PubMed Health⌕ Search

Biomedical subjects

Edward P Mulvey

Publications and source records attributed to Edward P Mulvey.

13 recordsLinked to original sources
PubMed2007

Violence and mental illness: a new analytic approach.

Empirical studies of violence and mental illness have used many different methods. Current state-of-the-art methods gather information from both subject and collateral interviews as well as official records. Typically these sources are treated as additive. Any report of a violent incident from any source is treated as true and all reported incidents are added to generate estimates of frequency. This paper presents a new statistical technique that uses the level of agreement between the sources of data to adjust those estimates. The evidence suggests that, although the additive technique for using multiple sources correctly estimates how many people are involved, it substantially underestimates the number of incidents. The new technique substantially reduces both false negatives and false positives.

Humans↗
PubMed2006

The classification of violence risk.

The Classification of Violence Risk (COVR) is an interactive software program designed to estimate the risk that a person hospitalized for mental disorder will be violent to others. The software leads the evaluator through a chart review and a brief interview with the patient. At the end of this interview, the software generates a report that contains a statistically valid estimate of the patient's violence risk-ranging from a 1% to a 76% likelihood of violence-including the confidence interval for that estimate, and a list of the risk factors that the program took into account to produce the estimate. In this article, the development of the COVR software is described and several issues that arise in its administration are discussed.

Antisocial Personality Disorder↗
PubMed2006

Substance use and community violence: a test of the relation at the daily level.

Prior research has consistently demonstrated an association between substance use and involvement in violence among individuals with mental illness. Yet little is known about the temporal quality of this relationship, largely because longitudinal data required to address this issue are not readily available. This study examined the relationship between substance use (alcohol, marijuana, and other drug use) and violence at the daily level within a sample of mentally ill individuals at high risk for frequent involvement in violence (N = 132). Results support the serial nature of substance use and violence, with an increased likelihood of violence on days following the use of alcohol or multiple drugs, but not the inverse relationship. Implications for the utility of substance use as a risk marker for the assessment of future violence are discussed.

Adult↗
PubMed2006

Psychiatric symptoms and community violence among high-risk patients: A test of the relationship at the weekly level.

Given the availability of violence risk assessment tools, clinicians are now better able to identify high-risk patients. Once these patients have been identified, clinicians must monitor risk state and intervene when necessary to prevent harm. Clinical practice is dominated by the assumption that increases in psychiatric symptoms elevate risk of imminent violence. This intensive study of patients (N = 132) at high risk for community violence is the first to evaluate prospectively the temporal relation between symptoms and violence. Symptoms were assessed with the Brief Symptom Inventory and threat/control override (TCO) scales. Results indicate that a high-risk patient with increased anger in 1 week is significantly more likely to be involved in serious violence in the following week. This was not true of other symptom constellations (anxiety, depression, TCO) or general psychological distress. The authors found no evidence that increases in the latter symptoms during 1 week provide an independent foundation for expecting violence during the following week.

Adolescent↗
PubMed2006

Treatment utilization and satisfaction: examining the contributions of Axis II psychopathology and the Five-Factor Model of personality.

Numerous studies have demonstrated a link between personality disorders (PDs) and increased treatment utilization and decreased satisfaction. However, few studies have examined the link between general personality models, such as the Five-Factor Model (FFM), and these treatment variables. The current study examines the role of depression, anxiety, and functioning, PDs, and the FFM in accounting for psychiatric treatment utilization and satisfaction with care in two distinct clinical samples (n = 99 and 544, respectively). The results suggest that both maladaptive personality symptoms and general personality traits are predictive of these outcome variables. Importantly, the findings regarding treatment utilization replicate across samples and level of personality assessment (i.e., FFM and PDs). It is argued that both types of personality information should be included in the initial treatment planning and implementation stages.

Adult↗
PubMed2005

What do clinicians expect? Comparing envisioned and reported violence for male and female patients.

Mental health professionals' (MHPs') accuracy in assessing the risk of violence in female patients is particularly limited. Based on assessments made by 205 MHPs of 605 patients in an emergency room, this study explored potential causes of MHPs' poorer accuracy in assessing women's potential for violence. The dimensions that underlie MHPs' envisioned violence in patients were identified and were compared with those that characterized patients' reported violence during a 6-month follow-up period. There were three key findings from their study. First, violence envisioned by MHPs differed depending on their professional role and varied in its congruence with patients' reported violence. Second, patients' violence was organized by dimensions of domesticity and substance relatedness; women's violent incidents were more domestic than were men's. Third, when MHPs envisioned violence that was highly conditional on psychiatric deterioration and medication noncompliance, violence often did not occur.

Adult↗
PubMed2005

An actuarial model of violence risk assessment for persons with mental disorders.

