Predicting criminal recidivism. Empirical studies and clinical practice in forensic psychiatry
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RU Radboud Universiteit Nijmegen, 23 juni 2005
Promotores : Staak, C.P.F. van der, Brink, W. van den Co-promotor : Koeter, M.W.J.
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SW OZ BSI BO
SubjectExperimental Psychopathology and Treatment
Research into the prediction of criminal relapse among offenders has yielded important insights over the last three decades. An overview of these is provided in the first part of this thesis. This introduction also highlights several shortcomings in the existing knowledgebase. Reduction of risk of reoffending in forensic psychiatric patients requires insight into dynamic risk factors, and evidence that they add predictive power to static risk indicators; there is a paucity of both. Furthermore, predictors need to be evaluated under clinically realistic circumstances rather than under the idealized conditions common in most research. The second part of the thesis addresses the development of a dynamic risk assessment instrument, its psychometric evaluation, and a study aimed to validate dynamic as well as static variables as predictors of reconviction in a naturalistic outcome study. Data on static and dynamic risk factors were collected for 151 patients discharged from Dutch forensic psychiatric hospitals within the system of TBS. Community follow-up was prospective, with a 5.5 year minimum. Officially recorded reconviction data were used to develop a prediction model. This contained 4 static and no dynamic predictors and had considerable predictive power. It was concluded that a small set of static predictors yielded a good estimate of future reconvictions; inclusion of dynamic predictors did not add predictive power. In the third part of the thesis findings are summarized and discussed. Dynamic predictors that are commonly used in TBS practice do not seem to predict actual reoffending. Though some drawbacks in the study design may partly explain this finding, static predictors nevertheless appear to be of prime importance. Furthermore, there are indications in the data that clinical evaluations are vulnerable to manipulation by patients. Consensus evaluation procedures, use of objective and uniform measures, and of psycho-physiological parameters are propagated as possible alternative approaches. However, society also needs to come to terms with the fact that future behavior can never be predicted without a substantial margin of error.
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