Legal Admissibility of the Rorschach and R-PAS: A Review of Research, Practice, and Case Law.

The special issue editors selected us to form an "adversarial collaboration" because our publications and teaching encompass both supportive and critical attitudes toward the Rorschach and its recently developed system for use, the Rorschach Performance Assessment System (R-PAS). We reviewed the research literature and case law to determine if the Rorschach and specifically R-PAS meet legal standards for admissibility in court. We included evidence on norms, reliability, validity, utility, general acceptance, forensic evaluator use, and response style assessment, as well as United States and selected European case law addressing challenges to mental examination motions, admissibility, and weight. Compared to other psychological tests, the Rorschach is not challenged at unusually high rates. Although the recently introduced R-PAS is not widely referenced in case law, evidence suggests that information from it is likely to be ruled admissible when used by a competent evaluator and selected variables yield scores that are sufficiently reliable and valid to evaluate psychological processes that inform functional psycholegal capacities. We identify effective and ethical but also inappropriate uses (e.g., psychological profiling) of R-PAS in criminal, civil, juvenile, and family court. We recommend specific research to clarify important aspects of R-PAS and advance its utility in forensic mental health assessment.

Youth gun carrying and household firearm ownership in 22 US states.

Youth gun carrying is associated with a range of adverse outcomes, including increased risks for homicide, suicide, school disciplinary problems, and criminal legal involvement. In this study we examined the association between state-level household firearm ownership rates and the odds of past-year gun carrying among high-school-aged youth. Using survey-weighted multivariable logistic regression models, results showed that each 1% point increase in state-level gun ownership was associated with a 2.7% (95% confidence interval [CI] = [1.1%, 4.2%], p = 0.001) increased odds of youth gun carrying, controlling for histories of school-based victimization, physical fighting, and substance use. Among a subset of weapon-carrying youth, state-level firearm availability was a significant factor in determining whether the weapon carried was a gun or a less lethal (i.e., nonfirearm) weapon (odds ratio = 1.021, 95% CI = [1.005, 1.038], p = 0.01). These findings show that firearm availability confers additional risk for youth gun carrying beyond the psychosocial risks emphasized in prior research and efforts to restrict youth access to firearms might be particularly important, especially in communities with high levels of household gun ownership.

Development and validation of a typology of criminal defendants admitted for inpatient competency restoration: A latent class analysis.

OBJECTIVE: To develop a typology of criminal defendants found incompetent to stand trial using data-driven classification techniques and validate it against forensically relevant outcomes. HYPOTHESES: We hypothesized that discrete groups of defendants determined to be incompetent exist that can be identified in the structure of observed clinical, demographic, and criminological data. We also expected that class membership would be differentially associated with competency restoration. METHOD: We coded hospital records for 492 consecutive male criminal defendants committed to a secure hospital for competency restoration between 2013 and 2017 (mean [M] age = 38.7 years, standard deviation [SD] = 14.2; 61.0% White, 34.2% Black, 2.6% Hispanic, 2.2% "Other"). Clinical, demographic, and criminological data were analyzed using latent class analysis. Validation analyses modeled competency restoration outcomes as a function of class membership. RESULTS: An 8-class solution best fit the data and included 3 discrete classes of patients with psychotic disorders (Class 2, n = 74; Class 3, n = 78; Class 6, n = 68), as well as classes characterized by intellectual limitations without comorbid psychosis (Class 4, n = 54), comorbid psychosis and intellectual limitations (Class 1, n = 41), mood disorders (Class 5, n = 80), older adults with neurocognitive disorders (Class 8, n = 59), and chronic instability (Class 7, n = 38). The restoration rate in the overall sample was 87.8%, and Classes 1-7 showed restoration rates similar to the overall sample, ranging from 82.9% to 100%. The restoration rate of Class 8 was 66.1%, and this was the only class to show significantly lower odds (odds ratio [OR] = 0.181, 95% confidence interval [CI: 0.093, 0.353], p < .001) and hazards (hazard ratio [HR] = 0.511, 95% CI [0.361, 0.724], p < .001) of restoration. CONCLUSION: Older adults with neurocognitive disorders admitted for competency restoration are at increased risk of failed restoration. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Risk Management with Clients Who Stalk, Threaten, and Harass Mental Health Professionals.

