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Integrating DSM-IV Factors to Predict Violence in High-Risk Psychiatric Patients


  • Donna M. Lynch M.S.N.,

    1. VA Connecticut (VACT) Healthcare System, Department of Nursing/118, 950 Campbell Avenue, West Haven; and Southern Connecticut State University, New Haven, CT.
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  • Helen C. Noel Ph.D.

    1. Retired; VACT Healthcare System, 950 Campbell Avenue, West Haven; Courtesy Clinical Professor/Graduate Nurse Practitioner Program, Yale University, New Haven; and Sacred Heart University, Fairfield, CT.
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Additional information—reprints not available from author:
Donna M. Lynch, M.S.N.
VA Connecticut (VACT) Healthcare System
Department of Nursing/118
950 Campbell Avenue
West Haven, CT 06516


Abstract:  This study incorporated Axis-II and Axis-IV factors in DSM-IV to test the relationship between predicted risk for violence assessed in the psychiatric emergency room and actual violence during hospitalization. Psychiatric nurses lack an objective instrument to use during the acute psychiatric assessment. The retrospective study comprised consecutive psychiatric admissions (n = 161) in one tertiary veterans’ hospital. Statistical testing for the predictive power of risk factors, relationships between variables, and violent events included nonparametric tests, factor analysis, and logistic regression. Of the 32 patients who committed violence during hospitalization, 12 had committed violence in the psychiatric emergency room. Statistical significance was shown for violent incidents and dementia, court-ordered admission, mood disorder, and for three or more risk factors. The 13-item Risk of Violence Assessment (ROVA) scale suggests validity and sensitivity for rating DSM-IV factors and psychosocial stressors to predict risk for violence during hospitalization. Replication studies are recommended to strengthen validity of the ROVA scale.