Biopsychosocial Model of Suicidal Behaviour

Introduction

There are a variety of models of suicidal behaviour. These models attempt to map suicidal behaviour or put it into boxes so that a helping professional can better understand how suicidal behaviour forms and how it can be treated and resolved. This Biopsychosocial Model comes from Kumar, U. & Mandal, M.K. (2010).

The model is first presented in textual format, followed by an image, and then an explanation.

Biopsychosocial Model

Biological, Environmental and Event factors feed into a Psychological Process. This psychological process leads to the development or exacerbation of a mental health issue and to suicidal behaviour. On a cognitive level, this affects how the individual thinks and feels about the past, present and future.

 

 

 

 

 

 

 

 

 

 

 

 

 

Biological Influences in Suicide

There are a number of biological factors that can increase the risk of suicide which have been reviewed by Pandey (2013). These include genetic predisposition of suicidal behaviour (Turecki, 2001) which may be related to increased prevalence of impulsiveness and aggressiveness.

5HT receptors are receptors in the brain that are activated by the neurotransmitter serotonin. Serotonin plays an important role in mood (Yohn, Guerges & Samuels, 2017), appetite and eating (Sharma & Sharma, 2012), sleep, memory and sexual function. Improperly functioning 5HT receptors may play a role both in depression and in suicidal behavior.

It has been well-documented that teens and adolescents are more impulsive than adults as their brains continue to develop up to age 25 (Kasen, Cohen & Chen, 2011) and this can increase their risk of suicide and homicide. (Glick, 2015) Witt et. al. (2008) examines this through the lens of the Interpersonal Theory of Suicide – suggesting that impulsive individuals are more likely to have acquired capability (through being exposed to pain), which is one of the 3 key elements of that Theory of Suicide.

Environmental Influences in Suicide

Environmental influences on suicidal behaviour include literal environmental factors like sunlight exposure and situational factors like presence of abuse, history of suicide attempts and other items that are commonly known as suicide risk factors.

Souêtre et. al. (1990) found that decreased sunlight exposure and lowered temperature was linked to increased risk of suicide. This may explain the high rate of suicide in Nordic and Scandinavian countries that lack many of the other risk factors for suicide. Lam et. al. (1999) found that light therapy decreased suicidal ideation in a population of women who struggled with Seasonal Affective Disorder (SAD).

Evans, Owens & Marsh (2005) found that an external locus of control (believing that life “happens to one” rather than one having control over their life) was associated with an increased risk of suicide in adolescents. This likely holds true in adults as well.

Other risk factors for suicide include the American Association of Suicidology’s IS PATH WARM mnemonic:

  • Ideation (thoughts of suicide)
  • Substance Abuse
  • Purposelessness
  • Anxiety
  • Trapped (a feeling of being trapped)
  • Hopelessness
  • Withdrawal (from others)
  • Anger
  • Recklessness
  • Mood Changes

Event Influences in Suicide

Sometimes an event occurs in someone’s life that is so devastating that it may lead to suicide. For instance, relational changes and other interpersonal issues (such as a loss of a relationship or fights with a friend) commonly precede a suicide attempt (Yen et. al., 2005; Bagge, Glenn & Lee, 2013; Conner, et. al., 2012)

In addition to interpersonal events as described above, events that may lead to suicidal behaviour include being arrested, charged or sentenced with a crime (Cooper, Appleby & Amos, 2002). Zhang & Ma (2012) also found this in a Chinese sample of suicide attempters, with the most common stressful life events preceding suicide involving family/home, hospital/health and marriage/love.

Conclusion

It’s clear that the biopsychosocial model of suicide has a fair amount of support for its component parts. It may be difficult to apply the Biopsychosocial Model directly in a clinical or therapeutic context. For that reason, other models may be preferred for intervention purposes.

References

Bagge, C. L., Glenn, C. R., & Lee, H. (2013). Quantifying the impact of recent negative life events on suicide attempts. Journal Of Abnormal Psychology122(2), 359-368. doi:10.1037/a0030371

Conner, K. R., Houston, R. J., Swogger, M. T., Conwell, Y., You, S., He, H., & … Duberstein, P. R. (2012). Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type. Drug & Alcohol Dependence120(1-3), 155-161. doi:10.1016/j.drugalcdep.2011.07.013

Cooper, J., Appleby, L., & Amos, T. (2002). Life events preceding suicide by young people. Social Psychiatry & Psychiatric Epidemiology37(6), 271.

