A Systematic Review of the Predictive Validity of the VRAG-R

Structured risk assessment tools are essential in forensic psychiatry to evaluate the likelihood of recidivism. The Violence Risk Appraisal Guide-Revised (VRAG-R) was developed as an update to the VRAG, but its predictive validity across offender populations remains underexamined. Our study aimed to examine the predictive validity of the VRAG-R for general, violent (including and excluding sexual offenses), and sexual recidivism. We conducted a systematic review and meta-analysis, searching 10 databases and gray literature sources for studies reporting psychometric outcomes for the VRAG-R published since 2013. Risk of bias was assessed using Prediction Model Risk of Bias Assessment (PROBAST) and data extraction followed the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS) checklist. Area under the curve (AUC) values were pooled using random-effects meta-analysis. In total, 15 studies comprising 3,932 participants were included. The VRAG-R showed acceptable predictive validity for general recidivism (pooled AUC = .71, 95% CI: .67 to .75) and violent recidivism (AUC = .72, 95% CI: .69 to .75). Predictive validity for sexual recidivism was modest (AUC = .65, 95% CI: .61 to .68). In conclusion, the VRAG-R demonstrates acceptable predictive validity for general and violent recidivism, comparable with other tools. Its performance in predicting sexual recidivism, however, is limited and concerns about generalizability remain. Future research should prioritize diverse samples, reporting of calibration, and continued evaluation of performance.