Although most psychologists will at some point be confronted with a client who engages in stalking, threatening, or harassing behavior (STHB), few feel prepared to manage these situations. In this article, the results of a survey of 112 psychologists who endorsed experiencing STHB are reported. Psychologists were asked about their perceptions of client motivations and personality pathology, frequency of use of 18 risk management responses, and perceived effectiveness of these responses. The effectiveness of risk management strategies differed by client level of personality organization and motivation for STHB. Some of the most commonly used risk management responses were among those most likely to result in adverse outcomes, particularly with certain types of clients. Efforts to develop empirically derived risk management strategies for clinicians confronted with STHB should integrate contextual variables, such as client personality and motivation.

Firearm Legislation and Fatal Police Shootings in the United States.

OBJECTIVES: To examine whether stricter firearm legislation is associated with rates of fatal police shootings. METHODS: We used a cross-sectional, state-level design to evaluate the effect of state-level firearm legislation on rates of fatal police shootings from January 1, 2015, through October 31, 2016. We measured state-level variation in firearm laws with legislative scorecards from the Brady Center, and for fatal police shootings we used The Counted, an online database maintained by The Guardian. RESULTS: State-level firearm legislation was significantly associated with lower rates of fatal police shootings (incidence rate ratio = 0.961; 95% confidence interval = 0.939, 0.984). When we controlled for sociodemographic factors, states in the top quartile of legislative strength had a 51% lower incidence rate than did states in the lowest quartile. Laws aimed at strengthening background checks, promoting safe storage, and reducing gun trafficking were associated with fewer fatal police shootings. CONCLUSIONS: Legislative restrictions on firearms are associated with reductions in fatal police shootings. Public Health Implications. Although further research is necessary to determine causality and potential mechanisms, firearm legislation is a potential policy solution for reducing fatal police shootings in the United States.

Violence Risk Assessment and Management in Outpatient Clinical Practice.

OBJECTIVE: The aims of this review were to highlight fundamental distinctions between risk assessment in forensic versus therapeutic settings, review the best available evidence regarding key risk and protective factors for violence of particular relevance to clinicians in outpatient therapeutic settings, and describe an approach to evaluating and managing violence risk in outpatient treatment. METHOD: An integrative literature review was undertaken to examine violence risk and protective factors most relevant to outpatient clinicians in therapeutic settings. RESULTS: Based on the available research, the Integrative Outpatient Violence Risk Assessment and Management (IVRAM) model, a 5-step strategy for evaluating and managing violence risk in therapeutic contexts, is introduced. The IVRAM emphasizes the integration of nomothetic and idiographic data through a focus on empirically derived dynamic risk and protective factors in the context of an individualized anamnestic analysis. CONCLUSION: Clinicians working in forensic and therapeutic settings will increasingly benefit from the contributions of the other as the distinctions between risk assessment and risk management continue to decrease.

Rorschach measures of aggression: a laboratory-based validity study.

This study sought to complement the archival research designs that have established the empirical foundations of Rorschach aggression scores, including Exner's ( 2003 ) Aggressive Movement (AG) score and Meloy and Gacono's ( 1992 ) Aggressive Content (AgC), Aggressive Past (AgPast), and Aggressive Potential (AgPot) variables. Utilizing a highly controlled laboratory-based aggression paradigm and self-report measures of violence history in a sample of 35 undergraduate males with an average age of 19.38 (SD = 2.11), this study found that only AgC was positively associated with in vivo aggression (r = .40, p = .02). None of the Rorschach measures of aggression were significantly associated with self-reported violence history, although there were several trends approaching significance. Theoretical and methodological implications are discussed.

Research on Youth Suicide and Sexual Orientation is Impacted by High Rates of Missingness in National Surveillance Systems.