Evans, W. P., Owens, P., & Marsh, S. C. (2005). Environmental Factors, Locus of Control, and Adolescent Suicide Risk. Child & Adolescent Social Work Journal22(3/4), 301-319. doi:10.1007/s10560-005-0013-x

Glick, A. R. (2015). The role of serotonin in impulsive aggression, suicide, and homicide in adolescents and adults: a literature review. International Journal Of Adolescent Medicine And Health, (2), 143. doi:10.1515/ijamh-2015-5005

Kasen, S., Cohen, P., & Chen, H. (2011). Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort. Suicide And Life-Threatening Behavior, (2), 180.

Kumar, U & Mandal, M.K. (2010). Suicidal Behavior: Assessment of People-at-Risk. New Delhi, India: SAGE Publications.

Lam, R. W., Carter, D., Misri, S., Kuan, A. J., Yatham, L. N., & Zis, A. P. (1999). A controlled study of light therapy in women with late luteal phase dysphoric disorder. Psychiatry Research86185-192. doi:10.1016/S0165-1781(99)00043-8

Pandey, G. N. (2013). Biological basis of suicide and suicidal behavior. Bipolar Disorders15(5), 524-541. doi:10.1111/bdi.12089

Sharma, S., & Sharma, J. (2012). Regulation of Appetite: Role of Serotonin and Hypothalamus. Iranian Journal Of Pharmacology & Therapeutics11(2), 73-79.

Souêtre, E., Wehr, T.A., Douillet, P. & Darcourt, G. (1990) Influence of environmental factors on suicidal behavior. Psychiatry Research. 32(3):253-63.

Turecki, G. (2001). Suicidal behavior: is there a genetic predisposition?. Bipolar Disorders3(6), 335-349.

Witte, T. K., Merrill, K. A., Stellrecht, N. E., Bernert, R. A., Hollar, D. L., Schatschneider, C., & Joiner, J. E. (2008). Research report: “Impulsive” youth suicide attempters are not necessarily all that impulsive. Journal Of Affective Disorders107107-116. doi:10.1016/j.jad.2007.08.010

Yen, S., Pagano, M. E., Shea, M. T., Grilo, C. M., Gunderson, J. G., Skodol, A. E., & … Zanarini, M. C. (2005). Recent Life Events Preceding Suicide Attempts in a Personality Disorder Sample: Findings From the Collaborative Longitudinal Personality Disorders Study. Journal Of Consulting And Clinical Psychology73(1), 99-105. doi:10.1037/0022-006X.73.1.99

Yohn, C. N., Gergues, M. M., & Samuels, B. A. (2017). The role of 5-HT receptors in depression. Molecular Brain101-12. doi:10.1186/s13041-017-0306-y

Zhang, J., & Ma, Z. (2012). Research report: Patterns of life events preceding the suicide in rural young Chinese: A case control study. Journal Of Affective Disorders140161-167. doi:10.1016/j.jad.2012.01.010

Cite this article as: MacDonald, D.K., (2017), "Biopsychosocial Model of Suicidal Behaviour," retrieved on September 21, 2017 from http://dustinkmacdonald.com/biopsychosocial-model-suicidal-behaviour/.
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SIMPLE STEPS Model for Suicide Risk Assessment

Introduction

The SIMPLE STEPS Model (McGlothlin, 2008) for suicide risk assessment provides a simple mnemonic similar to others like SADPERSONS (Patterson, et. al., 1983) or IS PATH WARM (from the American Association of Suicidology). Each of these is correlated with increasing suicide lethality and so this can be a useful short-hand to remember these items.

Suicide risk assessment on the crisis line is mostly concerned with imminent risk, and many suicide screeners designed for lay people may miss important variables in a goal to be simplistic; the SIMPLE STEPS model appears to avoid both of these traps, by providing an assessment tool simple enough to be used in the crisis line environment but comprehensive enough to be used by counsellors or therapists for ongoing monitoring of suicide risk.

