The predictive performance of criminal risk assessment tools used at sentencing: Systematic review of validation studies.

Although risk assessment tools have been widely used to inform sentencing decisions, there is uncertainty about the extent and quality of evidence of their predictive performance when validated in new samples. Following PRISMA guidelines, we conducted a systematic review of validation studies of 11 commonly used risk assessment tools for sentencing. We identified 36 studies with 597,665 participants, among which were 27 independent validation studies with 177,711 individuals. Overall, the predictive performance of the included risk assessment tools was mixed, and ranged from poor to moderate. Tool performance was typically overestimated in studies with smaller sample sizes or studies in which tool developers were co-authors. Most studies only reported area under the curve (AUC), which ranged from 0.57 to 0.75 in independent studies with more than 500 participants. The majority did not report key performance measures, such as calibration and rates of false positives and negatives. In addition, most validation studies had a high risk of bias, partly due to inappropriate analytical approach used. We conclude that the research priority is for future investigations to address the key methodological shortcomings identified in this review, and policy makers should enable this research. More sufficiently powered independent validation studies are necessary.

War and Well-Being: The Association between Forgiveness, Social Support, Posttraumatic Stress Disorder, and Well-Being during and after War.

Exposure to war can lead to numerous traumatic experiences affecting the daily lives and personal well-being of the civilian population. However, no research to date has examined the associations between postwar well-being and posttraumatic stress disorder (PTSD) symptoms, tendency to forgive, and social support during and following war. Authors examined a sample of 160 Israeli civilians who were exposed to rocket and missile fire during the 2014 Gaza War. Time 1 (Tl) started approximately one week after the beginning of the war and ended four weeks later following the first 72-hour ceasefire declaration by the United Nations. Respondents were re-approached by personal e-mail approximately one month after T1. A structural equation model design showed that higher postwar tendency to forgive, and social support, are associated with higher postwar well-being. It is notable that higher social support during the war had a negative effect on postwar well-being. In addition, higher posttraumatic symptoms and well-being during the war had a positive effect on higher postwar well-being. The study findings reinforce the importance of personal variables in postwar well-being. However, increased awareness of both social support and PTSD symptoms as "double-edged sword" resources is advisable, considering the different effects of social support and PTSD symptoms on well-being both during and after the war.

Risk factors for DSM-5 posttraumatic stress symptoms (PTSS) among Israeli civilians during the 2014 Israel-Hamas war.

In light of current modifications in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria for posttraumatic stress disorder (PTSD), this study aimed to revalidate well-known PTSD risk factors related to terrorism and war in Israel, namely, proximity to the Gaza Strip, dissociative symptoms, acute stress disorder (ASD) symptoms, and social support. One hundred and sixty Israeli civilians were assessed during the 2014 Israel-Hamas war at 2 time points: 1 week after the beginning of the operation (t1) and 1 month after initial evaluation (t2), using the DSM-5 PTSD Symptom Levels Scale (PSLS; Gil, Weinberg, Or-Chen, & Harel, 2015). A paired t test analysis showed significant reduction in the respondents' posttraumatic stress symptoms (PTSS) 1 month after the initial assessment point. A structural equation model (SEM) showed that higher ASD symptoms at t1 and higher dissociative symptoms at t2 increased the risk for PTSS at t2. Conversely, higher peritraumatic dissociation at t1 decreased the risk for PTSS at t2. Proximity to the Gaza Strip, and social support, failed to demonstrate significant association with PTSS at t2. DSM-5 PTSS 1 month after prolonged traumatic exposure are strongly associated with high ASD symptoms at 1 week as a risk factor; high levels of peritraumatic dissociation at 1 week as a protective factor; and high levels of dissociative symptoms at 1 month as a risk factor. Theoretically and clinically the findings of the study further suggest that ongoing massive terrorism and war cannot be viewed or treated as identical to other traumas.

Risk factors for DSM 5 PTSD symptoms in Israeli civilians during the Gaza war.

BACKGROUND: In light of the current modifications presented in the diagnostic criteria of posttraumatic stress disorder (PTSD) in the DSM 5, this study aimed at revalidating well-known PTSD risk factors, including gender, peritraumatic dissociation, social support, level of threat, and trait tendency for forgiveness. METHOD: Five hundred and one Israeli civilians were assessed during real-time exposure to missile and rocket fire at the eruption of the Gaza war. Assessments took place approximately one to 2 weeks after the beginning of this military operation, relying on web administration of the study, which allowed simultaneous data collection from respondents in the three regions in Israel that were under attack. RESULTS: A structural equation model design revealed that higher levels of forgiveness toward situations were associated with fewer PTSD symptoms, whereas peritraumatic dissociation and high levels of objective and subjective threat were positively associated with PTSD symptoms. Additionally, females were at higher risk for PTSD symptoms than males. CONCLUSIONS: The findings of this study provide further evidence for the importance of directing preventive attention to those vulnerable to the development of elevated levels of PTSD symptoms. Theoretical and clinical implications of the findings are discussed.