OBJECTIVE: The sexual orientation of youth who die by suicide in the United States is usually unknown. This study assessed how observed patterns of unknown sexual orientation are likely to affect research findings. METHODS: We analyzed the National Violent Death Reporting System (NVDRS) Restricted Access Dataset to assess whether sexual orientation among youth suicide decedents is disproportionately known for different demographics. We then assessed the degree to which estimated sexual minority rates would be affected if researchers were to assume either (a) that sexual orientation data is missing completely at random, or (b) that orientation information is missing at random after accounting for observed demographic patterns. RESULTS: <10% of the sample had known sexual orientation. Sexual orientation was more frequently known for females, white people, and older people, and missingness varied by geography. The choice between modeling the data as missing completely at random versus at random conditional upon demographics had a > 2-fold impact on estimated sexual minority rates among youth suicide decedents. CONCLUSION: Research on sexual orientation and youth suicide is strongly impacted by how researchers account (or do not account) for missingness.

Optimal per test cutoff scores and combinations of failure on multiple embedded performance validity tests in detecting performance invalidity in a mixed clinical sample.

We tested the usefulness of six embedded performance validity tests (EPVTs) in identifying performance invalidity in a mixed clinical sample. Using a retrospective design, 181 adults were classified as valid (n = 146) or invalid (n = 35) performance based upon their performance on one of three standalone PVTs (Test of Memory Malingering, Victoria Symptom Validity Test, Dot Counting Test). Multiple cutoffs were identified corresponding to predetermined false positive rates of 0, 5, 10, and 15% for each of six EPVTs. EPVT cutoffs corresponding to the predetermined false positive benchmarks were generally more conservative than currently established scores. Sensitivity was low (.0%-42.9%) for individual EPVTs across these cutoffs and was moderately improved by the combination of multiple EPVT failures. The optimal number of EPVT failures using the 10% false positive rate was ≥ 2. Although the overall classification accuracy of 80.7% and specificity of 89.0% were comparable to prior research, the sensitivity of 45.7% was more modest than previous estimates. Low sensitivities indicate that this combination of EPVTs failed to detect a majority of invalid performers.

Occupational exposure to traumatic evidence and posttraumatic stress symptoms in forensic science professionals: Prevalence and patterns.

Forensic science professionals are routinely exposed to potentially traumatizing evidence. This study aimed to estimate the prevalence of occupational posttraumatic stress disorder (PTSD) among forensic science professionals, identify job-related correlates of PTSD symptoms, and examine the role of social support in mitigating PTSD symptomology. In response to recruitment through the American Academy of Forensic Sciences, the American Society of Crime Laboratory Directors, and Evidence Technology Magazine, 449 forensic science professionals participated in the current study. Results found that 73.5% (n = 330) of the overall sample experienced at least one work-related traumatic event consistent with meeting Criterion A for PTSD, and these rates were higher for field-based respondents (n = 203, 87.9%). The prevalence of past-month provisional PTSD was 21.6% for the full sample. Disaggregated PTSD rates were 29.0% and 14.5% for field-based and non-field-based respondents, respectively. These rates were 6- to 8-fold higher than the past-year prevalence of PTSD in the general US population, estimated to be 3.5%, and were found to be at least as high as those observed in prior epidemiological research with non-treatment seeking members of the US military deployed to war zones in Iraq and Afghanistan. Results further showed that social support was protective against PTSD symptomology. The high rates of occupational exposure to trauma and consequent PTSD symptomology observed in this large sample of forensic science professionals highlight the under-acknowledged psychological risks of these occupations and the need for enhanced attention to mental health resources for these professionals.

Intelligence is a poor predictor of nonrestorability of competence to stand trial.

