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Actuarial prediction of violent recidivism in mentally disordered offenders

  • ROBERT J. SNOWDEN (a1), NICOLA S. GRAY (a1) (a2), JOHN TAYLOR (a3) and MALCOLM J. MacCULLOCH (a1) (a2) (a4)

Actuarial instruments may be useful in predicting long-term violence in mentally disordered patients. We compared two instruments that differ in terms of what they are designed to predict (general versus violent recividism) and the inclusion of stable mental health variables.


A large sample of mentally disordered patients were scored on two risk assessment instruments, the Violence Risk Appraisal Guide (VRAG) and the Offender Group Reconviction Scale (OGRS), based on information at the point of discharge. Their criminal histories for at least 2 years following discharge were obtained from official records.


Both instruments were good predictors of both violent and general offending. Over shorter periods (<1 year) the VRAG had very good predictive validities for both types of offences [areas under the receiver operating characteristic curves (AUCs) >0·85], which were significantly better than the OGRS. For longer follow-up periods the instruments had approximately equal prediction accuracy. However, both instruments predicted far more offences than were in fact recorded.


The VRAG is a very good predictor of future violence in the UK sample. The OGRS may also be of value as it can be completed quickly and without the need for mental health variables. Caution is needed, however, as both instruments appeared to over-predict the levels of reconvictions in this sample.

Corresponding author
*Address for correspondence: Professor R. J. Snowden, School of Psychology, Cardiff University, Cardiff CF10 3AT, Wales, UK. (Email:
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P. S. Appelbaum , P. C. Robbins & J. Monahan (2000). Violence and delusions: data from the MacArthur violence risk assessment study. American Journal of Psychiatry 157, 566572.

J. Arboleda-Florez , H. Holley & A. Crisanti (1998). Understanding casual paths between mental illness and violence. Social Psychiatry and Psychiatric Epidemiology 33, s38s46.

L. Arseneault , T. E. Moffitt , A. Caspi , P. J. Taylor & P. A. Silva (2000). Mental disorders and violence in a total birth cohort. Archives of General Psychiatry 57, 979986.

H. E. Barbaree , M. C. Seto , C. M. Langton & E. J. Peacock (2001). Evaluating the predictive accuracy of six risk assessment instruments for adult sex offenders. Criminal Justice and Behavior 28, 490521.

J. Bonta , M. Law & K. Hanson (1998). The prediction of criminal and violent recividism among mentally disordered offenders: a meta-analysis. Psychological Bulletin 123, 123142.

K. S. Douglas , M. Yoemans & D. P. Boer (2005). Comparative validity analysis of multiple measures of violence risk in a sample of criminal offenders. Criminal Justice and Behavior 32, 479510.

M. Doyle & M. Dolan (2006). Predicting community violence from patients discharged from mental health services. British Journal of Psychiatry 189, 520526.

M. Doyle , M. Dolan & J. McGovern (2002). The validity of North American risk assessment tools in predicting in-patient violent behaviour in England. Legal and Criminological Psychology 7, 141154.

W. Gardner , C. W. Lidz , E. P. Mulvery & E. C. Shaw (1996 a). Clinical versus actuarial predictions of violence in patients with mental illness. Journal of Consulting and Clinical Psychology 64, 602609.

W. Gardner , C. W. Lidz , E. P. Mulvery & E. C. Shaw (1996 b). A comparison of actuarial methods for identifying repetitively violent patients with mental illnesses. Law and Human Behaviour 20, 3548.

P. Gendreau , T. Little & C. Goggin (1996). A meta-analysis of the predictors of adult offender recividism. What works! Criminology 34, 575607.

A. J. J. Glover , D. E. Nicholson , T. Hemmati , G. A. Bernfeld & V. L. Quinsey (2002). A comparison of predictors of general and violent recividism among high risk federal offenders. Criminal Justice and Behavior 29, 235249.

M. Grann , H. Belfrage & A. Tengstrom (2000). Actuarial assessment of risk for violence. Predictive validity of the VRAG and the historical part of the HCR-20. Criminal Justice and Behavior 27, 97114.

M. Grann & I. Wedin (2002). Risk factors for recidivism among spousal assault and spousal homicide offenders. Psychology, Crime and Law 8, 523.

N. S. Gray , C. Hill , A. McGleish , D. Timmons , M. J. MacCulloch & R. J. Snowden (2003). Prediction of violence and self-harm in mentally disordered offenders: a prospective study of the efficacy of HCR-20, PCL-R and psychiatric symptomatology. Journal of Consulting and Clinical Psychology 71, 443451.

N. S. Gray , R. J. Snowden , S. MacCulloch , H. Phillips , J. Taylor & M. J. MacCulloch (2004). Relative efficacy of criminological, clinical and personality measures of future risk of offending in mentally disordered offenders: a comparative study of HCR-20, PCL:SV and OGRS. Journal of Consulting and Clinical Psychology 72, 523530.

