Biopsychosocial risk factors for intimate partner violence perpetration and victimization in adolescents and adults reported after the COVID-19 pandemic onset: a scoping review protocol

OBJECTIVE

This scoping review aims to provide a comprehensive summary of the biological, psychological, and sociological risk factors for intimate partner violence (IPV) victimization and perpetration reported after the onset of the COVID-19 pandemic.

INTRODUCTION

IPV is a significant public health concern, characterized by various forms of violence inflicted by intimate partners. The onset of the COVID-19 pandemic significantly increased the global prevalence of IPV. While prior research has identified factors linked to IPV, the risk factors reported in the literature during this period have not been systematically mapped. Additionally, the similarities and differences in risk factors between perpetration and victimization have not been well delineated.

INCLUSION CRITERIA

This review will focus on individuals aged 12 years or older involved in dyadic romantic relationships. Primary studies and systematic reviews published from the year 2020 will be included. Full-text papers, preprints, theses, and dissertations published in English will be included. Studies focusing on factors unrelated to IPV risk will be excluded. Non-systematic reviews, opinion pieces, and protocols will also be excluded.

METHODS

Following the JBI methodology for scoping reviews, systematic searches will be conducted for both peer-reviewed and gray literature. Independent reviewers will screen records, select eligible studies, and extract data using a standardized form. Key risk factors will be mapped to explore their interplay.

DETAILS OF THE REVIEW ARE AVAILABLE IN OPEN SCIENCE FRAMEWORK

https://osf.io/c2hkm.

Psychiatric inpatient services in Ontario, 2019-2021: a cross-sectional comparison of admissions, diagnoses and acuity during the COVID-19 prerestriction, restriction and postrestriction periods

BACKGROUND

The COVID-19 pandemic was associated with increased mental health problems in the general population, yet psychiatric hospital admissions decreased. Early evidence suggested that psychiatric admissions normalized within weeks; we sought to examine the longer-lasting impacts on the psychiatric inpatient population beyond this initial period.

METHODS

We compared Ontario Mental Health Reporting System admission data for patients admitted to 8 psychiatric hospitals in Ontario, Canada, between 3 time periods - before restrictions were imposed (June 22, 2019, to Mar. 16, 2020), during restrictions (Mar. 17 to June 21, 2020) and after restrictions were lifted (June 22, 2020, to Mar. 16, 2021) for changes in involuntary status, diagnoses and clinical presentation using descriptive analysis. For clinical presentation, we extracted scores on 4 Resident Assessment Instrument-Mental Health symptom scales (Depressive Severity Index, Cognitive Performance Scale, Positive Symptoms Scale-Long Version and Social Withdrawal Scale), and 2 behaviour scales (Aggressive Behavior Scale and Violence Sum).

RESULTS

A cross-sectional sample of 9848 patients was included in the analysis. The mean number of daily admissions decreased 19% from 16.4 (standard deviation [SD] 8.0) before the restriction period to 13.3 (SD 6.1) during the restriction period, and was still 6% below prerestriction levels after restrictions were lifted 15.4 (SD 6.8), with standard error difference of 1.03 (95% confidence interval -0.22 to 2.29). From the pre- to the postrestriction periods, the proportion of involuntary patients increased by 6 percentage points, and the proportions of patients diagnosed with a psychotic disorder or personality disorder increased by 4 percentage points and 1 percentage point, respectively.

INTERPRETATION

Psychiatric admissions did not fully return to prerestriction levels in absolute rates and patient acuity after COVID-19 restrictions were lifted. Psychiatric services must prepare to appraise and respond to any increased acuity through interventions for patients, workforce planning and mental health support for staff.

Adverse Childhood Experiences and Offending as a Function of Acquired Brain Injury Among Men in a High Secure Forensic Psychiatric Hospital

BACKGROUND

Acquired brain injury (ABI) is a serious problem that disproportionately affects individuals in correctional services, but relatively little is known about ABI risks and correlates in forensic psychiatric services.

METHODS

We conducted a retrospective chart review of all admissions to a high secure forensic hospital in Ontario, Canada from January 2009 to December 2012 (n = 637) and collected data on ABI, psychiatric diagnoses, developmental disadvantage, criminal offending, and in-hospital aggression. A k-means cluster analysis was employed to assess risk factors by which men with ABI could be identified and multivariate general linear models were used to identify ABI-related differences in offending history and in-hospital aggression.

RESULTS

One-fifth of the men had a documented ABI indicator. Based on our cluster analysis, ABI was more likely to be identified by greater adverse childhood experiences (ACEs), more health problems from pregnancy to childhood, and lower socioeconomic status, suggesting that ABI within the forensic context is associated with greater developmental disadvantage. Men with ABI had more serious pre-admission offences, but not more serious admission offences or in-hospital aggression. Men with ABI were more likely than those without to have higher scores on the Violence Risk Appraisal Guide or to be diagnosed with mood and personality disorders, and less likely to have a schizophrenia diagnosis, suggesting an association between ABI and general mental health pathologies but not with psychotic illness.

CONCLUSIONS

The disadvantage of ABI among men in forensic psychiatric hospitals is most likely evinced in antisocial behaviour rather than serious mental illness. Given that ACEs are likely to precede or co-occur with ABI, strategies that mitigate ACEs hold promise for ABI prevention.

Recent Developments in Islet Biology: A Review With Patient Perspectives

Navigating the coronavirus disease-2019 (COVID-19, now COVID) pandemic has required resilience and creativity worldwide. Despite early challenges to productivity, more than 2,000 peer-reviewed articles on islet biology were published in 2021. Herein, we highlight noteworthy advances in islet research between January 2021 and April 2022, focussing on 5 areas. First, we discuss new insights into the role of glucokinase, mitogen-activated protein kinase-kinase/extracellular signal-regulated kinase and mitochondrial function on insulin secretion from the pancreatic β cell, provided by new genetically modified mouse models and live imaging. We then discuss a new connection between lipid handling and improved insulin secretion in the context of glucotoxicity, focussing on fatty acid-binding protein 4 and fetuin-A. Advances in high-throughput "omic" analysis evolved to where one can generate more finely tuned genetic and molecular profiles within broad classifications of type 1 diabetes and type 2 diabetes. Next, we highlight breakthroughs in diabetes treatment using stem cell-derived β cells and innovative strategies to improve islet survival posttransplantation. Last, we update our understanding of the impact of severe acute respiratory syndrome-coronavirus-2 infection on pancreatic islet function and discuss current evidence regarding proposed links between COVID and new-onset diabetes. We address these breakthroughs in 2 settings: one for a scientific audience and the other for the public, particularly those living with or affected by diabetes. Bridging biomedical research in diabetes to the community living with or affected by diabetes, our partners living with type 1 diabetes or type 2 diabetes also provide their perspectives on these latest advances in islet biology.

