Role of assessment components and recent adverse outcomes in risk estimation and prediction: use of the Short Term Assessment of Risk and Treatability (START) in an adult secure inpatient mental health service

The Short Term Assessment of Risk and Treatability is a structured judgement tool used to inform risk estimation for multiple adverse outcomes. In research, risk estimates outperform the tool's strength and vulnerability scales for violence prediction. Little is known about what its’component parts contribute to the assignment of risk estimates and how those estimates fare in prediction of non-violent adverse outcomes compared with the structured components. START assessment and outcomes data from a secure mental health service (N=84) was collected. Binomial and multinomial regression analyses determined the contribution of selected elements of the START structured domain and recent adverse risk events to risk estimates and outcomes prediction for violence, self-harm/suicidality, victimisation, and self-neglect. START vulnerabilities and lifetime history of violence, predicted the violence risk estimate; self-harm and victimisation estimates were predicted only by corresponding recent adverse events. Recent adverse events uniquely predicted all corresponding outcomes, with the exception of self-neglect which was predicted by the strength scale. Only for victimisation did the risk estimate outperform prediction based on the START components and recent adverse events. In the absence of recent corresponding risk behaviour, restrictions imposed on the basis of START-informed risk estimates could be unwarranted and may be unethical.

Simulation-based mentalizing generates a ‘proxy’ self-reference effect in memory

The self-reference effect (SRE) in memory is thought to depend on specialized mechanisms that enhance memory for self-relevant information. We investigated whether these mechanisms can be engaged “by proxy” when we simulate other people, by asking participants to interact with two virtual partners: one similar and one dissimilar to self. Participants viewed pairs of objects and picked one for themselves, for their similar partner, or their dissimilar partner. A surprise memory test followed that required participants to identify which object of each pair was chosen, and for whom. Finally, participants were shown both partners’ object pairs again, and asked to indicate their personal preference. Four key findings were observed. Overlap between participants’ own choice and those made for their partner was significantly higher for the similar than the dissimilar partner, revealing participants’ use of their own preferences to simulate the similar partner. Recollection of chosen objects was significantly higher for self than for both partners and, critically, was significantly higher for similar than dissimilar partners. Source confusion between self and the similar partner was also higher. These findings suggest that self-reference by proxy enhances memory for non-self-relevant material, and we consider the theoretical implications for functional interpretation of the SRE.