Criminal defendants found incompetent to stand trial (IST) may only be committed for competency restoration if their restoration success is considered likely and when this aim can be met within a "reasonable" period of time. In this study, we evaluated the predictive validity and test accuracy of standardized intelligence testing on the classification of nonrestorability in a sample of 293 male patients adjudicated IST and committed for inpatient restoration. At 90 days, 17.0% of cases with FSIQ scores within one standard deviation of the mean were unrestored, and nonrestoration rates increased with each additional FSIQ standard deviation decrement to 29.5%, 38.8%, and 59.5%. Time-to-event analyses found that whereas half of patients with FSIQ scores of 56 or higher would be predicted to be restored within 64 days, the median restoration timeline was 145 days for patients with FSIQ scores of 55 or below. Positive predictive values associated with the range of possible FSIQ scores were uniformly low at modeled nonrestoration prevalence rates of 5%, 15%, and 25%, rarely exceeding chance levels. We conclude that although FSIQ scores are relevant to predictions of nonrestorability, particularly when scores are at least three standard deviations below average, the accuracy of individual FSIQ-based predictions of nonrestorability are limited.

Racial Disparities in Pregnancy-associated Intimate Partner Homicide.

Pregnancy-associated femicide accounts for a mortality burden at least as high as any of the leading specific obstetric causes of maternal mortality, and intimate partners are the most common perpetrators of these homicides. This study examined pregnancy-associated and non-pregnancy-associated intimate partner homicide (IPH) victimization among racial/ethnic minority women relative to their non-minority counterparts using several sources of state-level data from 2003 through 2017. Data regarding partner homicide victimization came from the National Violent Death Reporting System, natality data were obtained from the Centers for Disease Control and Prevention's National Center for Health Statistics, and relevant sociodemographic information was obtained from the U.S. Census Bureau. Findings indicated that pregnancy and racial/ethnic minority status were each associated with increased risk for partner homicide victimization. Although rates of non-pregnancy-associated IPH victimization were similar between Black and White women, significant differences emerged when limited to pregnancy-associated IPH such that Black women evidenced pregnancy-associated IPH rates more than threefold higher than that observed among White and Hispanic women. Relatedly, the largest intraracial discrepancies between pregnant and non-pregnant women emerged among Black women, who experienced pregnancy-associated IPH victimization at a rate 8.1 times greater than their non-pregnant peers. These findings indicate that the racial disparities in IPH victimization in the United States observed in prior research might be driven primarily by the pronounced differences among the pregnant subset of these populations.

Antisociality and intimate partner violence: the facilitating role of shame.

Numerous theories classify distinct subtypes of men who perpetrate violence against female partners. These theories contend that a large portion of these men possess antisocial characteristics that may increase risk for violence. Affectively, these men have been found to externalize their emotions, including shame and guilt, and it has been suggested that this process contributes to the perpetration of partner violence. Therefore, this study sought to examine the role of shame and guilt in the association between antisociality and partner violence perpetration (i.e., psychological, physical, and sexual). Based on a sample of 423 undergraduate men, this study found that shame moderated the association between antisociality and partner violence perpetration such that as shame increases, the associations between antisociality and all three types of partner violence perpetration increase. These findings contribute to the theoretical understanding of typological models of partner violence and have clinical implications for batterer intervention programs.

The role of cognitive functioning in predicting restoration among criminal defendants committed for inpatient restoration of competence to stand trial.

In the United States, the due process and equal protection clauses of the 14th Amendment require that criminal defendants found incompetent to stand trial be committed for competency restoration only for such a time considered to be reasonable to achieve this aim. Adherence to these protections requires that forensic clinicians have the capacity to accurately identify defendants unlikely to be restored and to provide evidence-based estimates regarding anticipated restoration timelines. The present study examines restoration rates in a large sample (N = 492) of incompetent male defendants consecutively admitted for inpatient competency restoration between 2013 and 2017. Expanding on prior research suggesting that shared cognitive deficits might underlie impaired competency-related abilities across diverse psychiatric illnesses, the predictive classification accuracy of the Mini Mental State Examination (MMSE) on restoration was examined. Results showed that 90.4% of all defendants were restored in an average of 90.5 days and that restoration rates differed across psychiatric classification, such that patients with mood and psychotic disorders were more likely to be restored whereas those with intellectual disabilities and neurocognitive disorders were less likely. The MMSE was associated with restoration outcomes, such that over 90% of patients with no or mild cognitive impairment were restored compared to 68% of patients with severe cognitive impairment. Multivariable logistic regression showed that each one-point decrease on the MMSE total score was associated with a 19.7% (p < .001) increased odds of restoration failure and the MMSE total score produced an area under the curve (AUC) of 0.767. The MMSE appears to provide a brief, reliable screening instrument to quantify the presence and severity of cognitive impairment underlying a range of serious psychiatric illness that is capable of discriminating defendants based upon their likelihood of being restored in a reasonable amount of time with a moderate degree of accuracy.