Items in the SIMPLE STEPS Model

  • Suicidal – Is the individual expressing suicidal ideation?
  • Ideation – What is their suicidal intent?
  • Method – How detailed and accessible is their suicidal method?
  • Perturbation – How strong is their emotional pain
  • Loss – Have they experienced actual or perceived losses? (Relationships, material objects)
  • Earlier Attempts – What previous attempts has the individual experienced, what happened after those attempts?
  • Substance Use – Is the individual abusing drugs, alcohol, or other substances?
  • (Lack of) Troubleshooting Skills – Are they able to see alternatives or options other than suicide?
  • Emotions / Diagnosis – “Assessment of emotional attributes (hopelessness, helplessness, worthlessness, loneliness, agitation, depression, and impulsivity) and diagnoses commonly associated with completed suicide (e.g., substance abuse, mood disorders, personality disorders, etc.)” (McGlothlin, et. al., 2016)
  • (Lack of) Protective Factors – What is keeping this person safe from suicide? Who are their supports (internal such as personal values and external like people), resources and agencies
  • Stressors and Life Events – What has happened in their life to lead them to suicide?

Sharp readers will identify that these elements map very neatly onto the DCIB Model of Suicide Risk Assessment, but perhaps provide a better mnemonic in order to make sure that clinicians who do not have the DCIB in front of them are able to perform that assessment.

Validation of the SIMPLE STEPS Model

McGlothlin, et. al. (2016) used 13,000 calls over six years to a crisis line and correlated the SIMPLE STEPS items with the lethality risk present in that call. One limitation of this study is that it used self-reported (by the helpline worker taking the call) lethality rather than using another evidence-based risk assessment in order to compare with. I am satisfied that McGlothlin addressed this in his limitations section, where he noted the difficulty with using data collected in this manner.

References

McGlothlin, J. (2008). Developing clinical skills in suicide assessment, prevention and treatment.
Alexandria, VA: American Counseling Association

McGlothlin, J., Page, B., & Jager, K. (2016). Validation of the SIMPLE STEPS Model of Suicide Assessment. Journal Of Mental Health Counseling, 38(4), 298-307. doi:10.17744/mehc.38.4.02

Patterson, W.M., Dohn, H.H., Patterson, J. & Patterson, G.A. (1983). “Evaluation of suicidal patients: the SAD PERSONS scale.” Psychosomatics 24(4): 343–5, 348–9. doi:10.1016/S0033-3182(83)73213-5. PMID 6867245

Cite this article as: MacDonald, D.K., (2017), "SIMPLE STEPS Model for Suicide Risk Assessment," retrieved on September 21, 2017 from http://dustinkmacdonald.com/simple-steps-model-suicide-risk-assessment/.

 

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Childhood and Adolescent Taxon Scale (CATS)

Introduction

The Childhood and Adolescent Taxon Scale (CATS) worksheet was originally created to accompany the Violence Risk Appraisal Guide (VRAG) and the Sex Offender Risk Appraisal Guide (SORAG). Although the Psychopathy Checklist-Revised (PCL-R; Hare, 1991) can be used to assess psychopathy, there are many situations where a Psychologist or other individual trained in the administration of this tool is not available. In this situation, the CATS tool can be used to assess psychopathy instead.

Quinsey et. al. (2006) determined that the CATS tool is an appropriate replacement for the PCL-R assessment when determining psychopathy on the VRAG and SORAG assessments. Lister (2010) examined the CATS and found that there were no differences in rates of psychopathy as determined by the PCL-R and the CATS with Caucasian and African-American individuals.

Conduct Disorder Symptoms

In order to answer question 4 below, it’s necessary to identify how many conduct disorder symptoms are present.

Count those present those that occurred before age 16 except for items 13 and 15 which are before aged 16:

  1. Often bullied, threatened or intimidated others
  2. Often initiated physical fights
  3. Used a weapon that could cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  4. Was physically cruel to people
  5. Was physically cruel to animals
  6. Stolen while confronting a victim (e.g., mugging, purse snatching, extortion, robbery)
  7. Forced someone into sexual activity
  8. Deliberately engaged in fire setting with the intention of causing serious damage
  9. Deliberately destroyed others’ property (other than by fire setting)
  10. Broken into someone else’s house, car, or building
  11. Often lied to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  12. Stolen items of nontrivial value without confronting a victim (like shoplifting, theft, or forgery)
  13. Before [age] 13, stayed out late at night, despite parental prohibitions
  14. Ran away from home overnight (or longer) at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  15. Before [age] 13, was often truant from school

Childhood & Adolescent Taxon Scale (CATS) Items

The CATS scale has 8 items that are reviewed below, along with supplementary scoring guidelines.

