Psychiatric symptoms and community violence among high-risk patients: A test of the relationship at the weekly level

Jennifer L. Skeem, University of Nevada
Carol A. Schubert, University of Pittsburgh
Candice L. Odgers, University of Virginia
Edward P. Mulvey, University of Pittsburgh
William P. Gardner, University of Pittsburgh
Charles W. Lidz, University of Massachusetts Medical School

Abstract

Given the availability of violence risk assessment tools, clinicians are now better able to identify high-risk patients. Once these patients have been identified, clinicians must monitor risk state and intervene when necessary to prevent harm. Clinical practice is dominated by the assumption that increases in psychiatric symptoms elevate risk of imminent violence. This intensive study of patients (N = 132) at high risk for community violence is the first to evaluate prospectively the temporal relation between symptoms and violence. Symptoms were assessed with the Brief Symptom Inventory and threat/control override (TCO) scales. Results indicate that a high-risk patient with increased anger in 1 week is significantly more likely to be involved in serious violence in the following week. This was not true of other symptom constellations (anxiety, depression, TCO) or general psychological distress. The authors found no evidence that increases in the latter symptoms during 1 week provide an independent foundation for expecting violence during the following week.