Coping Strategies in Women and Children Living with Domestic Violence: Staying Alive

Purpose

Children exposed to domestic violence are at risk of adverse short- and long-term psychosocial effects and of being abused themselves. However, mothers and children face systemic gaps when seeking safety from domestic violence services and police. Safety planning typically focuses on women, overlooking their multiple social identities and excluding their children. We explored safety strategies used by mothers and children coping together with severe domestic violence.

Method

Interviews with 30 mothers who experienced severe or potentially life-threatening domestic violence and 5 adults who experienced domestic violence in childhood were qualitatively analyzed using thematic analysis, revealing five major themes: ongoing communication, appeasing the abuser, soothing activities, exposure reduction, and fostering independence.

Results

Interpreting participants' experiences in terms of the mother-child dyad, we found that mothers and their children worked together to reassure each other, keep each other safe, and make plans to leave their abuser.

Conclusions

Safety planning for the mother-child dyad could build on children's existing coping strategies and recognize and support children's desire to protect their mother and themselves effectively and safely according to their developmental stage.

Workplace stressors and PTSD among psychiatric workers: The mediating role of burnout

Critical workplace events (e.g., assaults), chronic stressors, burnout, and work conditions all affect nurse well-being. The present study investigated associations among these sources of stress and posttraumatic stress disorder (PTSD) symptoms in psychiatric nurses, hypothesizing that burnout would mediate the paths between workplace stressors and PTSD. Surveys were completed by 611 psychiatric nurses or allied health staff working on inpatient units in three psychiatric hospitals. Participants reported on critical events and chronic stressors specific to providing psychiatric care and completed the Maslach Burnout Inventory (MBI), Areas of Worklife Survey (AWS) (work conditions), and PTSD Checklist for DSM-5. Data were analysed using structural equation modelling. Burnout had a direct relation to PTSD symptoms and partially mediated the effect of exposure to critical events, but not chronic stressors, on PTSD symptoms. Chronic stressors related to patients' disturbing behaviour (e.g., flooding room, eating non-food items) had a direct effect on PTSD symptoms, but those related to resisting care (e.g., screaming constantly, physically resisting care) had no significant association. Worklife conditions had a negative direct effect on Burnout and indirect effect on PTSD, whereby participants reporting poorer alignment of work conditions with their expectations had higher Burnout and PTSD symptom scores. Different sources of workplace stress have different relations to PTSD symptoms, and Burnout has both direct and mediation effects. Interventions aimed at reducing patients' aggressive and disturbing acts and improving healthcare providers' burnout and worklife factors in hospitals may all be needed to reduce PTSD among psychiatric staff.

The influence of changes in clinical factors on high-security forensic custody dispositions

The demand for forensic psychiatric beds is increasing, while many individuals are "stuck" in the system. Index offense severity and other legal considerations are associated with longer forensic stays but factors amenable to change such as symptoms of mental illness and aggression may also influence forensic decisions. We examined forensic review board decisions over time among 89 men admitted to a high-security forensic hospital. Almost half received a disposition to remain at their first hearing. Overall, dispositions were not associated with violence risk. The odds of a disposition to remain were higher for men with more in-hospital assaults and higher scores on a measure of clinical factors. Dispositions changed over time and this change was sensitive to clinical factors. We conclude that decisions were consistent with a cascading system of loosening security over time. Further longitudinal research following large samples through the forensic system is recommended.

Privacy and safety: Issues of dual compliance in high-secure and other forensic psychiatric hospitals

Health care organizations are obligated to provide safe and effective treatment to their patients and also protect the safety of their workers. This paper analyzes the tensions arising from legislative regimes that, respectively, protect privacy and workplace safety, using a large, tertiary high-secure forensic psychiatric hospital in Ontario, Canada, as an example. In Ontario, the Personal Health Information Protection Act (PHIPA) prohibits personal health information (PHI) from being disclosed to individuals who fall outside the "circle of care," including nonclinical employees who have direct involvement with patients and may be at risk of violence. PHIPA permits the disclosure of information where there is a risk of violence, but the statute's scheme for privacy protection was not designed to address, and may not be compatible with, the operations and requirements of high-secure forensic and other psychiatric hospitals. At the same time, the Occupational Health and Safety Act (OHSA) creates a regulatory framework that sets health and safety standards, including an employer's duty to disclose the risk of violence. OHSA prosecutions and proceedings demonstrate how these duties have been enforced against psychiatric hospitals. We examine this regulatory backdrop, explaining that PHIPA provides little guidance to psychiatric hospitals, where the risk of violence is elevated. We also discuss issues of dual compliance that arise from a hospital's legal obligations under PHIPA and OHSA. Finally, we turn to the ongoing clinical and operational challenges, suggesting strategies for increasing staff safety. These include strengthening the therapeutic alliance and providing patients with the option of consenting to disclosure of PHI to those outside the circle of care.

Workplace violence and risk factors for PTSD among psychiatric nurses: Systematic review and directions for future research and practice

WHAT IS KNOWN ON THE SUBJECT?: Trauma among psychiatric nurses and other healthcare workers is related to workplace violence, but other risk factors may also contribute, including those occurring before, during or after workplace violence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Most previously identified PTSD risk factors were not tested or supported in research with psychiatric nurses, although there is promising evidence for risk factors including severe or injurious assault, cumulative exposure, burnout, and other worker characteristics. We identify directions for research needed to improve knowledge, including collecting data before nurses experience workplace violence, defining workplace risk factors consistently and conducting and reporting qualitative analysis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Provide training in risk assessment and violence prevention to psychiatric nurses. Offer mental health support to those exposed to violence, especially with cumulative exposure. ABSTRACT: Introduction Psychiatric nurses are at risk of workplace violence and post-traumatic stress disorder (PTSD). There is limited understanding of pre-trauma and post-trauma risk factors. Aim Our aim was to review factors associated with workplace PTSD in psychiatric nurses. Method We searched quantitative and qualitative studies from 1980 to 2019 in 23 databases plus abstracts for studies on psychiatric hospital nursing staff, potentially traumatic workplace events, workplace factors and PTSD. Following duplicate abstract (n = 10,064) and full-text (n = 199) screening, data were extracted in duplicate from 19 studies. Using best-fit framework synthesis, we identified workplace violence, pre-trauma and post-trauma risk factors. Results Six variables yielded evidence in at least two empirical studies scoring at least 6/8 on a quality measure, or one such study plus more than one other study ("promising": severe/injurious assault, cumulative exposure, burnout, poor mental health, low compassion satisfaction, neuroticism). Four were supported by at least one better quality study or at least two others ("suggestive": gender, poor training, any physical aggression exposure, compassion fatigue). Discussion Pre-trauma measures, consistent definitions of workplace exposures and thorough reporting of quantitative results are needed to improve research. Implications for Practice Violence prevention and mental health care for exposed nurses appear the most promising targets for PTSD prevention. Therefore, it is particularly important to understand workplace violence and mental health among nurses working in psychiatric hospitals.