W. M. Grove , D. H. Zald , B. S. Lebow , B. E. Snitz & C. Nelson (2000). Clinical versus mechanical prediction: a meta-analysis. Psychological Assessment 12, 1930.

J. A. Hanley & B. J. McNeil (1983). A method of comparing the areas under the receiving operating characteristic curves derived from the same cases. Radiology 148, 839843.

G. T. Harris , M. E. Rice & J. A. Camilleri (2004). Applying a forensic actuarial assessment (the Violence Risk Appraisal Guide) to nonforensic patients. Journal of Interpersonal Violence 19, 10631074.

G. T. Harris , M. E. Rice & C. A. Cormier (2002). Prospective replication of the Violence Risk Appraisal Guide in predicting violent recidivism among forensic patients. Law and Human Behavior 26, 377394.

G. T. Harris , M. E. Rice & V. L. Quinsey (1993). Violent recidivism of mentally disordered offenders: the development of a statistical prediction instrument. Criminal Justice and Behavior 20, 315335.

G. T. Harris , M. E. Rice , V. L. Quinsey , M. L. Lalumiere , D. Boer & C. Lang (2003). A multisite comparison of actuarial risk instruments for sex offenders. Psychological Assessment 15, 413425.

S. Hodgins & C.-G. Janson (2002). Criminality and Violence Among the Mentally Disordered: The Stockholm Metropolitan Project. Cambridge University Press: Cambridge.

D. G. Kroner & J. F. Mills (2001). The accuracy of five risk appraisal instruments in predicting institutional misconduct and new convictions. Criminal Justice and Behavior 28, 471489.

W. Loza , D. B. Villeneuve & A. Loza-Fanous (2002). Predictive validity of the Violence Risk Appraisal Guide: a tool for assessing violent offender's recidivism. International Journal of Law and Psychiatry 25, 8592.

A. Maden , F. Scott , R. Burnett , G. H. Lewis & P. Skapinakis (2004). Offending in psychiatric patients after discharge from medium secure units: prospective national cohort study. British Medical Journal 328, 1534.

D. E. McNiel , A. L. Gregory , J. N. Lam , R. L. Binder & G. R. Sullivan (2003). Utility of decision support tools for assessing acute risk of violence. Journal of Consulting and Clinical Psychology 71, 945953.

J. F. Mills , M. N. Jones & D. G. Kroner (2005). An examination of the generalizability of the LSI-R and VRAG probability bins. Criminal Justice and Behavior 32, 565585.

J. F. Mills , D. G. Kroner & T. Hemmati (2003). Predicting violent behaviour through a static-stable variable lens. Journal of Interpersonal Violence 18, 891904.

J. Monahan (1992). Mental disorder and violent behavior. American Psychologist 47, 511521.

D. Mossman (1994). Assessing predictions of violence: being accurate about accuracy. Journal of Consulting and Clinical Psychology 62, 783792.

T. H. Pham , C. Ducro , B. Marghem & C. Reveillere (2005). Prediction of recidivism among prison inmates and forensic patients in Belgium. Annales Medico-Psychologiques 163, 842845.

H. Phillips , N. S. Gray , S. MacCulloch , J. Taylor , S. C. Moore , P. Huckle & M. J. MacCulloch (2005). Risk assessment in offenders with mental disorders. Relative efficacy of personal demographics, criminal history, and clinical variables. Journal of Interpersonal Violence 20, 833847.

V. L. Quinsey , G. T. Harris , M. E. Rice & C. A. Cormier (1998). Violent Offenders: Appraising and Managing Risk. American Psychological Association: Washington, DC.

M. E. Rice & G. T. Harris (1995). Violent recidivism: assessing predictive validity. Journal of Consulting and Clinical Psychology 63, 737748.

M. E. Rice & G. T. Harris (1997). Cross-validation and extension of the Violence Risk Appraisal Guide for child molesters and rapists. Law and Human Behavior 21, 231241.

M. E. Rice & G. T. Harris (2005). Comparing effect sizes in follow-up studies: ROC area, Cohen's d, and r. Law and Human Behavior 29, 615620.

G. Sjostedt & N. Langstrom (2002). Assessment of risk for criminal recidivism among rapists: a comparison of four different measures. Psychology, Crime and Law 8, 2540.

A. Tengstrom (2001). Long-term predictive validity of historical factors in two risk assessment instruments in a group of violent offenders with schizophrenia. Nordic Journal of Psychiatry 55, 243249.

F. Urabaniok , T. Noll , S. Grunewald , J. Steinbach & J. Endrass (2006). Prediction of violent and sexual offences: a replication study of the VRAG in Switzerland. Journal of Forensic Psychiatry and Psychology 17, 2331.

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Psychological Medicine
  • ISSN: 0033-2917
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