior and the relevance of particular subscales."
Watt, K. A., et al. (2018). "Violence risk identification, assessment, and management practices in inpatient psychiatry." Journal of Threat Assessment and Management 5(3): 155-172.
Excerpt: "The analysis revealed limited use of formal identification and assessment instruments for violence and diversity with respect to strategies used to manage violence. These findings have implications for highlighting promising practices that are currently being used, and identifying potential areas for future improvement.
Williams, K. R. (2012). "Family violence risk assessment: A predictive cross-validation study of the Domestic Violence Screening Instrument-Revised (DVSI-R)." Law and Human Behavior 36(2): 120-129.
Excerpt: "This research was a cross-validation study of the Domestic Violence Screening Instrument-Revised (DVSI-R), using a diverse, statewide sample of 3,569 family violence perpetrators in Connecticut.... Three issues were central, which have been ignored in previous research on family violence risk assessment: (1) analyzing five refined measures of behavioral recidivism, (2) determining whether perpetrator characteristics and types of family and household relationships (beyond just heterosexual intimate partners) moderate the empirical relations between the DVSI-R and the behavioral recidivism measures, and (3) determining whether structured clinical judgment about the imminent risk of future violence to the victim or to others corresponds with recidivism predicted by the DVSI-R total numeric risk scores. The empirical findings showed that the DVSI-R had significant predictive accuracy across all five measures of recidivism. With one exception, these relations did not vary by gender, age, or ethnicity; and again with one exception, no significant evidence was found that types of family or household relationships moderated those empirical relations. In short, the evidence suggested that the DVSI-R was a robust risk assessment instrument, having applicability across different types of perpetrators and different types of family and household relationships."
Wilson, C. M., et al. (2013). "Predictive Validity of Dynamic Factors: Assessing Violence Risk in Forensic Psychiatric Inpatients." Law and Human Behavior.
Excerpt: "Results of event history analyses demonstrated that changes in dynamic risk factors significantly predicted institutional violence, even after controlling for static risk factors."
Wong et al. (2012). "Quality of resident violence risk assessments in psychiatric emergency settings." The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie 57(6): 375-380.
Excerpt: "Psychiatric residents identify significantly fewer risk factors for violence than staff psychiatrists. Resident performance was correlated with increasing experience and education. It was not related to self-confidence in performing this task."
Yao et al. (2012). "The application of a violence risk assessment tool among Chinese psychiatric service users: A preliminary study." Journal of Psychiatric and Mental Health Nursing 19(5): 438-445.
Excerpt: " The Violence Risk Screening-10 (V-RISK-10) is one of the few instruments available for evaluating violence risk among general psychiatric service users.... Compared to the results of the original V-RISK-10, its predictive accuracy was lower. However, with some modification, the V-RISK-10 still shows promise as an instrument for use in daily practice in Chinese clinical settings."