Elementary School Maladjustment

This refers to the first 8 years of formal schooling after kindgarten. A couple of incidents of truancy, smoking on school property or other minor incidents like this would be classified as Mild or Moderate. Severe incidents include repeated truancy or violent actions like assault. Also included in Severe is actions that result in criminal convictions like selling drugs at school.

  • 0 – No Problems
  • 0 – Slight (Minor discipline or attendance) or Moderate Problems
  • 1 – Severe Problems (Frequent disruptive behavior and/or attendance or behavior resulting in expulsion or serious suspensions)

Teenage Alcohol Problem

The National Institute on Alcohol Abuse and Alcoholism produces a guide to screening and intervening with youth (NIAAA, 2015) who consume alcohol. Their screening and assessment rubric can be used to determine if there is a teenage alcohol problem.

Based on the empirically determined risk guidelines, someone who is 12-15 and drinks more than 6 days in the past year would indicate a 1 below, someone who is 16 and drinks more than 12 days in the last year, someone who is 17 would need to drink more than 24 days while an individual who is 18 or higher would need to drink more than 52 days a year.

  • 0 – No
  • 1 – Yes

Childhood Aggression Rating

  • 0 – No Evidence of Aggression
  • 0 – Occasional Moderate Aggression
  • 1 – Occasional or Frequent Extreme Aggression

More Than 3 DSM Conduct Disorder Symptoms

These are the conduct disorder symptoms filled out below.

  • 0 – No
  • 1 – Yes

Ever suspended or expelled from school

  • 0 – No
  • 1 – Yes

Arrested under the age of 16

  • 0 – No
  • 1 – Yes

Lived with both biological parents to age 16 (except for death of parents)

Separation for more than one month is required for coding a “no” on this item. This could be because of institutionalization, divorce, or other separations but does not include death of one or both parents.

  • 0 – Yes
  • 1 – No

Scoring the CATS

Each of these items will result in a 0 or 1 score. All items are summed and the value can then be used to complete Item 12.b on the VRAG or item 14b on the SORAG.

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Hare, R.D. (1991) The Hare Psychopathy Checklist-Revised (Hare PCL-R). Toronto: Multi-Health Systems.

Lister, M.B. (2010) A Comparison of the Violence Risk Appraisal Guide, Psychopathy Checklist, and child and Adolescent Taxon Scale: Predictive Utility And Cross Cultural Generalizable. Dissertation.

National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2015). Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. Retrieved on January 28, 2017 from https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf

Cite this article as: MacDonald, D.K., (2017), "Childhood and Adolescent Taxon Scale (CATS)," retrieved on September 21, 2017 from http://dustinkmacdonald.com/childhood-adolescent-taxon-scale-cats/.
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Using the Sex Offender Risk Appraisal Guide (SORAG)

Introduction

Following up on my article about how to use the Violence Risk Appraisal Guide (VRAG), this article reviews how to use a tool that is bundled with that tool, the Sex Offender Risk Appraisal Guide (SORAG). Like the VRAG, this is an actuarial tool that can be used to predict the risk of re-offending among sex offenders.

Before reading about the SORAG, it is helpful to review the VRAG post as many of the elements that are covered in that post are required before proceeding to the SORAG items. It is recommended that any completion of the SORAG be preceded by a completion of the VRAG as this will save you a significant amount of time.

Completing the SORAG

Like the VRAG, the first step is to complete the Childhood & Adolescent Taxon Scale (CATS) worksheet and the list of Conduct Disorder Symptoms.

Cormier-Lang Criminal History Scores

In order to answer item 5 on the SORAG, Criminal History Score for Non-Violent Offenses Prior to the Index Offense, it’s necessary to complete the Cormier-Lang Criminal History worksheet also provided on the SORAG. This worksheet is completed by filling out the number of non-violent offenses and applying the weight to them noted on the sheet.

Sex Offender Risk Appraisal Guide (SORAG) Items

The SORAG itself has 14 items that are similar to those found on the VRAG.