The Relation of childhood adversity and antisociality to suicide attempts in men admitted to forensic psychiatric hospital

Suicide is a leading cause of death in custody. Although previous studies with prison inmates suggest a strong relation between childhood adversity and suicidal behavior, as well as between childhood adversity and antisociality, this has not been explored in the forensic psychiatric system. We compared 211 men admitted to a forensic hospital having a lifetime history of suicide attempts with 275 men with no suicide history in the same institution. Data were retrospectively coded from information gathered during their assessment and medical records. We examined associations of adverse childhood events and antisociality with suicide attempt history in a series of regression analyses. Childhood adversity was present in majority of individuals and significantly more common for individuals with a history of suicide attempts (76.8%) than those with no suicide attempts (63.3%). The suicide attempt group also experienced a greater number of adverse childhood events. Physical abuse, parental separation, and parental psychiatric history during childhood were associated with suicide attempts. Men with a suicide attempt history had higher antisociality scores than the comparison group and adult antisocial behavior partially mediated the relationship between adverse childhood experiences and suicide attempts. Men in forensic hospital who have suffered multiple experiences of childhood adversity are at increased risk for exhibiting antisocial behavior and engaging in suicidal attempts. Early interventions targeted toward antisociality and trauma-informed care in the forensic hospital are needed to support the mental health of the forensic population.

Workplace interventions to prevent or reduce post-traumatic stress disorder and symptoms among hospital nurses: A scoping review

OBJECTIVES

The aim of this study was to identify literature on evaluated workplace interventions to prevent or reduce the prevalence or impact of work-related post-traumatic stress disorder (PTSD) and PTSD symptoms among hospital nurses. A second objective was to summarise and compare the characteristics and effectiveness of these interventions.

BACKGROUND

A substantial proportion of nurses report PTSD symptoms. Previous reviews have synthesised interventions to address PTSD in military and other high-risk populations, but similar work focusing on nurses has yet to be conducted.

METHODS

We conducted a scoping review with the question: What interventions have been studied to prevent or treat PTSD symptoms or PTSD among nurses working in hospitals? We followed the PRISMA Scoping Review Checklist using an unregistered protocol. We searched in twelve academic and grey literature databases (e.g. MedLine, CINAHL) with no language restrictions. We included publications reporting on interventions which were evaluated for measurable impacts on PTSD and PTSD symptoms among nursing staff working in inpatient settings from 1980 to 2019, and charted study characteristics in a spreadsheet.

RESULTS

From 7746 results, 63 studies moved to full-text screening, and six studies met inclusion criteria. Methodologies included three randomised controlled studies, one quasi-experimental study, one pre-post feasibility study and one descriptive correlational study. Four studies reported a significant reduction in PTSD scores in intervention groups compared with baseline or comparison, when using debriefing, guided imagery or mindfulness-based exercises.

CONCLUSIONS

This review identified six studies evaluating hospital-based interventions to reduce PTSD and PTSD symptoms among hospital nurses, with some positive effects reported, contributing to a preliminary evidence base on reducing workplace trauma. Larger studies can compare nurse subpopulations, and system-level interventions should expand the focus from individuals to organisations.

RELEVANCE TO CLINICAL PRACTICE

This review can inform nursing and hospital leaders developing evidence-based interventions for PTSD among nurses.

Using Graphs in Sexual Violence Risk Communication: Benefits May Depend on the Risk Metric

Actuarial scales provide a relatively objective and reliable assessment of individuals' risk of recidivism. Recent research has explored how graphs can improve quantitative risk communication. We tested whether graphs can improve understanding and perception of sexual violence risk when matched with risk metric. Participants (N = 676) were recruited from Amazon's MTurk platform and read a brief description of a man convicted of a sexual offense, including results of a fictional sexual recidivism risk scale. In Study 1, absolute risk of recidivism enabled participants to distinguish between individuals with relatively high and low risk of sexual recidivism. In Study 2, this distinction was enhanced by adding a graph, especially when percentiles were communicated. Risk ratios increased perceived risk. Objective numeracy increased understanding and reduced perceived risk. We recommend that risk communication assumes limited statistical numeracy, and further research with practitioners to test the effect of graphs and risk metrics on forensic/judicial decisions.

Perceptions of Workplace Violence and Workplace Stress: A Mixed Methods Study of Trauma among Psychiatric Workers

Posttraumatic stress disorder (PTSD) among psychiatric workers is related to workplace violence and work-specific stress. We used quantitative and qualitative approaches to survey PTSD symptoms, critical events, chronic exposures, and occupational stress in 84 psychiatric workers. All but three had directly experienced critical events, over half experienced someone's life being in danger, and 14% screened positive for PTSD. Symptoms correlated with critical events and perceived threat to life. Respondents described emergency codes, direct involvement, and repeated exposure as most stressful. Symptoms also correlated with nonviolent stressors, replicating previous research and indicating need to reduce both violence and workplace stress.

Beyond workplace violence: Direct and vicarious trauma among psychiatric hospital workers. A qualitative study

AIM

We aimed to explore psychiatric nurses' and other psychiatric workers' understanding of trauma in the context of their relationships with the people they care for and the effects on their mental health.

BACKGROUND

Workplace violence in psychiatric hospitals can lead to mental health problems, including posttraumatic stress disorder. Professional relationships with the people they care for may complicate psychiatric workers' experiences of trauma.

