THE MACARTHUR VIOLENCE
RISK ASSESSMENT STUDY

INTRODUCTION

Background

The public perception that mental disorder is strongly associated with violence drives both legal policy (e.g., civil commitment) and social practice (e.g., stigma) toward people with mental disorders. This study describes and characterizes the prevalence of community violence in a sample of people recently discharged from acute psychiatric facilities at three sites. Prevalence rates for violence are presented that derive from three sources -- self-report, reports of collateral informants, and official agency records. The violence is described in terms of the type of act committed, its target, and its location. Prevalence rates are examined for change over time by segmenting a 1-year follow-up into 5 10-week periods. At one site, comparative violence rates were obtained by the same research interviewers applying the same instruments both to recently discharged patients and to other persons living in the same neighborhoods.

Methods

Overview

1,136 male and female civil patients between 18 and 40 years old were enrolled in a study that monitored violence to others every 10 weeks during their first year after discharge. Patient self-reports were augmented by reports from collaterals and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks.

Detailed Methods

Patient Sample

Admissions were sampled from acute inpatient facilities at 3 sites: Western Psychiatric Institute and Clinic (Pittsburgh, PA) (a university-based specialty hospital); Western Missouri Mental Health Center (Kansas City, MO) (a public mental health center); Worcester State Hospital (a state psychiatric hospital) and the University of Massachusetts Medical Center (Worcester, MA) (a university-based general hospital). Selection criteria were: (1) civil admissions, (2) between the ages of 18 and 40, (3) English-speaking, (4) White, or African American ethnicity (or Hispanic in Worcester only), and (5) a chart diagnosis of schizophrenia, schizophreniform, schizoaffective, depression, dysthymia, mania, brief reactive psychosis, delusional disorder, alcohol or drug abuse or dependence, or a personality disorder. Eligible patients were sampled according to age, gender, and race to maintain a consistent distribution of these characteristics across sites. The mean time between hospital admission and approach by the research interviewer to obtain informed consent was 4.5 days. Eligible subjects were excluded if they had been hospitalized for 21 days or more prior to being approached. Data collection began in mid-1992 and ended in late 1995.

Hospital Data Collection

Hospital data collection was conducted in 2 parts: (1) an interview by the research interviewer to obtain data on demographic and historical factors; and (2) an interview by a research clinician (Ph.D. or MA/MSW) to confirm the chart diagnosis using the DSM-III-R Checklist (or to confirm a personality disorder using the Structured Interview for DSM-III-R Personality when no eligible Axis I diagnosis was present). Checklist diagnoses corresponded to a chart diagnosis in 85.7% of the cases. Discrepant diagnoses were resolved by a consultant psychiatrist at each site. Patients remaining in the hospital for more than 145 days were dropped from the study (n=3).

Supplementary data were abstracted from patients' charts. A full discussion of all measures can be found elsewhere. To obtain information on sample bias, similar chart information was collected for a random sample of patients (n = approximately 1,000 at each site) who were eligible for the study but not enrolled.

Post-Discharge Data Collection

Patients were recontacted in the community by the research interviewers and interviewed 5 times (every 10 weeks) over 1 year from the date of discharge. Patient interviews were in person (89%) or by telephone (11%). A collateral informant was also interviewed (in person: 45%; by telephone: 55%) on the same schedule. During each follow-up, a patient was asked to nominate as a collateral the person who was most familiar with his or her behavior in the community. If the nominee did not have at least weekly contact with the subject, the interviewer suggested a more appropriate person based on a review of the subject's social network data. Collaterals were most often family members (47.1%), but were also friends (23.9%), professionals (13.9%), significant others (12.4%), or others (e.g., co-workers; 2.7%). Patients and collaterals were paid for their participation. Arrest and re-hospitalization records were also obtained.

Violence Coding and Reconciliation

Subjects and collaterals were asked whether the subject had engaged in several categories of aggressive behavior in the past 10 weeks. If a positive response was given, the subject or collateral was asked to list the number of times the behavior occurred. Detailed information was obtained about each act, including the target and location.