  1. Lived with both biological parents to age 16 (except for death of parent)
  2. Elementary School Maladjustment
  3. History of alcohol problems
  4. Marital status (at the time of or prior to index offense)
  5. Criminal history score for nonviolent offenses (from Cormier-Lang system)
  6. Criminal history score for violent offenses (from Cormier-Lang system)
  7. Number of previous convictions for sexual offenses (pertains to convictions known from all available documentation to be sexual offenses prior to the index offense)
  8. History of sex offenses only against girls under 14 (including index offenses; if offender was less than 5 years older than victim, always score +4)
  9. Failure on prior conditional release (includes parole or probation violation or revocation, failure to comply, bail violation, and any new arrest while on conditional release)
  10. Age at index
  11. 11. Meets DSM criteria for any personality disorder (must be made by appropriately licensed or certified professional)
  12. Meets DSM criteria for schizophrenia (must be made by appropriately licensed or certified professional)
  13. Phallometric test results
  14. 14. a. Psychopathy Checklist score (if available, otherwise use item 12.b. CATS score)
    14. b. CATS score (from the CATS worksheet)
    14. WEIGHT (Use the highest circled weight from 12 a. or 12 b.)

You’ll note that many of these items are available from the VRAG. The tool indicates where there are overlaps in order to save you time filling out the worksheets and tools.

Determining Risk Level of Sex Offenders

After completing the tool, you must take the total score of the SORAG and compare it to the below levels.

  • A score of -17 to +2 indicates an individual is at Low risk for re-offending
  • A score of +3 to +19 indicates an individual is at Medium risk for re-offending
  • A score of +20 to +34 indicates an individual is at High risk for re-offending

An individual who is on the border between these two levels should have that indicated. For instance, someone who scores at +1 or +2 should be noted as “Low-Medium Risk” to highlight that they are at the edge of the established risk level.

Recidivism Rates using the SORAG

Rather than grouping an individual into low, medium or high risk categories, it is often more illuminating to examine the recidivism rates. These come from Violent Offenders as well.

Probability of Recidivism
SORAG score 7 years 10 years
< − 9 0.07 0.09
−9 to -4 0.15 0.12
-3 to +2 0.23 0.39
+3 to +8 0.39 0.59
+9 to +14 0.45 0.59
+15 to +19 0.58 0.76
+20 to +24 0.58 0.80
+25 to +30 0.75 0.89
> +31 1.00 1.00

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Cite this article as: MacDonald, D.K., (2017), "Using the Sex Offender Risk Appraisal Guide (SORAG)," retrieved on September 21, 2017 from http://dustinkmacdonald.com/using-sex-offender-risk-appraisal-guide-sorag/.
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Using the Violence Risk Appraisal Guide (VRAG)

Introduction

The Violence Risk Appraisal Guide (VRAG; Quinsey, Harris, Rice, & Cormier, 2006) is a tool that can be used to estimate statistically the risk of recidivism. It is comprised of 12 items that are associated with a risk of re-offending and is completed with all available information. You can download the full VRAG in PDF format. The Sexual Offender Risk Appraisal Guide (SORAG) is reviewed in another article.

The VRAG is an actuarial risk assessment, involving a mathematical technique applied to determines what factors were present in offenders who later went on to commit violent crimes. (Brown & Singh, 2014) This approach eliminates the bias found in unstructured judgement.

The VRAG has been examined in over 40 studies, and has been found effective even with individuals who have a lower IQ. (Camilleri & Quinsey, 2011)

Completing the VRAG

The first step to completing the VRAG is to complete the Childhood & Adolescent Taxon Scale. Below, where a request for information relates to an “index offense” that is the one that led to the individual entering the Criminal Justice system

Childhood & Adolescent Taxon Scale (CATS) Worksheet

This scale includes 8 items that are scored from 0 to 1, based on the coding guidelines provided. These items are:

  1. Elementary School Maladjustment
  2. Teenage Alcohol Problem
  3. Childhood Aggression Rating
  4. More Than 3 DSM Conduct Disorder Symptoms
  5. Ever suspended or expelled from school
  6. Arrested under the age of 16
  7. Lived with both biological parents to age 16 (except for death of parents)

Conduct Disorder Symptoms

Next, the assessor will complete the list of Conduct Disorder symptoms, circling those that occurred before age 16 except for items 13 and 15 which are before aged 16:

