Incremental Validity of Patients’ Self-Reported Anger Beyond Structured Professional Judgment Tools in the Prediction of Inpatient Aggression

Rahul Jalil, Jorg Huber, Judith Sixsmith, Geoffrey Dickens

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Mental health inpatients’ self-reported violence risk predicts actual aggressive outcomes. Anger, for which there are well-evidenced interventions, commonly precedes inpatient aggression. We aimed to determine whether patients’ self-reported anger added incremental validity to violence prediction beyond routinely completed violence risk assessments. A correlational, pseudo-prospective study design was employed. N = 76 inpatients in secure hospitals completed self-report validated anger measures; routinely collected clinicians' ratings on structured professional judgment tools, and aggressive incident data for a 3-month follow-up period were extracted from clinical records. Thirty four (45%) participants were violent; self-reported anger and clinician-risk ratings were significantly positively correlated. Self-reported anger predicted aggressive outcomes but not incrementally beyond relevant risk assessment subscale and item scores. It may not be beneficial for all patients to self-report anger as part of continuous violence risk assessments, but those who score highly on anger-relevant items of risk assessment tools could be considered for further assessment to support risk-management interventions.
Original languageEnglish
Number of pages12
JournalInternational Journal of Forensic Mental Health
Publication statusE-pub ahead of print - 26 Mar 2019



  • Anger
  • inpatient aggression
  • patients' self-report
  • risk assessment

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