Factors associated with dangerous behavior in forensic inpatients: results from a pilot
E. M. Ball, D. Young, L. A. Dotson, L. T. Brothers and D. Robbins,
Bull. Amer. Acad. Psychiatry & the Law
22(4): 605-20, 1994.
This study was designed to identify risk factors associated with violence within a forensic inpatient
hospital setting. The primary purpose was to develop a screening tool to aid in the rapid
identification of patients requiring high versus low security ward placement. Subjects included 232
consecutive admissions during a five-month period to a 300-bed forensic division within a
public-sector psychiatric hospital. Demographic, historical, and current clinical variables were
collected, and dangerous behaviors were documented by nursing staff on a daily basis. The
associations between dangerous outcomes and various risk factors were examined using chi-square
or t tests, as appropriate. Stepwise logistic regression analysis was performed to assess the
contribution of each risk factor significantly associated with violent behavior. A strong association
was found between 10 risk factors and the incidence of violence in our forensic population. These
factors included current clinical factors (grossly inappropriate behavior observed on the ward, an
assessment of current escape risk); historical factors (psychiatric hospitalization history, criminal
history variables, and a self-report of prior violence); and one demographic variable (length of stay).
Of the 10 risk factors then included in the stepwise regression analysis, four contributed significantly
to the final predictive model. Grossly inappropriate behavior, patient self-report of prior violence,
history of psychiatric hospitalization, and a history of 10 or more prior psychiatric hospitalizations
were most predictive of a violent outcome. Although situational and environmental variables also
must be incorporated into final assessments and decisions, the identified significant variables can
provide an additional tool in the rapid assessment of violence potential.