Childhood Maltreatment and Psychosis: A Comparative Validity Study of Maltreatment Indices.

Childhood maltreatment is a robust risk factor for psychosis, but it remains unclear whether different measurement methods provide equivalent validity in predicting psychotic symptoms. This study compared the predictive validity of two common indices of maltreatment at age 12-children's self-report and Child Protective Services (CPS) reports-on the development of psychotic symptoms at age 18 using data from a large, multisite longitudinal study (N = 629). Consistent with prior research, agreement was low between indices, with the prevalence of self-reported maltreatment being 2-3 times higher. A quarter of the sample endorsed at least one psychotic symptom at age 18, most commonly delusions. While CPS-indicated maltreatment was generally not associated with later psychotic symptoms, all forms of self-reported maltreatment were. Sexual abuse demonstrated a particularly strong relationship with psychosis, especially hallucinations. These results suggest that self-reports may provide stronger predictive validity than CPS indications of maltreatment in the assessment of psychosis risk, indicating that a child's interpretation of trauma matters more than the traumatic event itself in this regard.

Adolescent Suicide, Household Firearm Ownership, and the Effects of Child Access Prevention Laws.

OBJECTIVE: This study has 3 objectives: to examine the association between state-level firearm ownership and suicide among adolescents of high school age; to compare the strength of the firearm ownership-suicide association among adolescents relative to adults; and to evaluate the relationship between 11 child access prevention (CAP) laws and suicide. METHOD: Using an ecological time series cross-sectional design, we modeled suicide rates from January 1, 1991, to December 31, 2017, as a function of household firearm ownership and states' implementation of CAP provisions using fixed effect negative binomial models. RESULTS: There were 37,652 suicides among adolescents between the ages of 14 and 18 years during the study period, and more than half of all suicides (51.5%, n = 19,402) involved firearms. Each 10 percentage-point increase in states' firearm ownership was associated with a 39.3% (35.1%-43.5%) increase in firearm suicide, which in turn contributed a 6.8% (2.5%-11.1%) increase in all-cause suicide. The association between firearm ownership and suicide was approximately 2 times stronger among adolescents relative to adults. Policies mandating locks and safe storage were associated with a 13.1% (2.7%-22.3%) reduction in adolescent firearm suicide and an unexplained 8.7% (1.2%-15.7%) reduction in non-firearm suicide. CAP provisions were associated with reduced firearm suicide across the lifespan, but effects were stronger among adolescents. CONCLUSION: There is an increased risk of adolescent suicide associated with household firearm ownership, and safe storage provisions are associated with decreased adolescent firearm suicide.

Firearm Use Increases Risk of Multiple Victims in Domestic Homicides.

Domestic homicides account for more than one in four homicides in the United States and frequently involve multiple victims. This study examined the prevalence of firearm use in domestic homicides in the United States and the associated risk of a multiple homicide event. We used weighted negative binomial regression to model the effects of firearm use on the number of additional victims in domestic and nondomestic homicides using data from the Federal Bureau of Investigation's Supplementary Homicide Reports. Results showed that firearms were used in 54.1 percent of domestic homicides. Firearm use was associated with a 70.9 percent and 38.7 percent increased incidence of additional victimization in domestic and nondomestic homicides, respectively. Whereas male and female perpetrators differed minimally in the likelihood of additional victims in domestic homicides committed with a non-firearm (3.6% versus 2.5%), males were nearly three times more likely to have multiple victims in domestic homicides involving a firearm (6.9% versus 2.4%). Interaction tests showed that the risk of additional victims associated with firearm use was stronger in domestic situations than in nondomestic situations and among male perpetrators. These findings highlight the risk of multiple homicides in domestic homicide situations and the role of firearms in expanding the risk of victimization beyond a single victim.

