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Assessing the risk of imminent aggression in mentally ill young offenders
John Kasinathan1, Christopher Marsland2, Philip Batterham3
1Consultant Forensic Psychiatrist, Adolescent Unit, The Forensic Hospital, Justice Health, New South Wales Health, Sydney, NSWConjoint Lecturer, Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSWForensic Mental Health Service Australian Capital Territory Health, Canberra, ACTVisiting Fellow, Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia johnkas@med.usyd.edu.au.
Objectives:
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.
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