The Reliability And Validity Of The Historical, Clinical,Risk Management-Chinese Version And Its Applications

Objectives:1. To examine the reliability and validity of the Chinese Version of the Historic Clinical Risk management (HCR-CV) in Chinese male inpatients with schizophrenia.2. To evaluate its applicability on risk assessment of male inpatients with schizophrenia and mentally ill offenders in prison hospital.3. To investigate the violence predictive validity of the HCR-CV and to ascertain the risk factors of violent behavior in inpatients with schizophrenia and mentally ill offenders in prison hospital.Methods:1. One hundred and fifty six schizophrenic inpatients recruited from Nanjing Brain Hospital, and all subjects participated in the retest reliability assessment after2weeks. Twelve schizophrenic inpatients participated in the inter-ratter reliability assessed by two psychiatrists. Reliability was evaluated by Cronbach’s a coefficients, interrater reliability, item-subscale correlations and test-retest reliability, while validity was assessed by constructural validity, concurrent validity, predictive validity, and correlations between scores of PCL-R and MOAS.2. One hundred and fifty six schizophrenic inpatients from Nanjing Brain Hospital and89mentally ill offenders in prison hospital were assessed by the HCR-CV, Psychopathic Checklist-Revised (PCL-R), Barratt Impulsivity Scale, Version-11(BIS-11), Modified Overt Aggression Scale(MOAS), Positive And Negative Syndrome Scale(PANSS), and Self-rating Depression Scale(SDS). The same instruments were used for the inpatients with schizophrenia after2weeks and4weeks of admission. Mentally ill offenders in prison hospital completed MOAS only followed up4weeks after the first interview.3. The definition of violence in the current study is based on the scores of MOAS. Non-aggression is zero of total score of the scale. Aggression is only verbal aggression subscale’s score higher than1. Violence is any of the other three subscales scored higher than1("aggression against property","autoaggression" or "aggression towards others"). All individuals in violent group had committed at least one act of physical violent behavior, such as throwing an object, harming themselves or attacking others. Non-violent group included non-aggressive and only verb aggressive group. Descriptive statistics, t test, variance analysis, correlation, ROC and LOGISTIC regression analysis were used in data analysis.Results:1. The reliability and validity of19-item HCR-CV that deleted the item of "PCL-R", did not change significantly. The new item "the early deviant family environment" added in the original version was also deleted, because it did not correlate significantly to violence in this study. The Cronbach’s a coefficients of the new HCR-CV ranged from.584～.775; interrater consistency coefficients ranged from.820～.965; the test-retest reliability coefficients ranged from.523～.953; the correlation coefficient between items and factors ranged from.264～.836; AUC of total score and subscale scores ranged from.600～.732, the AUC of total score of HCR-CV was.721, cut-off was21, and sensitivity and specificity were60.00%,77.30%respectively, correctly classification was75.64%. AUC of historic subscale score was.732, cut-off was10, and sensitivity and specificity were53.33%,90.07%respectively, correctly classification was86.54%. Discrimination validity:All total score and subscale scores of HCR-CV were significantly different between violent group and non-violent group. Criterion-related validity:All total score and subscale scores of HCR-CV were related with scores of MOAS and PCL-R significantly.2. The incidence of verbal aggression, physical aggression against objects, physical aggression against self and physical aggression against others of inpatients with schizophrenia was68.6%,37.8%,19.9%and42.3%respectively at admission. The incidence went down of34.6%,3.8%,1.3%,6.4%respectively after2weeks follow-up, and droped to23.7%,2.1%,0%and3.1%respectively after4weeks follow-up. All patients were divided into violent group and non-violent group by MAOS total score. Violent group had the higher level of depression and excited hostility of PANSS (P<.05). LOGISTIC regression analyses were conducted to examine the risk factors of inpatients with schizophrenia, Odds Ratios (OR) of three factors were greater than1, including total score of HCR-CV (OR=1.330), history of suicide (5.567) and history of self-harm (3.083).3. In the first interview, the incidence of verbal aggression, physical aggression against objects, physical aggression against self and physical aggression against others of mentally ill offenders in prison hospital was69.7%,27.0%,32.6%and27.0%. The incidence droped to49.4%,28.1%,21.3%and16.9%respectively after4weeks follow-up. Violent group had the higher level of depression and excited hostility of PANSS (P<.05) than that of non-violent group. Total score of PCL-R (OR=1.176) and the history of violent behavior (OR=3.545) were the main risk factors of mentally ill offenders in prison hospital. The AUC of total score of HCR-CV was.621(JP>.05).Conclusions:1. The revised HCR-CV is an efficient and valid instrument for risk assessment in Chinese male inpatients with schizophrenia.2. Among male schizophrenic inpatients and mentally ill offenders, the verbal aggression and physical aggression were common in hospital.3. Depression and excited hostility of PANSS could be the risk factors of violence in male inpatients with schizophrenia and the mentally ill offenders in prison hospital.4. The revised HCR-CV showed good predictive validity for short-term risk assessment among male schizophrenic inpatients.