Cognitive Contributors to Risk of Harm to Others
Research type
Research Study
Full title
Cognitive Contributors to Risk of Harm to Others: A Feasibility Study
IRAS ID
231852
Contact name
Sarah Janes
Contact email
Duration of Study in the UK
3 years, 0 months, 1 days
Research summary
Research Summary:
Although there is now increasing evidence that cognitive impairments (an injury in the brain that can cause a person to have trouble remembering, learning new things, concentrating, or making decisions) are related to violence, a majority of these impairments are not currently taken into consideration when assessing for the risk of violence in offending populations. This study is a single site feasibility study (a small scale study done to test how practical a larger, more complete study would be) which will examine the sensitivity, appropriateness and predictability of cognitive measures (tools that measure a person's ability to learn, concentrate, and make decisions, as well as their intelligence) to increase our understanding of their potential usefulness in enhancing existing measures of violence risk in forensic psychiatric inpatients.A total of 20 patients from The State Hospital in Carstairs will be recruited and consented where baseline assessments and file review will be conducted. After being assessed using a battery of cognitive measures (approximately 2 one hour sessions or more based on the needs of the participant), the patient's personal records in written, electronic and database form (DATIX records, nurse’s notes, and seclusion notes) will be recorded at 6 calendar months after the initial battery of tests were administered. This will be done to count the amount of inpatient incidents that occurred, and will be used for quantitative analysis to look at the predictability of the measures. Primary feasibility outcomes relate to the tolerability and feasibility of the measures, participant recruitment and completion/non-completion rates, and the appropriateness and sensitivity of the measures for this population. By answering the feasibility outcomes, the proposed project will inform the decision on whether to conduct a larger subsequent study using these measures.
Lay Summary of Results:
Violence risk assessments are tools used by professionals to assess the level of danger an individual poses to themselves or others. The tools include a list of characteristics and behaviours that are related to violence risk, also known as risk factors. Using past and present information, professionals identify which risk factors the individual has, and then formulates an opinion on how to best treat and manage them. However, one of the problems with violence risk assessments is that they do not always accurately identify individuals who will act violently in the future, suggesting that they could be improved. Research has also found that forensic populations, or individuals who commit crimes, are more likely than the general population to have a history of head injuries, substance misuse, certain diagnoses, and childhood trauma, all of which can cause damage to areas of the brain. When certain areas of the brain become damaged, the abilities (known as cognitive abilities) they hold can become impaired (known as cognitive impairments). Cognitive impairments relate to violence risk as they can increase impulsivity, carelessness, and socially inappropriate behaviours, and can reduce self-control, attention, planning abilities, and goal setting making it more difficult to desist from offending, and to behave in a pro-social manner. In addition to their relationship with violence risk, cognitive impairments may also inhibit an individual from fully benefitting from treatment programmes, understanding simple instructions, and from carrying out daily tasks. Though, despite the relationship with violence risk and poor treatment outcomes, most cognitive abilities are not considered during risk assessments.This research assessed the cognitive abilities of two samples of violent offenders (e.g., individuals who have committed a violent offence), and then investigated their relationship with violence and their ability to improve the accuracy of risk assessments, focusing on a list of cognitive abilities that were identified in the literature, and by experts in this field. Our findings indicate that most cognitive abilities were not related to violence risk in these samples, and only a few demonstrated the ability to improve the accuracy of risk assessment tools (e.g., in the inpatient sample, increased recognition of emotions and lack of insight moderately improved the accuracy of risk assessments, but none in the community sample). However, several participants demonstrated poor performances on the measures of cognitive abilities suggesting that many of them may be functioning at a lower level than normal. The conclusions of this research are that while many cognitive risk factors may not meaningfully improve the accuracy of risk assessments, cognitive abilities should still be assessed as part of a risk assessment to identify the cognitive strengths and weaknesses of offenders to inform individualized treatment plans and support for rehabilitation.
REC name
West of Scotland REC 3
REC reference
17/WS/0189
Date of REC Opinion
1 Sep 2017
REC opinion
Favourable Opinion