Aggression in adolescents presents a significant problem for psychiatric units. The Dynamic Appraisal of Situational Aggression (DASA) is an empirically validated measure designed to appraise the risk of imminent aggression (within the next 24 hours) in adult patients. Our aim was to examine the predictive validity of the DASA: Youth Version (DASA:YV) with youth-specific items, in young offenders hospitalised with a mental illness.
Methods:
This prospective validation study involved 4440 DASA:YV ratings of mentally ill adolescents in a secure hospital. At 24 hours post-assessment, the nursing staff documented whether patients had behaved aggressively: physically, verbally or towards property. Predictive accuracy was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.
Results:
The DASA:YV significantly predicted any imminent aggression (AUC = 0.754). Additional youth-specific items conferred a greater predictive yield, as compared to adult-derived items (p = 0.014).
Conclusions:
It is possible to monitor the risk state of hospitalised mentally ill youth, so that heightened states can be detected early, thus facilitating interventions to reduce the risk of violence.
DaffernMMayerMMartinT. A preliminary investigation into patterns of aggression in anAustralian forensic psychiatric hospital. J Forens Psychiatry Psychol2003; 14: 67–84.
2.
BarzmanDHBrackenburyLSonnierL. Brief Rating of Aggression by Children and Adolescents (BRACHA): Development of a tool for assessing risk of inpatients’ aggressive behavior. J Am Acad Psychiatry Law2011; 39: 170–179.
3.
Royal College of Psychiatrists (RCP). Healthcare Commission national audit of violence 2006–2007. London: RCP, 2007.
4.
GadonLJohnstoneLCookeD. Situational variables and institutional violence: A systematic review of the literature. Clin Psychol Rev2006; 26: 515–534.
5.
Royal Australian and New Zealand College of Psychiatrists (RANZCP). Position Statement 6: Minimising the use of seclusion and restraint in people with mental illness. RANZCP, 2010.
6.
ChingHDaffernMMartinT. Reducing the use of seclusion in a forensic psychiatric hospital: Assessing the impact on aggression, therapeutic climate and staff confidence. J Forensic Psychiatry Psychol2010; 21: 737–760.
7.
FisherW. Restraint and seclusion: A review of the literature. Am J Psychiatry1994; 15: 1584–1591.
8.
SailasEFentonM. Seclusion and restraint for people with serious mental illness. Cochrane Datab Systemat Rev2012; 2: CD001163.
9.
Department of Health. A new Mental Health Act for Victoria: Summary of proposed reforms. Melbourne: State Government of VIC, 2012.
10.
DouglasKSSkeemJL. Violence risk assessment: Getting specific about being dynamic. Psychol Public Policy Law2005; 11: 347–383.
11.
DaffernMHowellsK. The prediction of imminent aggression and self- harm in personality disordered patients of a high security hospital using the HCR-20 clinical scale and the Dynamic Appraisal of Situational Aggression. Int J Forens Mental Health2007; 6: 137–143.
12.
QuinseyVHarrisGRiceM. Violent offenders: Appraising and managing risk. 2nd ed.Washington, DC: American Psychological Association, 2006.
13.
AlmvikRWoodsPRasmussenK. The Brøset Violence Checklist: Sensitivity, specificity, and inter-rater reliability. J Interpers Viol2000; 15: 1284–1296.
14.
OgloffJRPDaffernM. The dynamic appraisal of situational aggression: An instrument to assess risk for imminent aggression in psychiatric inpatients. Behav Sci Law2006; 24: 799–813.
15.
Barry-WalshJDaffernMDuncanS. The prediction of imminent aggression in patients with mental illness and/or intellectual disability using the Dynamic Appraisal of Situational Aggression instrument. Australas Psychiatry2009; 17: 493–496.
16.
DaffernMHowellsKHamiltonL. The impact of structured risk assessments followed by management recommendations on aggression in patients with personality disorder. J Forens Psychiatry Psychol2009; 20: 661–679.
17.
VojtGMarshallLAThomsonLDG. The assessment of imminent inpatient aggression: A validation study of the DASA-IV in Scotland. J Forensic Psychiatry Psychol2010; 21: 789–800.
18.
GriffithJJDaffernMGodberT. Examination of the predictive validity of the Dynamic Appraisal of Situational Aggression in two mental health units. Int J Mental Health Nurs2013; 22: 485–492.
19.
NeedhamIAbderhaldenCMeerR. The effectiveness of two interventions in the management of patient violence in acute mental inpatient settings: Report on a pilot study. J Psychiatric Mental Health Nurs2004; 11: 595–601.
20.
AbderhaldenCNeedhamIDassenT. Structured risk assessment and violence in acute psychiatric wards: Randomised controlled trial. Brit J Psychiatry2008; 193: 44–50.
21.
VandeSandeRNijmanHLNoorthoornEO. Aggression and seclusion on acute psychiatric wards: Effect of short-term risk assessment. Brit J Psychiatry2011; 199: 473–478.
22.
BorumRBartelPForthAE. Manual for the Structured Assessment of Violence Risk in Youth (SAVRY) Version 1.1. Odessa, FL: Psychological Assessment Resources, 2003.
23.
ChuCMHooEDaffernM. Assessing the risk of imminent aggression in institutionalized youth offenders using the dynamic appraisal of situational aggression. J Forens Psychiatry Psychol2012; 23: 168–183.
24.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, text revision (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Press; 2000.
25.
WebsterCDDouglasKSEavesD. HCR-20: Assessing risk for violence. Version 2 ed. British Columbia, Canada: Mental Health, Law and Policy Institute of Simon Fraser University, 1997.
26.
DaffernMOgloffJRPChuCM. The Dynamic Appraisal of Situational Aggression: Youth Version (DASA:YV). Victoria: Centre for Forensic Behavioural Science at Monash University, 2008.
27.
DouglasKSWebsterCD. Predicting violence in mentally and personality disordered individuals. In: RoeschRHartSDOgloffJRP (eds) Psychology and law: The state of the discipline. New York: Plenum, 1999, pp. 175–239.
