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Predicting self- and other-directed violence among discharged psychiatric patients: the roles of anger and psychopathic traits

Published online by Cambridge University Press:  18 July 2011

M. T. Swogger ,
Z. Walsh ,
B. Y. Homaifar ,
E. D. Caine  and
K. R. Conner
M. T. Swogger*
Affiliation:
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
Z. Walsh
Affiliation:
University of British Columbia, Okanagan, Canada
B. Y. Homaifar
Affiliation:
VA VISN 19 Mental Illness Research, Education, and Clinical Center (MIRECC), Denver, CO, USA
E. D. Caine
Affiliation:
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA Canandaigua VA Center of Excellence, Canandaigua, NY, USA
K. R. Conner
Affiliation:
Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA Canandaigua VA Center of Excellence, Canandaigua, NY, USA
*
*Address for correspondence: Dr M. T. Swogger, Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA. (Email: Marc_Swogger@urmc.rochester.edu)
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Abstract

Background

We examined the extent to which trait anger and psychopathic traits predicted post-discharge self-directed violence (SDV) and other-directed violence (ODV) among psychiatric patients.

Method

Participants were 851 psychiatric patients sampled from in-patient hospitals for the MacArthur Violence Risk Assessment Study (MVRAS). Participants were administered baseline interviews at the hospital and five follow-up interviews in the community at approximately 10-week intervals. Psychopathy and trait anger were assessed with the Psychopathy Checklist: Screening Version (PSC:SV) and the Novaco Anger Scale (NAS) respectively. SDV was assessed during follow-ups with participants and ODV was assessed during interviews with participants and collateral informants. Psychopathy facets and anger were entered in logistic regression models to predict membership in one of four groups indicating violence status during follow-up: (1) SDV, (2) ODV, (3) co-occurring violence (COV), and (4) no violence.

Results

Anger predicted membership in all three violence groups relative to a non-violent reference group. In unadjusted models, all psychopathy facets predicted ODV and COV during follow-up. In adjusted models, interpersonal and antisocial traits of psychopathy predicted membership in the ODV group whereas only antisocial traits predicted membership in the COV group.

Conclusions

Although our results provide evidence for a broad role for trait anger in predicting SDV and ODV among discharged psychiatric patients, they suggest that unique patterns of psychopathic traits differentially predict violence toward self and others. The measurement of anger and facets of psychopathy during discharge planning for psychiatric patients may provide clinicians with information regarding risk for specific types of violence.

Keywords

Aggressionangerpsychopathysuicideviolence
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 2 , February 2012 , pp. 371 - 379
Copyright
Copyright © Cambridge University Press 2011

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