METHODS

We qualitatively analysed responses of 30 psychiatric workers who answered relevant open-ended questions in a survey of workplace violence and posttraumatic stress disorder symptoms.

RESULTS

We found that respondents were profoundly affected by violence and vicarious trauma through the current and previous suffering of people in their care. The effects of vicarious exposure and other potentially psychologically traumatic events were often made worse by lack of organizational support.

CONCLUSION

Not only direct exposure to violent events but also indirect exposure, vicarious traumatic stress and perceived lack of organizational support affect staff's well-being.

IMPLICATIONS FOR NURSING MANAGEMENT

Management should ensure that mental health supports are not limited to workers directly affected by workplace violence but should extend to those who witnessed the event and to those regularly exposed to vicarious trauma.

Criminogenic needs and intimate partner violence: Association with recidivism and implications for treatment

The Risk-Need-Responsivity (RNR) principles of effective correctional service that are well supported in the general offending literature have less often been applied to the assessment and treatment of intimate partner violence (IPV). Well validated IPV risk assessment tools are now widely available, and IPV treatment programs that match treatment intensity to assessed risk have shown promising pre-to-post treatment effects. The present study builds on the study of RNR principles in IPV by exploring criminogenic needs and their relation to recidivism and to recently proposed treatment intensity categories derived from an IPV risk assessment tool. We reanalyzed data from 1,421 men with a police report of IPV in the original Ontario Domestic Assault Risk Assessment (ODARA) dataset, to explore the prevalence of antisocial personality traits, procriminal attitudes, substance use, poor relationships, and work/school problems and their relation to IPV recidivism and ODARA-based treatment intensity categories. Needs were present in 17% (procriminal attitudes) to 42% (substance use) of men. All needs except poor relationships were positively related to IPV recidivism; in logistic regression analyses, antisocial personality traits (OR = 1.80) and poor relationships (OR = 0.61) incrementally predicted IPV recidivism over the ODARA (OR = 1.40). Men placed in higher treatment intensity categories based on the risk assessment score had more criminogenic treatment needs. Findings support using the ODARA to select individuals for the most intensive IPV treatment, and suggest that assessing and treating criminogenic needs may improve IPV treatment outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mental health workers' experiences of support and help-seeking following workplace violence: A qualitative study

The consequences of workplace trauma among mental health staff can include physical injuries and somatic disorders, professional exhaustion and burnout, depression, anxiety, and other occupational stress injuries. For the well-being of staff and patients, there is a need to understand mental health workers' experiences following exposure to workplace trauma, any subsequent mental health problems, and the process of help-seeking. The nuances of these experiences can best be captured through qualitative exploration. In this study, we explored inpatient mental health workers' experiences of support and help-seeking following workplace violence. Four overall themes emerged from interviews with 12 participants: (i) validation as motivation for help-seeking; (ii) stigma as a barrier to help-seeking; (iii) gaps in services provided; and (iv) desire for accessible and effective trauma support and education. This study demonstrates the need for supportive management responses and peer support, access to specialized and confidential trauma-informed mental health services, and reductions in stigma, victim blaming, and other barriers to help-seeking among mental health workers.

Post-traumatic Stress Disorder, Depression, Anxiety Symptoms and Help Seeking in Psychiatric Staff: Trouble de stress post-traumatique, dépression, symptômes d'anxiété et recherche d'aide chez le personnel psychiatrique

BACKGROUND AND METHODS

In this study, we surveyed 761 psychiatric hospital staff (69% women, 71% full-time, 56% nursing) regarding their exposure to trauma in the workplace; symptoms of post-traumatic stress disorder (PTSD), depression, and anxiety; help seeking; and perceived barriers for help seeking.

RESULTS

Significant proportions of staff met the screening cutoffs for probable PTSD (16%), depression (20%), and anxiety (16%). Comorbidity was high, with approximately half of those meeting the screening cutoff for PTSD also meeting the cutoffs for depression or anxiety. Only PTSD symptoms were uniquely associated with exposure to trauma in the workplace, but both PTSD and depression symptoms significantly predicted help seeking. Staff who met one or more screening cutoffs perceived more barriers to help seeking such as difficulty with accessing services.

CONCLUSION

Implications for supporting psychiatric staff exposed to trauma are discussed.

Contribution of Critical Events and Chronic Stressors to PTSD Symptoms Among Psychiatric Workers

OBJECTIVE

Psychiatric staff are exposed to critical events (e.g., violence, physical threats) in the workplace and thus are at risk of posttraumatic stress disorder (PTSD). The authors examined the prevalence of PTSD symptoms among psychiatric hospital staff in Canada and the role of potentially traumatic critical events and chronic stressors (e.g., witnessing patients engaging in self-injury) in affecting psychiatric staff's mental health.

METHODS

The authors analyzed cross-sectional survey data from 761 psychiatric staff (69% female, 57% nursing, 64% with more than 5 years of experience in mental health). The analysis focused on questions about exposure to critical events and chronic stressors.

RESULTS

Sixteen percent of participants met a screening cutoff score on the PTSD Checklist-5, a self-report PTSD measure. Almost all staff (96%) had been directly or indirectly exposed to at least one critical event, and two-thirds (67%) had been directly exposed to at least one such event. Nursing staff reported higher scores than did allied health staff. A regression analysis yielded a model in which both critical events and chronic stressors were significant contributors to the variance in PTSD symptoms; professional discipline and gender did not explain additional variance.

CONCLUSIONS

PTSD is a significant concern for psychiatric staff. Exposure to violence and chronic stressors were found to contribute significantly and independently to explaining PTSD symptom checklist scores.

