Predicting hospital aggression in secure psychiatric care

Risk assessment instruments have become a preferred means for predicting future aggression, claiming to predict long-term aggression risk. We investigate the predictive value over 12 months and 4 years of two commonly applied instruments (HCR-20, VRAG) in a secure psychiatric population with personality disorder. Focus was on aggression in hospital. The actuarial risk assessment (VRAG) was generally performing better than the structured risk assessment (HCR-20), although neither approach performed particularly well overall. Any value in their predictive potential appeared focused on the longer time period under study (4 years) and was specific to certain types of aggression. The value of these instruments for assessing aggression in hospital among personality-disordered patients in a high secure psychiatric setting is considered