Coping strategies and internal resources of dispositional optimism and mastery as predictors of traumatic exposure and of PTSD symptoms: A prospective study.

This prospective study aimed at examining the role of trait internal resources and coping strategies in predicting traumatic exposure and levels of posttraumatic stress disorder (PTSD) symptoms after such exposure. In total, 870 Israeli students participated in the study, of whom 182 (20%) reported a lifetime history of traumatic exposure at baseline (t1), and a total of 231 (27%) respondents reported traumatic exposure during follow-up (t2, t3). After controlling the effect of lifetime history of traumatic exposure either by using it as a covariate in a multivariate analysis of covariance (MANCOVA) or as a predictor in regression analyses, the results indicate that individuals high on trait avoidance coping style and low on mastery are at a higher risk for traumatic exposure, while those high on trait problem-focused coping style, mastery and dispositional optimism are at a lower risk for PTSD symptoms after such exposure.

Forgiveness, coping, and terrorism: do tendency to forgive and coping strategies associate with the level of posttraumatic symptoms of injured victims of terror attacks?

OBJECTIVE: The study examined the tendency to forgive (self, others, and situations) and coping strategies (problem-focused, emotion-focused, and avoidance) among terror attack victims as associated with posttraumatic stress disorder (PTSD) symptom severity. METHOD: The sample included 108 terror victims who had been injured in terror attacks (mean age 46.23, standard deviation = 11.61; 58.3% male). Participants agreed to undergo assessments of their PTSD symptoms, coping strategies, and tendency to forgive. RESULTS: A nested structural equation model design showed that tendency to forgive is positively associated with problem-focused coping and negatively associated with avoidance coping. Additionally, tendency to forgive and problem-focused coping are associated with decreased PTSD symptom severity, whereas emotion-focused coping is associated with elevated PTSD symptom severity. CONCLUSIONS: Tendency to forgive and coping strategies are significantly associated with each other and with severity of PTSD symptoms among individuals injured in terror attacks. Theoretical and clinical implications of the findings are discussed.

Personality traits, coping style, and perceived threat as predictors of posttraumatic stress disorder after exposure to a terrorist attack: a prospective study.

OBJECTIVES: This prospective study examined the role of pretraumatic personality factors, coping style, proximity to a terrorist attack, and its perceived threat to the survivors in the prediction of posttraumatic stress disorder (PTSD) after a suicide bomber's attack on a bus. METHOD: The study sample consisted of 180 undergraduate students who were coincidentally evaluated 2 weeks before a terrorist explosion in a bus heading toward their university and reevaluated 1 week, 1 month, and 6 months after the explosion. RESULTS: A hierarchal regression model revealed that increased risk for PTSD was associated with direct exposure to the attack, indirect exposure to the attack, preattack harm avoidance personality dimension, state avoidance coping style, and perceived threat posed by the attack. CONCLUSIONS: The findings indicate that premorbid personality characteristics, as well as subjective and objective factors related to the traumatic exposure, increased the risk for the development of PTSD.

Memory of the traumatic event as a risk factor for the development of PTSD: lessons from the study of traumatic brain injury.

Traumatic memories, and the mechanisms by which they operate, continue to occupy a central role in the scientific investigation of risk factors for the development of posttraumatic stress disorder (PTSD). However, empirically based studies are constrained by practical and ethical considerations and are limited to naturalistic models. Consequently, the paradigms most appropriate for the exploration of the relationship between traumatic memories and PTSD have been identified in conditions involving traumatic events where memories may be compromised. Indeed, traumatic brain injury, a condition that is commonly associated with memory impairment, has often been utilized as a naturally occurring model for the study of traumatic memory and its contribution to the development of PTSD. This article presents a critical review of these research efforts and discusses their theoretical and clinical implications.

Evaluation of premorbid personality factors and pre-event posttraumatic stress symptoms in the development of posttraumatic stress symptoms associated with a bus explosion in Israel.