Workplace characteristics of forensic and nonforensic psychiatric units associated with posttraumatic stress disorder (PTSD) symptoms

Workplace factors associated with the development of posttraumatic stress disorder (PTSD) in inpatient psychiatric settings have received limited attention. In this study, we examined critical exposures, patient care stressors, and aspects of workplace environment that are potentially associated with PTSD symptoms in a sample of 633 clinical staff (68% nursing staff, 70% female) who provided direct day-to-day care for patients, and indicated they worked in either forensic (57%) or nonforensic units (43%). Forensic staff reported more direct exposure (74%) to a wider variety of potentially traumatic events and chronic stressors than nonforensic staff (66%). Forensic staff also endorsed more PTSD symptoms. Using the PTSD Checklist for DSM-5 (PCL-5; Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, DSM-5), 22% of forensic staff and 11% of nonforensic staff met the screening cut-off for possible PTSD; PTSD symptom scores were predicted both by direct exposure and unit type. Additionally, workplace environment and organizational trust were negatively correlated with PTSD symptom scores, where forensic staff reported a greater degree of incongruence with their workplace and lower levels of trust in management, compared with nonforensic staff. These results offer a snapshot of the more adverse work environment and associated risks faced by clinical staff on forensic units compared with nonforensic settings. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Adverse Childhood Experiences and Criminal Propensity Among Intimate Partner Violence Offenders

Adverse childhood experiences (ACEs), defined as exposure to abuse and adverse household events, are prevalent among certain offenders including those who commit intimate partner violence (IPV). However, it is not clear how ACEs relate to criminal propensity among IPV offenders, who have been shown to exhibit less antisociality and institutional violence than other offenders. We compared 99 male offenders with a current or previous offense of IPV with 233 non-IPV violent offenders and 103 nonviolent offenders undergoing institutional forensic assessment. This convenience sample allowed for use of extensive psychosocial records as well as study of institutional violence. IPV offenders had the highest mean ACE score and more extensive criminal propensity on some measures (violent and nonviolent criminal history and psychopathy) than both other groups. ACEs were associated with most measures of criminal propensity in the whole sample but with only one (actuarial risk of violent recidivism) in the subsample of IPV offenders. Finding that ACEs are prevalent among IPV offenders even in this sample with extensive mental illness demonstrates the robustness of this phenomenon. IPV offenders, though, are similar to other violent offenders in this respect, and there is insufficient evidence that ACEs represent a criminogenic need among IPV offenders specifically. Further research could draw from the batterer typology literature and attend to IPV offenders' broader criminal careers.

Co-Occurring Substance Use, PTSD, and IPV Victimization: Implications for Female Offender Services

The co-occurrence of substance use disorders (SUDs) and post-traumatic stress disorder (PTSD) among women who have been the victims of intimate partner violence (IPV) is complex and causal associations cannot be assumed. Although the presence of co-occurring disorders among IPV victims is a well-established research finding, there is a need for improved understanding of their prevalence and related mental health treatment requirements among female offenders. We review research indicating that service providers working with IPV victims can expect to encounter women with extensive concurrent problems and examine evidence for integrated treatment for SUD, PTSD, and IPV. We propose an outline for assessing and treating SUD and PTSD among female offenders who have experienced IPV victimization. We intend this review to build on previous calls in the co-occurring disorders literature and help integrate the research and treatment evaluation literatures in a way that points to practical implications for policy and practice in female offender services.

Assessment of Risk for Seclusion Among Forensic Inpatients: Validation and Modification of the Risk of Administrative Segregation Tool (RAST)

Seclusion is used in psychiatric care to protect patients and staff or to manage aggression but may have adverse effects. The ability to identify at-risk patients could help reduce seclusion. This study tested the Risk of Administrative Segregation Tool's (RAST) ability to predict any seclusions among 229 male forensic inpatients followed for up to 1 year of hospitalization, and days spent secluded, controlling for length of stay. RAST scores were lower than in correctional samples. The RAST did not predict seclusions in Year 1, but modification of three items to fit the forensic population (RAST-F) offered a small improvement. Among 62 patients hospitalized for more than 1 year, the RAST significantly predicted seclusions in Year 2, and the modifications improved prediction. The present modest findings support the RAST's potential to help identify patients most in need of clinical efforts to avert seclusion. Replication in larger samples, including female patients, is needed.

Staff and patient accounts of PRN medication administration and non-pharmacological interventions for anxiety

Most psychiatric inpatients will receive psychotropic PRN medication during their hospital stay for agitation, anxiety, and/or insomnia. While helpful in some cases, caution is warranted with regard to PRN use due to inherent risks of additional medication; therefore, experts advise that non-pharmacological interventions should be attempted first where indicated. However, research to date highlights that, in practice, non-pharmaceutical approaches are attempted in a minority of cases. While some information is known about the practice of PRN administration and the use of and barriers to implementing non-pharmacological interventions for treating acute psychiatric symptoms, full understanding of this practice is hampered by poor or altogether missing documentation of the process. This study used interviews with patients and staff from two psychiatric hospitals to collect first-person accounts of administering PRN medication for anxiety, thereby addressing the limitations of relying on documented notation found in previous research. Our results indicate that nurses are engaging in non-pharmacological interventions more often than had previously been captured in research. However, the types of strategies suggested are not typically evidence based and further, only happening approximately half the time. The barriers to providing such care are centred on two main beliefs about client choice and efficacy of these non-medical strategies. Implications for research and practice are discussed.

Documentation of psychotropic pro re nata medication administration: An evaluation of electronic health records compared with paper charts and verbal reports

AIMS AND OBJECTIVES

To describe the documentation of pro re nata (PRN) medication for anxiety and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process.

BACKGROUND

The ability to accurately document patients' symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, Nursing process and critical thinking, Saddle River, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544-1552) and considerable information missing (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544-1552). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker et al., 2008, J Clin Nurs, 17, 1122-1131).

DESIGN

The project was a mixed-method, two-phase study that collected data from two sites.

METHODS

In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice.

RESULTS

Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration.

CONCLUSIONS

We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation.

RELEVANCE TO CLINICAL PRACTICE

Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be made through training, using structured report templates and by switching to electronic databases.

The Criminogenic and Noncriminogenic Treatment Needs of Intimate Partner Violence Offenders

The criminogenic needs of general offenders have been empirically studied, but the criminogenic treatment needs of intimate partner violence (IPV) offenders, or how they compare with other violent or nonviolent offenders, have not been as thoroughly explored. Therefore, we examined and compared the criminogenic and noncriminogenic needs of 99 IPV offenders, 233 non-IPV violent offenders, and 103 nonviolent offenders, all of whom were men who had undergone institutional forensic assessment. Results indicated that IPV offenders had more treatment needs than the other two offender groups, including the Central Eight criminogenic needs. These findings support a focus on criminogenic treatment needs in batterer intervention programs for men, consistent with the principles of effective intervention for offenders.

Psychiatric Hospital Workers’ Exposure to Disturbing Patient Behavior and Its Relation to Post-Traumatic Stress Disorder Symptoms

Background

About 10% of health-care workers experience post-traumatic stress disorder (PTSD); the rate is higher among workers exposed to aggression.

Objective

We extended this research by examining PTSD and exposure to violence and other disturbing patient behaviors, among nursing and other staff on inpatient psychiatric units (forensic and nonforensic).

