Predicting aggression in acute inpatient psychiatric setting using BVC, DASA, and HCR-20 Clinical scale

Abstract

The assessment and prevention of aggressive behavior are critical components of contemporary psychiatric inpatient care, treatment, and management. This prospective study compared the predictive validity of three dynamic violence risk assessment measures (i.e. Brøset Violence Checklist (BVC), Dynamic Appraisal of Situational Aggression (DASA), and HCR-20 Clinical scale) for imminent aggression (within the next 24 h). The DASA and BVC were developed specifically to assess imminent violence within psychiatric hospitals, whereas the HCR-20 is a ‘general’ violence risk assessment measure that can also be used for this purpose. Daily risk ratings were completed for 70 psychiatric inpatients; a total of 3449 ratings for each risk assessment measure were obtained. Results showed that the DASA and BVC were acceptable to outstanding predictive validity and were more accurate than the HCR-20 Clinical scale for predicting inpatient aggression. Actuarial and structured professional ratings were similar for the prediction of verbal threats, but actuarial ratings were more accurate for predicting interpersonal violence. Overall, these findings support the use of structured dynamic risk assessment measures to aid in the prediction of imminent aggression within inpatient psychiatric settings.