The Safe pilot study: A prospective naturalistic study with repeated measures design to test the psychosis - violence link in and after discharge from forensic facilities

Stål Bjørkly,Petter Laake,John Olav Roaldset,Kevin S Douglas

doi:10.1016/j.psychres.2021.113793

Abstract

The research evidence is very strong for high recidivism rates of violence after discharge from forensic facilities. Big data research has found that a substantial proportion of the forensic population with relapse into violence has a psychosis diagnosis and a criminal record. However, more research on the association between psychotic symptoms and violence may inform and enhance risk assessment, prevention, and treatment. We conducted a prospective naturalistic study with a repeated measures design in a sample of 22 psychotic patients during follow-up after discharge from forensic mental health facilities. We had three aims: to test the predictive validity of three psychotic symptom scales for violence, to analyze main and interaction effects between psychotic symptoms and previous criminal conviction, and to explore the feasibility and potential benefit of the repeated measures design for prospective follow-up research. Interpreted within the limitation of the small sample size, the results were promising for all scales, particularly for adjusted effects without interaction. Two scales remained significant when their interaction with criminal conviction was adjusted. This indicates that risk judgment of psychotic patients with criminal conviction can be improved by adding measurement of fluctuations in psychotic symptoms. The repeated measures design was instrumental in this research.

Highlights

Despite some exceptions (e.g., Hayes et al, 2014), research indicates high violent recidivism rates after discharge from forensic facilities (e.g., Fazel et al, 2016; Krona et al, 2016; Tabita, et al, 2012)
A risk factor must be shown to change in nature, frequency, or severity, and these changes must be associated with sub sequent changes in violence risk
We suggest that dynamic risk factors combined with criminal conviction may optimize assessment of risk of future violence in this group

Summary

Introduction

Despite some exceptions (e.g., Hayes et al, 2014), research indicates high violent recidivism rates after discharge from forensic facilities (e.g., Fazel et al, 2016; Krona et al, 2016; Tabita, et al, 2012). In searching for clinical predictors of violent recidivism, diagnoses such as schizo phrenia (e.g., Douglas et al, 2009), personality disorder (e.g., O’Connell and Marcus, 2019), childhood victimization (Krona et al, 2016) and drug abuse (e.g., Walter et al, 2019) have been identified. Diagnoses may be significant risk factors of violence, their clinical relevance ostensibly is low, relative to a symptom-level approach. This paper reports findings from a prospective investigation of psychotic symptoms as dynamic violence risk factors. A risk factor must be shown to change in nature, frequency, or severity, and these changes must be associated with sub sequent changes in violence risk (e.g., de Vries Robbe et al, 2015)

Methods

Results

Discussion

Conclusion