Method

Surveys were completed online or in person by 219 respondents (30% response rate). Participants indicated which disturbing behaviors they had been exposed to and ranked the worst three behaviors in each of three categories: most unpleasant to work with, most disruptive to patient care, and most upsetting. Most ( n = 192) also completed the PTSD Checklist (PCL).

Results

All but two participants reported exposure to at least one disturbing behavior and ranked violence, feces smearing, and screaming constantly as the worst experiences overall. On the PCL, 24% scored above the cut off for probable PTSD. Nursing staff had the highest scores, with no difference between nursing staff on forensic versus nonforensic units. PCL score showed a small positive correlation with the number of disturbing behaviors experienced.

Conclusion

PTSD symptoms are common among psychiatric hospital workers, not only nursing staff. Future research using clinical assessment, longitudinal designs, and measurement of nonviolent disturbing behaviors is recommended.

Sixty-Six Years of Research on the Clinical Versus Actuarial Prediction of Violence

In their meta-analysis of clinical versus statistical prediction models, Ægisdóttir et al. (this issue) extended previous findings of statistical-method superiority across such variables as clinicians’ experience and familiarity with data. In this reaction, the authors are particularly interested in violence prediction, which yields the greatest support for actuarial models. In the past decade, actuarial prediction has continued to improve, but clinicians have not readily adopted these models, and new models have emerged that encourage reliance on unaided clinical judgment. Psychologists have made progress developing and disseminating actuarial risk assessments and should use the most accurate available measure suited to the task.

Weight Gain and Its Correlates Among Forensic Inpatients

OBJECTIVE

We investigated changes in weight, body mass index (BMI), and other indices of the metabolic syndrome in forensic inpatients. Weight gain associated with newer antipsychotics (APs) is well established in the general psychiatric population.

METHODS

We examined the medical records of 291 men admitted to a forensic hospital at admission and again at discharge or 365 days later if still in hospital. We also recorded diagnosis and smoker status on admission and quantified psychotropic treatment and adherence, physical activity, and daytime occupation during the hospitalization.

RESULTS

On admission, 33% were obese and 22% of the 106 patients for whom sufficient data were available met criteria for metabolic syndrome. Among patients staying at least 30 days, 60% were weighed again before discharge but repeated blood pressure and waist circumference measures were uncommon, even among those at greatest risk. The 122 forensic inpatients with sufficient information gained an average of 12% of their body weight and 40% increased by at least 1 BMI category, gaining an average of 3.67 kg per month. Weight gain was associated with duration of time and was not attributable to being underweight on admission, diagnosis of schizophrenia, atypical AP treatment, medication adherence, or having been a smoker.

CONCLUSIONS

Patients gained weight during forensic hospitalization independent of medication use. We recommend further research using consistent measurement and wider sampling of both metabolic syndrome indicators and its individual and systemic causes in forensic populations.

Cost-effectiveness of electronic training in domestic violence risk assessment: ODARA 101

The need for domestic violence training has increased with the development of evidence-based risk assessment tools, which must be scored correctly for valid application. Emerging research indicates that training in domestic violence risk assessment can increase scoring accuracy, but despite the increasing popularity of electronic training, it is not yet known whether it can be an effective method of risk assessment training. In the present study, 87 assessors from various professions had training in the Ontario Domestic Assault Risk Assessment either face-to-face or using an electronic training program. The two conditions were equally effective, as measured by performance on a post-training skill acquisition test. Completion rates were 100% for face-to-face and 86% for electronic training, an improvement over a previously evaluated manual-only condition. The estimated per-trainee cost of electronic training was one third that of face-to-face training and expected to decrease. More rigorous evaluations of electronic training for risk assessment are recommended.

Evidence for risk estimate precision: implications for individual risk communication

Actuarial risk assessment instruments using well-established predictor variables measured at the individual level (e.g., age, criminal history, psychopathy) discriminate well between recidivists and non-recidivists across diverse samples. Data indicating the relative risk of recidivism can inform policy decisions about allocating resources according to risk within a correctional system, consistent with the first of the risk-need-responsivity (RNR) principles. Evidence for the precision of absolute risk as applied to an individual based on scores from many samples, however, has proven challenging. In this paper, we present a study examining the association of actuarial risk estimate precision with sample size using the Post Conviction Risk Assessment (PCRA; Lowenkamp et al., 2013), in samples of up to 26,642 offenders. Results indicate that the precision of individual estimates can be demonstrated with sufficient sample size. We believe that the implications of absolute risk for the communication of an individual offender's risks have been poorly understood. We argue that the purpose of individual-level risk communication is to ensure the effective application of policy, which requires matching a new case to aggregate data. We illustrate how an offender's risk might thus be communicated, and conclude that this function is distinct from management of an individual's criminogenic needs and identification of effective and suitable treatments.

Communicating the risk of violent and offending behavior: review and introduction to this special issue

How to communicate risk of recidivism in correctional and forensic contexts has been a subject of scholarly discussion for two decades. This emerging literature, however, is sparse compared with studies on the assessment of risk for violent and offending behavior. In this special issue of Behavioral Sciences and the Law, we have gathered together empirical and review papers exemplifying promising directions and methodologies. We begin with a review of the state of the field, and lessons that can be drawn from research into medical risk assessment and risk communication, finding that many of the same principles apply to the forensic context. How risks are framed, and how numerate assessors are, affects how risk information is understood and applied. We discuss the existing research bearing on these issues, as well as the conceptual, practical, empirical, and legal implications of communicating risk using numerical or categorical risk terms. Along with the seven articles in this volume, we suggest directions for future research on measuring and communicating change, understanding and managing the statistical literacy of those who use and communicate risk assessments, and developing a theoretical framework for forensic risk communication research. We hope this volume will help integrate and invigorate research into forensic risk communication.

Availability of services for parents living with mental disorders: a province-wide survey

OBJECTIVE

There is evidence that parents living with mental disorders have limited access to parenting support. We conducted a survey of mental health agencies in Ontario, Canada, to establish a benchmark from which progress in service availability can be evaluated, and to identify any barriers to availability in terms of program location and parent gender.

METHOD

We surveyed 119 directors of community and inpatient mental health service agencies (54% response rate) and directors of 80 different agencies to which they referred clients for parenting support services (56% response rate). Respondents indicated the types of parenting support services they provided and the clientele they served.