For statistical analyses, acts were divided into 2 categories of seriousness: Violence (battery that resulted in physical injury; sexual assaults; assaultive acts that involved the use of a weapon; or threats made with a weapon in hand) and other aggressive acts (battery that did not result in physical injury). Acts reported by any information source were reviewed by two independent coders to obtain a single reconciled report of violence. Only the most serious act for each incident was coded. A hierarchy of coding rules is available from the authors.

Community Sample -- Pittsburgh

The University of Pittsburgh's Center for Social and Urban Research identified a community sample in Pittsburgh such that the distribution of the census tracts in which that sample resided was the same as the distribution of the census tracts in which the patients resided during the year following discharge. In addition to living in a specified census tract, the community respondent had to have lived at the current address for at least 2 months, be between the ages of 18 and 40, and be of either white or African-American ethnicity.

Sample frames were constructed by compiling lists of all addresses within the census tract. In order to incorporate no-phone households, 1990 U.S. Census data were used to provide an estimate of the number of such households per census tract (3.4% of the total) and that proportion of interviews were obtained by soliciting respondents in public places.

The subjects in the community sample were interviewed only once. They and their collaterals were questioned about the subjects' behavior in the past 10 weeks. Official arrest records were also obtained.

Funding Source

Funding for this study was provided by the John D. and Catherine T. MacArthur Foundation's Research Network on Mental Health and the Law with a supplemental grant from the National Institute of Mental Health (grant # R01 49696) to interview the collateral informants.

DATA AND DOCUMENTATION

Data are provided as both SPSS data (.sav) files and SPSS portable (.por) files, allowing for data to be used with a wide variety of statistical software packages. There are six separate sub-sets of data for this study (see below). Each sub-set corresponds to a distinct phase in the data collection process. For those wishing to download the entire data set, we have also provided an additional file that contains all six sub-sets as one file (MacAlldata_SPSS.exe / MacAlldata_POR.exe).

Coding information is provided through a series of code books. Each of the six code books correspond to a data file. Additionally, throughout the code books, there are references made to code sheets. These code sheets were used to code and/or interpret particular variables. These code sheets can be found in the "Code Sheets" folder. Data sub-sets and their corresponding code books are as follows:

Subject Baseline Interview Coding (baseline_SPSS.exe / baseline_POR.exe)

  • Clinical Interview / Tracking Variables Manual
  • Research / Baseline Calculated Variables Manual

Subject Follow-up Interview Coding Manual (follsubj_SPSS.exe / follsubj_POR.exe)

Collateral Follow-up Interview Coding Manual (follcoll_SPSS.exe / follcoll_POR.exe)

Community Sample -- Subject Interview Manual (commsubj_SPSS.exe / commsubj_POR.exe)

Community Sample -- Collateral Interview Manual (commcoll_SPSS.exe / commcoll_POR.exe)

Reconciled Violence Coding Manual (violence_SPSS.exe / violence_POR.exe)

Code Sheets

  • MacArthur Code sheets (These files are all of the code sheets that were used in the study. The following is a list of each code sheet in the set.)
    • Relationship Codes (MAC REL CODES)
    • Occupation Codes (MAC JOB CODES)
    • Revised categories for violence probe question (MAC PROBE QUES)
    • Street Drug Codes (MAC DRUG CODES)
    • Medication Codes (MAC MED CODES)
    • Crime Classification Codes (MAC CRIME CLASS)
    • Global Assessment of Functioning (GAF)
MACARTHUR RISK ASSESSMENT INSTRUMENTS BY INTERVIEW
 

Baseline Interview

Research

Baseline
Interview

Clinical

Baseline
Interview

Add-Ons

Follow-Up Interview

Subject

Follow-Up Interview

Collateral

Follow-Up (Subject)

Add-Ons

Community Interview

Subject

Community Interview

Collateral

ADL/Level of Functioning Check Mark     Check Mark     Check Mark  
Admission Profile Check Mark              
Admitting Incident Log* Check Mark                
Alcohol Use       Check Mark Check Mark   Check Mark Check Mark
Anger (Novaco/NAS) Check Mark         Check Mark Check Mark  
Arrests       Check Mark Check Mark   Check Mark Check Mark
Auditory Hallucinations Schedule   Check Mark  