This study examined the role played by indicators of premorbid personality in the development of posttraumatic stress symptoms (PTSS). The initial sample consisted of 185 undergraduate students who had coincidentally been evaluated for their PTSS levels 2 weeks prior to a terrorist explosion. A week after the explosion, the sample was assessed to determine the extent of actual exposure. Of the initial 185 students, 81 reported being exposed and thus constituted the final cohort. They were reevaluated at 1 month after the explosion. Both assessments included personality and PTSS evaluation. Data analyses revealed five positive predictors of PTSS levels: high pre-attack PTSS levels, personal exposure, significant other's exposure, indirect exposure, and high premorbid levels on the harm avoidance personality dimension.

Suicide attempters vs. ideators: are there differences in personality profiles?

The underlying question of the present study was whether suicide attempt and suicidal ideation are derived from the same personality dynamic among psychiatric outpatients. Participants included 80 males and females with a history of suicide attempt and 92 without such a history. All participants were evaluated individually with the Tridimensional Personality Questionnaire (TPQ; Cloninger, 1987) and with the Beck Suicide Inventory (BSI; Beck & Steer, 1991). Based on the evaluation results, those without a history of suicide attempt were divided into two groups: high and low suicidal ideations. Data analyses revealed that suicide attempt and suicidal ideation may emerge from distinct, yet somewhat overlapping, personality dynamics.

Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study.

OBJECTIVE: The present study examined prospectively the relationship between memory of the traumatic event and subsequent development of posttraumatic stress disorder (PTSD). More specifically, the aims of this study were to 1) investigate the possibility that lack of memory of the traumatic event might be a protective factor; 2) assess whether memory of the traumatic event equally affects the three symptom clusters of PTSD: reexperiencing, avoidance, and hyperarousal; and 3) explore the predictive value of memory of the traumatic event for the development of subsequent PTSD in the immediate aftermath of the event. METHOD: One hundred twenty subjects with mild traumatic brain injury who were hospitalized for observation were assessed immediately after the trauma and followed up 1 week, 3 months, and 6 months later. All participants underwent psychiatric evaluation and self-assessment of their memory of the traumatic event. RESULTS: Overall, 17 (14%) of the participants met full criteria for PTSD at 6 months. Subjects with memory of the traumatic event were significantly more likely to develop PTSD than those without memory of the traumatic event; the difference between the groups resulted primarily from the reexperiencing cluster. Logistic regression analysis revealed that memory of the traumatic event within the first 24 hours is a strong predictor of PTSD 6 months after the event. CONCLUSIONS: Our study indicated that memory of a traumatic event is a strong predictor and a potential risk factor for subsequent development of PTSD. Future studies are needed to show whether these findings can be generalized to other traumatic conditions.

The relation between memory of the traumatic event and PTSD: evidence from studies of traumatic brain injury.

OBJECTIVE: This paper focuses on the relation between memory and posttraumatic stress disorder (PTSD). More specifically, it addresses the debate regarding the role of memory of the traumatic event in the development of PTSD. Traumatic brain injury (TBI) is used as a naturally occurring model for traumatic exposure that is often associated with memory impairment. METHOD: We present a critical review of the literature on studies assessing the relation between TBI and PTSD, with a focus on memory of the traumatic event as a critical factor. We also discuss results from recent studies conducted by our group. RESULTS: The literature review offers an inconclusive picture wherein a significant proportion of the studies indicate that PTSD and TBI are mutually exclusive, especially in individuals who exhibit lack of memory for the traumatic event. This finding supports the possibility that lack of memory may protect against the development of PTSD. However, some studies show that PTSD does occur in patients with head injury, suggesting that PTSD may develop in TBI survivors--even in those who cannot remember the traumatic event. Generally speaking, though, the overall balance of the findings (including our own findings) seems to support the possibility that, in subjects with TBI, impaired memory of the traumatic event is associated with reduced prevalence of PTSD. CONCLUSIONS: The suggestion that amnesia regarding the traumatic event may protect against the development of PTSD has both theoretical and practical importance. This review focused on the case of traumatic brain injury as a model for impaired memory for the traumatic event. However, it still remains to be proven that the conclusions based on these findings are generalizable beyond the case of TBI. While some patients with posttraumatic amnesia do develop PTSD despite lack of memory for the traumatic event, the majority of those who lack memory for the event seem to be protected from developing the disorder. Nevertheless, based on this assumption, we suggest that pharmacologic disruption of newly acquired--or even old--traumatic memories, which has been shown to be possible in animals, might therapeutically benefit trauma survivors.