The effects of PTSD symptomatology on laboratory-based aggression.

The present study sought to examine the relationship between posttraumatic stress disorder (PTSD) symptomatology and aggression using a highly controlled, quasi-experimental laboratory-based aggression paradigm among a sample of 85 undergraduate students not help-seeking for current PTSD phenomena. Congruent with theory and past research, results showed that PTSD symptomatology was positively associated with aggression. In demonstrating this effect using a laboratory-based methodology, the present study provides a heuristic for future researchers to explore potential mediators and moderators of the PTSD-aggression relationship.

Firearm Ownership and Domestic Versus Nondomestic Homicide in the U.S.

INTRODUCTION: Gun ownership is associated with firearm mortality, although this association differs across victim-offender relationships. This study examines the relationship between gun ownership and domestic versus nondomestic homicide rates by victim sex. METHODS: Several sources of state-level panel data from 1990 through 2016 were merged from each of the 50 states to model domestic (i.e., family and intimate partners) and nondomestic firearm homicide as a function of state-level household firearm ownership. Firearm ownership was examined using a validated proxy measure and homicide rates came from the Supplemental Homicide Reports of the Federal Bureau of Investigation's Uniform Crime Reports. Negative binomial regression with fixed effects was used to model the outcomes and employed generalized estimating equations to account for clustering within states. Statistical analyses were completed in 2018. RESULTS: State-level firearm ownership was uniquely associated with domestic (incidence rate ratio=1.013, 95% CI=1.008, 1.018) but not nondomestic (incidence rate ratio=1.002, 95% CI=0.996, 1.008) firearm homicide rates, and this pattern held for both male and female victims. States in the top quartile of firearm ownership had a 64.6% (p<0.001) higher incidence rate of domestic firearm homicide than states in the lowest quartile; however, states in the top quartile did not differ significantly from states in the lowest quartile of firearm ownership in observed incidence rates of nondomestic firearm homicide. CONCLUSIONS: State-level firearm ownership rates are related to rates of domestic but not nondomestic firearm homicide.

Effects of Risk-Based Firearm Seizure Laws in Connecticut and Indiana on Suicide Rates, 1981-2015.

OBJECTIVE: This study evaluated whether risk-based firearm seizure laws in Connecticut and Indiana affect suicide rates. METHODS: A quasi-experimental design using annual state-level panel data from the 50 states between 1981 and 2015 was used. When analyses controlled for a range of risk factors for population-level suicide rates, the effects of Connecticut and Indiana's firearm seizure laws on firearm and nonfirearm suicide rates were evaluated by using the synthetic-control methodology and difference-in-place placebo tests. Sensitivity analyses employed regression-based difference-in-differences analyses with randomization inference. RESULTS: Indiana's firearm seizure law was associated with a 7.5% reduction in firearm suicides in the ten years following its enactment, an effect specific to suicides with firearms and larger than that seen in any comparison state by chance alone. Enactment of Connecticut's law was associated with a 1.6% reduction in firearm suicides immediately after its passage and a 13.7% reduction in firearm suicides in the post-Virginia Tech period, when enforcement of the law substantially increased. Regression-based sensitivity analyses showed that these findings were robust to alternative specifications. Whereas Indiana demonstrated an aggregate decrease in suicides, Connecticut's estimated reduction in firearm suicides was offset by increased nonfirearm suicides. CONCLUSIONS: Risk-based firearm seizure laws were associated with reduced population-level firearm suicide rates, and evidence for a replacement effect was mixed.