Check Mark

       
BPRS   Check Mark   Check Mark Check Mark   Check Mark Check Mark
Collateral Profile         Check Mark     Check Mark
Current Admission Check Mark              
Delusions Screening Questions   Check Mark   Check Mark     Check Mark  
DSM III-R Criteria Checklist   Check Mark            
Discharge Data Sheet     Check Mark          
Drug Use   Check Mark   Check Mark Check Mark   Check Mark Check Mark
Family History Check Mark           Check Mark  
Fantasies/ Thoughts / Daydreams Check Mark     Check Mark     Check Mark  
GAF   Check Mark   Check Mark     Check Mark  
Hospitalizations Check Mark     Check Mark     Check Mark  
Impulsiveness (BIS-11) Check Mark       Check Mark Check Mark Check Mark

Check Mark

MACARTHUR RISK ASSESSMENT INSTRUMENTS BY INTERVIEW (cont.)
 

Baseline Interview

Research

Baseline Interview

Clinical

Baseline
Interview

Add-Ons

Follow- Up
Interview

Subject

Follow- Up
Interview

Collateral

Follow- Up Int.(Subject)

Add-Ons

Community
Interview

Subject

Community
Interview

Collateral

Incident Description (for Level I incidents) Check Mark     Check Mark Check Mark   Check Mark Check Mark
IQ (WAIS-R -
Vocabulary Subscale)
          Check Mark Check Mark  
Interpersonal Relations Scale

(IRS-A)

Check Mark     Check Mark        
Interviewer Questionnaire Check Mark Check Mark   Check Mark Check Mark   Check Mark Check Mark
MMDAS-Part 1

  Check Mark   Check Mark        
MMDAS-Part 2   Check Mark   Check Mark        
Medications       Check Mark     Check Mark  
Mini-Mental Status   Check Mark            
NEO Five Factor Inventory           Check Mark Check Mark  
Neurology Screening Questions   Check Mark         Check Mark  
PCL: Screening Version           Check Mark Check Mark  
Perceived Stress Check Mark     Check Mark     Check Mark  
Personal Reaction Inventory (PRI) Check Mark         Check Mark Check Mark  
Personality Disorders
(SIDP-R)
          Check Mark Check Mark Check Mark
MACARTHUR RISK ASSESSMENT INSTRUMENTS BY INTERVIEW (cont.)

 

Baseline Interview

Research

Baseline
Interview

Clinical

Baseline
Interview

Add-Ons

Follow-Up
Interview

Subject

Follow-Up
Interview

Collateral

Follow-Up Int.
(Subject)

Add-Ons

Community
Interview

Subject

Community
Interview

Collateral

Police Contact / Institutions       Check Mark Check Mark   Check Mark Check Mark
Probe Questions (for Level I incidents) Check Mark     Check Mark Check Mark   Check Mark Check Mark
Rehospitalization Data Sheet     Check Mark          
Residence** Check Mark     Check Mark Check Mark   Check Mark Check Mark
Self-Harm Check Mark     Check Mark     Check Mark  
Sexual Abuse Screening Questions   Check Mark         Check Mark  
Social Network Inventory (SNI) Check Mark     Check Mark     Check Mark  
Social Support Check Mark     Check Mark     Check Mark  
Social Support Grid Check Mark     Check Mark      Check Mark  
Subject Profile             Check Mark  
Treatment       Check Mark Check Mark   Check Mark Check Mark
Violence Screen #1 Check Mark     Check Mark Check Mark   Check Mark Check Mark
Violence Screen #2       Check Mark Check Mark   Check Mark Check Mark
Weapon Availability       Check Mark Check Mark   Check Mark Check Mark
Work / School *** Check Mark     Check Mark Check Mark   Check Mark Check Mark
 
* The Admitting Incident Log contains the same type of questions/variables as contained in Screen #2
** Additional social support information related to subject's CURRENT residence can also be found in this section
*** The variables in the work/school section of each interview vary by interview (refer to code books for comparable variables)

 

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