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Rates of violence in persons identified as high risk by structured risk
assessment instruments (SRAIs) are uncertain and frequently unreported by
To analyse the variation in rates of violence in individuals identified
as high risk by SRAIs.
A systematic search of databases (1995–2011) was conducted for studies on
nine widely used assessment tools. Where violence rates in high-risk
groups were not published, these were requested from study authors. Rate
information was extracted, and binomial logistic regression was used to
Information was collected on 13 045 participants in 57 samples from 47
independent studies. Annualised rates of violence in individuals
classified as high risk varied both across and within instruments. Rates
were elevated when population rates of violence were higher, when a
structured professional judgement instrument was used and when there was
a lower proportion of men in a study.
After controlling for time at risk, the rate of violence in individuals
classified as high risk by SRAIs shows substantial variation. In the
absence of information on local base rates, assigning predetermined
probabilities to future violence risk on the basis of a structured risk
assessment is not supported by the current evidence base. This
underscores the need for caution when such risk estimates are used to
influence decisions related to individual liberty and public safety.
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