RESULTS

The most common parenting support service in mental health agencies was referral to another agency. Individuals with mental disorders were eligible for services at the referral agencies on a case-by-case basis, and few agencies had programs for children. Parenting services were associated with the number of staff in the agency and with offering programs in urban or both urban and rural locations, which perhaps also indicates larger size of the organization. Agencies served fathers and mothers approximately equally, but child care was uncommon.

CONCLUSIONS

Integrated clinical services for parents living with mental disorders are lacking. Such services should be designed to treat mental health as well as provide parenting skills intervention and practical support for parents, consistent with a recovery model.

Preliminary Validation of the ODARA for Female Intimate Partner Violence Offenders

Female perpetrators of assault against dating, cohabiting, or marital partners (intimate partner violence [IPV]) recidivate less than their male counterparts. Risk assessment instruments, though, have been developed almost exclusively on men. In a prospective, masked 9-year follow up of 30 female IPV offenders incarcerated in a correctional treatment institution within one decade, the base rate of IPV recidivism was 23%. The Ontario Domestic Assault Risk Assessment (ODARA) predicted IPV recidivism, receiver operating characteristic (ROC) area = .724, 95% confidence interval (CI) = [0.503, 0.944], but recidivism rates differed significantly from rates based on male samples. Gender-modified items did not improve prediction. We recommend further research with larger samples to seek improved recidivism estimates among female IPV offenders, but in the interim, we suggest the ODARA can be used to apportion intervention resources for female IPV perpetrators.

Weapon use increases the severity of domestic violence but neither weapon use nor firearm access increases the risk or severity of recidivism

Use of weapons is a risk factor for domestic violence severity, especially lethality. It is not clear, however, whether access to firearms itself increases assault severity, or whether it is characteristic of a subgroup of offenders who are more likely to commit severe and repeated domestic assault. This reanalysis of 1,421 police reports of domestic violence by men found that 6% used a weapon during the assault and 8% had access to firearms. We expected that firearm use would be rare compared to other weapons and that actual weapon use rather than firearm access would increase the severity of domestic assaults. Firearm access was associated with assault severity, but this was mostly attributable to use of nonfirearm weapons. Weapon use was associated with older age, lower education, and relationship history as well as to assault severity. Victims were most concerned about future assaults following threats and actual injuries. Although firearm access and weapon use were related to actuarial risk of domestic violence recidivism, neither predicted the occurrence or severity of recidivism. We conclude that, consistent with previous research in the United States and Canada, firearm use in domestic violence is uncommon even among offenders with known firearm access. Weapon use is characteristic of a subgroup of offenders who commit more severe domestic violence, and seizure of weapons may be an effective intervention.

Predictors of recidivism by stalkers: a nine-year follow-up of police contacts

In a subsample of a multisite stalking study (Mohandie, Meloy, McGowan, & Williams, 2006) comprising 78 offenders from one site, 77% committed new offenses within an average follow-up of 106 months (8.8 years). Over half (56%) were charged for new stalking related offenses and 33% for violent recidivism. Violent reoffending, including sexual offenses, was predicted by risk factors consistent with existing literature: younger age at first conviction, prior release failures, and criminal history. Stalking recidivism was predicted by pre-index offending scores, using the Cormier-Lang, and prior diagnosis of a mental illness. In addition, stalkers with previously diagnosed mental illness had significantly more police contacts as complainants than those without; their recidivism was also more likely to be non-violent.

How nonrecidivism affects predictive accuracy: evidence from a cross-validation of the Ontario Domestic Assault Risk Assessment (ODARA)

Prediction effect sizes such as ROC area are important for demonstrating a risk assessment's generalizability and utility. How a study defines recidivism might affect predictive accuracy. Nonrecidivism is problematic when predicting specialized violence (e.g., domestic violence). The present study cross-validates the ability of the Ontario Domestic Assault Risk Assessment (ODARA) to distinguish subsequent recidivists and nonrecidivists among 391 new cases with less extensive criminal records than previous cross-validation samples, base rate=27%, ROC area=.67. Excluding ambiguous nonrecidivists increases the base rate to 33%, ROC area=.74. Random samples of 50 recidivists and 50 unambiguous nonrecidivists yield ROC areas from .71 to .80. Published norms significantly underestimate official recidivism. Ambiguous nonrecidivism is prevalent and leads to underestimating base rates and predictive accuracy.

Actuarial assessment of violence risk in hospital-based partner assault clinics

Hospital-based partner assault clinics are a relatively recent addition to the community response to partner violence. In this study, 66% of 111 women attending hospital clinics for partner assault were physically injured and 43% reported death threats. Few concurrently used other services (shelters or police) and most relied on female friends and relatives for help. Many participants who currently lived with the perpetrator were contemplating leaving but only a third had made plans to do so. Participants faced an unusually high risk of future assault, according to both victim interview using the ODARA actuarial risk assessment and their own perceptions. Findings imply an important role for partner assault clinics and the feasibility of the victim service sector's using the same actuarial risk assessments as the criminal justice system.

An indepth actuarial assessment for wife assault recidivism: the Domestic Violence Risk Appraisal Guide

An actuarial tool, the Ontario Domestic Assault Risk Assessment (ODARA), predicts recidivism using only variables readily obtained by frontline police officers. Correctional settings permit more comprehensive assessments. In a subset of ODARA construction and cross-validation cases, 303 men with a police record for wife assault and a correctional system file, the VRAG, SARA, Danger Assessment, and DVSI also predicted recidivism, but the Hare Psychopathy Checklist (PCL-R) best improved prediction of recidivism, occurrence, frequency, severity, injury, and charges. In 346 new cases, ODARA and PCL-R independently predicted recidivism. An algorithm was derived for a combined instrument, the Domestic Violence Risk Appraisal Guide (DVRAG), and an experience table is presented (N=649). Results indicated the importance of antisociality in wife assault.

Does using nonnumerical terms to describe risk aid violence risk communication? Clinician agreement and decision making

Actuarial risk assessments yield valid numerical information about violence risk, but research suggests that forensic clinicians prefer to communicate risk using nonnumerical information (i.e., verbal terms such as high risk). In an experimental questionnaire study, 60 forensic clinicians disagreed on the interpretation of nonnumerical terms, and their nonnumerical risk estimates for one group of violent offenders were influenced by comparison with another group. Adding nonnumerical terms to numerical probability statements had no effect on hypothetical forensic decisions. These findings suggest that nonnumerical descriptive terms do not aid effective communication of violence risk and that contextual information might artificially affect estimated risk.