  • 1. Often bullied, threatened or intimidated others
  • 2. Often initiated physical fights
  • 3. Used a weapon that could cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  • 4. Was physically cruel to people
  • 5. Was physically cruel to animals
  • 6. Stolen while confronting a victim (e.g., mugging, purse snatching, extortion, robbery)
  • 7. Forced someone into sexual activity
  • 8. Deliberately engaged in fire setting with the intention of causing serious damage
  • 9. Deliberately destroyed others’ property (other than by fire setting)
  • 10. Broken into someone else’s house, car, or building
  • 11. Often lied to obtain goods or favors or to avoid obligations (i.e., “cons” others)
  • 12. Stolen items of nontrivial value without confronting a victim (like shoplifting, theft, or forgery)
  • 13. Before [age] 13, stayed out late at night, despite parental prohibitions
  • 14. Ran away from home overnight (or longer) at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  • 15. Before [age] 13, was often truant from school

Cormier-Lang Criminal History Scores for Non-Violent Offenses

This scoring form allows you to answer item number 5 below, the Criminal History Score for Non-Violent Offenses Prior to the Index Offense. This score is developed by counting the number of non-violent offenses and applying a weight to them. For instance, bank robbery is counted x7 while Indecent Exposure is counted x2. So an individual who has two instances of Indecent Exposure and 1 instance of Bank Robbery would have (2×2 = 4) + (1×7 = 7) = 4+7 = 11.

Violence Risk Appraisal Guide (VRAG) Items

Next are the 12 VRAG items. The tool provides detailed coding instructions for each of these:

  1. Lived with both biological parents to age 16 (except for death of parent):
  2. Elementary School Maladjustment:
  3. History of alcohol problems
  4. Marital status (at the time of or prior to index offense):
  5. Criminal history score for nonviolent offenses prior to the index offense
  6. Failure on prior conditional release (includes parole or probation violation or revocation, failure to comply, bail violation, and any new arrest while on conditional release):
  7. Age at index offense
  8. Victim Injury (for index offense; the most serious is scored):
  9. Any female victim (for index offense)
  10. Meets DSM criteria for any personality disorder (must be made by appropriately licensed or certified professional)
  11. Meets DSM criteria for schizophrenia (must be made by appropriately licensed or certified professional)
  12. a. Psychopathy Checklist score (if available, otherwise use item 12.b. CATS score)
  13. (Technically 12b) bCATS score (from the CATS worksheet)

Scoring the VRAG

Determining Risk

Risk categories are provided in the VRAG manual. They are approximated here although more detail is available in the complete manual. For each score, if an individual is close to the next score you should list them as a combination of the two. For instance an individual whose score is -10, -9 or -8 would be listed as Low-Medium rather than just Low.

  • -24 to -8 is Low Risk
  • -7 to +13 is Medium Risk
  • +14 to +32 is High Risk

Determining Rate of Recidivism

The risk of recidivism is presented below, from the same manual (pages 283-286):

Probability of Recidivism
VRAG score 7 years 10 years
< −22 0.00 0.08
−21 to −15 0.08 0.10
−14 to −8 0.12 0.24
−7 to −1 0.17 0.31
0 to +6 0.35 0.48
+7 to +13 0.44 0.58
+14 to +20 0.55 0.64
+21 to +27 0.76 0.82
> +28 1.00 1.00

This is to be interpreted as a percentage. For instance a score of -10 is in the -14 to -8 category; therefore an individual would have a 7 year recidivism rate of 12% and a 10 year recidivism rate of 24%.

References

American Psychological Association. (2006) Quinsey, V.L., Harris, G.T., Rice, M.E. & Cormier, C.A. (2006) 2nd Ed. Violent Offenders: Appraising and Managing Risk. Washington D.C: American Psychological Association.

Brown, J. & Singh, J.P. (2014) Forensic Risk Assessment: A Beginner’s Guide. Archives of Forensic Psychology. 1(1). 49-59. Retrieved on January 20, 2017 from http://www.archivesofforensicpsychology.com/web/wp-content/uploads/2015/01/Brown-and-Singh1.pdf

Camilleri, J.A. & Quinsey, V.L. (2011) Appraising the risk of sexual and violent recidivism among intellectually disabled offenders. Psychology, Crime & Law. 17(1) 59-74

Cite this article as: MacDonald, D.K., (2017), "Using the Violence Risk Appraisal Guide (VRAG)," retrieved on September 21, 2017 from http://dustinkmacdonald.com/using-violence-risk-appraisal-guide-vrag/.
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