OBJECTIVES: An actuarial model was developed in the MacArthur Violence Risk Assessment Study to predict violence in the community among patients who have recently been discharged from psychiatric facilities. This model, called the multiple iterative classification tree (ICT) model, showed considerable accuracy in predicting violence in the construction sample. The purpose of the study reported here was to determine the validity of the multiple ICT model in distinguishing between patients with high and low risk of violence in the community when applied to a new sample of individuals. METHODS: Software incorporating the multiple ICT model was administered with independent samples of acutely hospitalized civil patients. Patients who were classified as having a high or a low risk of violence were followed in the community for 20 weeks after discharge. Violence included any battery with physical injury, use of a weapon, threats made with a weapon in hand, and sexual assault. RESULTS: Expected rates of violence in the low- and high-risk groups were 1 percent and 64 percent, respectively. Observed rates of violence in the low- and high-risk groups were 9 percent and 35 percent, respectively, when a strict definition of violence was used, and 9 percent and 49 percent, respectively, when a slightly more inclusive definition of violence was used. These findings may reflect the "shrinkage" expected in moving from construction to validation samples. CONCLUSIONS: The multiple ICT model may be helpful to clinicians who are faced with making decisions about discharge planning for acutely hospitalized civil patients.

Actuarial Analysis↗
PubMed2005

Weekly community interviews with high-risk participants: operational issues.

To address several key questions in social science research, repeated interviews of individuals drawn from difficult populations are required. This article describes an approach for addressing the challenges associated with longitudinal interview studies, including locating research participants, obtaining reliable and valid interview data over time, and retaining participants across the course of the study. We applied this approach to conduct a study designed to identify changeable risk factors for violence among high-risk people with mental illness. To successfully conduct weekly interviews of these individuals in the community across a 6-month period, we developed a flexible and personalized interview format; carefully selected, trained, and supervised staff; and developed incentives to maximize participant retention. Each of these three steps is discussed as a guide for future longitudinal studies that involve interviewing difficult populations.

Adult↗
PubMed2003

Applicability of traditional and revised models of psychopathy to the Psychopathy Checklist: screening version.

Recently, psychopathy has become virtually synonymous with the Psychopathy Checklist (PCL) measures. However, the "gold standard" 2-factor model that underlines these measures has been questioned for its uncertain empirical support and emphasis on antisocial behavior that is not specific to psychopathic personality deviation. This study (N = 870 civil psychiatric patients) compares the fit of the traditional 2-factor model with that of a revised 3-factor model of psychopathy. The revised model better describes the structure of the Screening Version of the PCL (PCL:SV) than the traditional model. Although the revised model's exclusion of some items that assess antisocial behavior reduces the PCL:SV's power in predicting patient violence, this model arguably assesses psychopathy in a more specific, theoretically coherent fashion that may reduce misapplications of the construct. Implications for future research are discussed.

Adult↗
PubMed2002

Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited.

We examined the relationship between neighborhood structural characteristics and mental disorder using data from the National Institute of Mental Health's Epidemiological Catchment (ECA) surveys (n = 11,686). After controlling for individual-level characteristics, we found that neighborhood disadvantage was associated with higher rates of major depression and substance abuse disorder, and that neighborhood residential mobility was associated with higher rates of schizophrenia, major depression, and substance abuse disorder. Implications for future research on the social ecology of mental disorder are discussed.

Adult↗
PubMed2002

Psychopathy, treatment involvement, and subsequent violence among civil psychiatric patients.

Individuals with psychopathy typically are viewed as incurable cases that should be diverted from treatment settings to environments where their behavior can be monitored and controlled. The prevailing clinical conviction that psychopaths are untreatable has crucial implications, given the scarcity of mental health care resources, the number of legal contexts that call for assessment of treatability, and the explosion of research on psychopathy and violence risk over recent years. Based on a sample of 871 civil psychiatric patients (including 195 "potentially psychopathic" and 72 "psychopathic" patients), this study explores the relations among psychopathy, receipt of outpatient mental health services in real-world settings, and subsequent violence in the community. The results suggest that psychopathic traits do not moderate the effect of treatment involvement on violence, even after controlling statistically for the treatment assignment process. Psychopathic patients appear as likely as non-psychopathic patients to benefit from adequate doses of treatment, in terms of violence reduction. We interpret these results in light of prior research with offenders and analyze their implications for future research, policy, and practice.

Adult↗
PubMed1986

Delinquency cessation and adolescent development: preliminary data.

Recent research on juvenile criminal careers has documented a consistent drop in the prevalence of delinquent activity during late adolescence, but there are only a few limited investigations of the processes underlying this occurrence. The present report of retrospective interviews with a sample of recently "reformed" 15-20-year-old white males suggests directions for larger-scale and more rigorous research.

Adolescent↗