Coercive and precocious sexuality as a fundamental aspect of psychopathy

Sexual behavior is closely associated with delinquency and crime. Although psychopaths, by definition, have many short-term sexual relationships, it has not been shown that sexuality is a core aspect of psychopathy. A Darwinian view of psychopathy led to the hypothesis that psychopaths have a unique sexuality involving early, frequent, and coercive sex. Our subjects were 512 sex offenders assessed on the Hare Psychopathy Checklist (PCL-R). Five variables reflecting early, frequent, and coercive sex loaded on the same principal component in exploratory factor analysis on a subset of the sample, whereas PCL-R items pertaining to adult sexual behavior did not. Confirmatory factor analysis of the remaining subjects yielded a measurement model containing three inter-correlated factors - the traditional two PCL-R factors, and coercive and precocious sexuality. Taxometric analyses gave evidence of a natural discontinuity underlying coercive and precocious sexuality. Coercive and precocious sexuality yielded statistically significant associations with other study variables predicted by the Darwinian hypothesis. The present findings are consistent with prior empirical findings and support the hypothesis that psychopathy has been a nonpathological, reproductively viable, alternate life history strategy.

A brief actuarial assessment for the prediction of wife assault recidivism: the Ontario domestic assault risk assessment

An actuarial assessment to predict male-to-female marital violence was constructed from a pool of potential predictors in a sample of 589 offenders identified in police records and followed up for an average of almost 5 years. Archival information in several domains (offender characteristics, domestic violence history, nondomestic criminal history, relationship characteristics, victim characteristics, index offense) and recidivism were subjected to setwise and stepwise logistic regression. The resulting 13-item scale, the Ontario Domestic Assault Risk Assessment (ODARA), showed a large effect size in predicting new assaults against legal or common-law wives or ex-wives (Cohen's d = 1.1, relative operating characteristic area =.77) and was associated with number and severity of new assaults and time until recidivism. Cross-validation and comparisons with other instruments are also reported.

Predicting wife assault: a critical review and implications for policy and practice

In this review, the authors examine the research evidence for the prediction of wife assault recidivism, lethal wife assault, and wife assault onset. They also review and present original data on the effect of treatment attendance on wife assault risk. Violence does not always become a stable habit, and variables associated with wife assault onset do not necessarily predict recidivism. General antisociality, psychopathy, substance abuse, and a history of assault and psychological abuse in the relationship are the most promising predictors of recidivism. Formal risk assessments, and victims' predictions, have demonstrated value in predicting recidivism. The authors review existing assessments for wife assault onset and recidivism and explain the relative merits of actuarial tools and structured clinical assessments. Because of statistical and practical limitations to predicting lethal assault, they recommend using an actuarial assessment of wife assault risk, plus attention to the strongest correlates of lethal assault when lethality is a concern.

Adolescents' perceptions of the seriousness of sexual aggression: influence of gender, traditional attitudes, and self-reported experience

Little is known about adolescents' perceptions of interpersonal aggression and the role of traditional social attitudes in these perceptions. Sixteen-year-old students (N = 212) of both sexes rated the seriousness of 9 aurally presented scenarios depicting either sexual or nonsexual, physical aggression. Sex of perpetrator and sex of victim were manipulated partly factorially. Students also reported on their own experiences (as perpetrators and victims) of the aggression portrayed, and completed a measure of traditional sex role ideology. Sexual aggression was rated as more serious than nonsexual physical aggression, especially when involving physical force. Girls gave higher seriousness ratings than did boys. Male-to-female aggression was rated as most serious, and male-to-male aggression, least serious. Self-reported perpetrators tended to give lower ratings of seriousness than did victims. Traditional sex-role attitudes were associated with lower rated seriousness but not with reported perpetration or victimization. Multivariate analyses suggested that the effects of traditional sex-role attitudes could largely be subsumed by the effects of other study variables, especially participant sex. The role of attitudes as a direct cause of interpersonal aggression is discussed along with implications for intervention.

The influence of actuarial risk assessment in clinical judgments and tribunal decisions about mentally disordered offenders in maximum security

Research has shown that actuarial assessments of violence risk are consistently more accurate than unaided judgments by clinicians, and it has been suggested that the availability of actuarial instruments will improve forensic decision making. This study examined clinical judgments and autonomous review tribunal decisions to detain forensic patients in maximum security. Variables included the availability of an actuarial risk report at the time of decision making, patient characteristics and history, and clinical presentation over the previous year. Detained and transferred patients did not differ in their actuarial risk of violent recidivism. The best predictor of tribunal decision was the senior clinician's testimony. There was also no significant association between the actuarial risk score and clinicians' opinions. Whether the actuarial report was available at the time of decision making did not alter the statistical model of either clinical judgments or tribunal decisions. Implications for the use of actuarial risk assessment in forensic decision making are discussed.

The functions of aggression by male teenagers

A selectionist theory states that violence by males toward male peers originally served specific functions and violence to female peers served others. Differences in self-reported victimization and perpetration in studies of 1.452 high school students were hypothesized. In Study 1, male-to-male aggression was reported to be more prevalent than male-to-female aggression. For male-to-male aggression, perpetrator reports agreed with or exceeded victim reports, and victims were more often strangers than close friends, In contrast, for male-to-female aggression, there were consistently fewer reports from perpetrators than from victims, and victims were less often strangers than girlfriends. Study 2 obtained similar findings for reported frequency, number of victims and perpetrators, and sexual aggression. Study 3 showed that girls' aggression contrasted with that by boys with respect to intra- versus intersex aggression and perpetrator victim agreement.

The functions of aggression by male teenagers

A selectionist theory states that violence by males toward male peers originally served specific functions and violence to female peers served others. Differences in self-reported victimization and perpetration in studies of 1.452 high school students were hypothesized. In Study 1, male-to-male aggression was reported to be more prevalent than male-to-female aggression. For male-to-male aggression, perpetrator reports agreed with or exceeded victim reports, and victims were more often strangers than close friends, In contrast, for male-to-female aggression, there were consistently fewer reports from perpetrators than from victims, and victims were less often strangers than girlfriends. Study 2 obtained similar findings for reported frequency, number of victims and perpetrators, and sexual aggression. Study 3 showed that girls' aggression contrasted with that by boys with respect to intra- versus intersex aggression and perpetrator victim agreement.