Gender-Sensitive Violence Risk Assessment: Predictive Validity of Six Tools in Female Forensic Psychiatric Patients

Vivienne de Vogel*, Mieke Bruggeman, Marike Lancel

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Most violence risk assessment tools have been validated predominantly in males. In this multicenter study, the Historical, Clinical, Risk Management–20 (HCR-20), Historical, Clinical, Risk Management–20 Version 3 (HCR-20 V3 ), Female Additional Manual (FAM), Short-Term Assessment of Risk and Treatability (START), Structured Assessment of Protective Factors for violence risk (SAPROF), and Psychopathy Checklist–Revised (PCL-R) were coded on file information of 78 female forensic psychiatric patients discharged between 1993 and 2012 with a mean follow-up period of 11.8 years from one of four Dutch forensic psychiatric hospitals. Notable was the high rate of mortality (17.9%) and readmission to psychiatric settings (11.5%) after discharge. Official reconviction data could be retrieved from the Ministry of Justice and Security for 71 women. Twenty-four women (33.8%) were reconvicted after discharge, including 13 for violent offenses (18.3%). Overall, predictive validity was moderate for all types of recidivism, but low for violence. The START Vulnerability scores, HCR-20 V3 , and FAM showed the highest predictive accuracy for all recidivism. With respect to violent recidivism, only the START Vulnerability scores and the Clinical scale of the HCR-20 V3 demonstrated significant predictive accuracy.

Original languageEnglish
Pages (from-to)528-549
Number of pages22
JournalCriminal Justice and Behavior
Issue number4
Publication statusPublished - 1 Apr 2019
Externally publishedYes


  • female forensic psychiatric patients
  • gender
  • mortality
  • recidivism
  • risk assessment


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