Forensic Psychiatric Inpatients Research Articles

A comparison of patient ratings and staff ratings of disability using the World Health Organisation Disability Assessment Schedule in individuals with psychotic spectrum disorders who are forensic psychiatric inpatients.

Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients. To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors. Seventy-three patients self-rated on the WHODAS after 3months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared. Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings. Our mean WHODAS score findings echoed those in other patient samples-of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning.

Genetic studies on forensic-psychiatric inpatients? : Clinical, ethical and legal considerations

Research on people deprived of liberty raises serious questions, especially concerning behavioral genetic studies. Does including criminally detained patients with mental disorders in genetic studies lead to again of new knowledge and can this be ethically and legally justified? Evaluation of existing literature and interdisciplinary reflection. After areview of research ethics and legal norms, we consider the benefits and risks of behavioral genetic research, taking the unique situation of test persons deprived of their liberty into account. The fundamental right to freedom of research also justifies foundational research in forensic psychiatry and psychotherapy. The possible future benefits of improving treatment plans must be weighed against the risks resulting from potential data leaks and inappropriate public reception of research results. Then we analyze possible threats to voluntary and informed consent to study participation in more detail by the ethical concept of vulnerability. Alongside problems with grasping complex issues, above all dependencies and power dynamics in the correctional system play apivotal role. Recommendations on the ethical and legal inclusion of this study population are given. Including criminally detained study participants can be ethically and legally justified when autonomous consent is supported by specific organizational and legal procedures and measures, for example via aclear professional and organizational separation of correction and research.

Virtual reality-assisted assessment of paranoid ideation in forensic psychiatric inpatients: A mixed-methods pilot study.

Reliable and valid assessment of paranoia is important in forensic psychiatry for providing adequate care. VR technology may add to current assessment procedures, as it enables observation within realistic (social) situations resembling the complexity of everyday life. VR constitutes a promising tool within forensics, due to the restricted nature of forensic psychiatric hospitals and ethical challenges arising from observing potentially dangerous behaviors in real life. To investigate the feasibility of VR assessment for paranoid ideation in forensic psychiatric inpatients qualitatively by assessing the experiences of patients and a clinician, and to explore how the VR measures relate to established clinical measures. One clinician (experienced psychiatrist) and 10 forensic psychiatric inpatients with a history or suspicion of paranoid ideation were included. Patients participated in two immersive VR scenarios (bus and supermarket) during which paranoia was assessed by the clinician. Qualitative interviews were performed with patients and the clinician performing the assessment to investigate experiences and feasibility. Further, measures of paranoia, social anxiety, and positive symptoms were obtained. Nine out of 10 participants with varying levels of paranoid ideation completed the assessment. Manifest inductive content analyses of the interviews revealed general experiences, advantages such as enabling observing participants from a different perspective, and challenges of the VR assessment, such as a lack of objectivity and the laboriousness of the assessment for the clinician. Although more paranoia was experienced during the supermarket scenario, correlates with classical measures were only significant for the bus scenario. The VR assessment was appreciated by most patients and the clinician. Based on our results short, standardized VR assessment scenarios are feasible, however, they do not appear reliable or objective for assessing paranoia. The clinical usefulness is most likely as a collaborative tool and add-on measure to existing methods.

Exploring the added value of virtual reality biofeedback game DEEP in forensic psychiatric inpatient care-A qualitative study.

Low motivation and suboptimal cognitive skills are common among forensic psychiatric patients. By focusing on doing and experiencing, innovative technologies could offer an alternative to existing treatment for this patient group. One promising technology is DEEP, a VR biofeedback game that teaches diaphragmatic breathing, which has shown its potential in reducing stress in other populations. This exploratory study aimed at identifying if, how and for whom DEEP can be of added value in forensic mental healthcare. This study used a qualitative approach. Six focus groups with 24 healthcare providers and 13 semi-structured interviews with forensic psychiatric inpatients were conducted in two Dutch forensic mental healthcare organizations. All healthcare providers and patients experienced DEEP before participating. The data were coded inductively, using the method of constant comparison. The data revealed six themes with accompanying (sub)codes, including (1) the possible advantages and (2) disadvantages of DEEP, (3) patient characteristics that could make DEEP more or (4) less suitable and beneficial, (5) ways DEEP could be used in current treatment, and (6) conditions that need to be met to successfully implement DEEP in forensic mental healthcare. The results showed that DEEP can offer novel ways to support forensic psychiatric patients in coping with negative emotions by practicing diaphragmatic breathing. Its appealing design might be suitable to motivate a broad range of forensic psychiatric patient groups. However, DEEP cannot be personalized, which might decrease engagement and uptake of DEEP long-term. Regarding its place in current care, DEEP could be structurally integrated in existing treatment programs or used ad hoc when the need arises. Finally, this study showed that both healthcare providers and patients would need practical support and information to use DEEP. With its experience-based and gamified design, DEEP could be useful for forensic mental healthcare. It is recommended that patients and healthcare providers are included in the evaluation and implementation from the start. Besides, a multilevel approach should be used for formulating implementation strategies. If implemented well, DEEP can offer new ways to provide forensic psychiatric patients with coping strategies to better control their anger.

Adverse Childhood Experiences and Treatability in Dutch Patients with Cluster B Personality Disorders Mandated to Forensic Clinical Care: A Comparison of Men Convicted for Sexual and Violent Offenses

Adverse childhood experiences (ACEs) have been consistently linked to interpersonal violence and are highly prevalent in correctional populations, particularly in men who perpetrate (sexual) violent behavior. Although exposure to ACEs is common in men who perpetrate interpersonal violence, less is known about the differences between men who commit sexual versus non-sexual violence. This cross-sectional study reports on the differences in prevalence of adverse childhood experiences in Dutch men who committed sexual offenses (N = 29) versus those who committed (non-sexual) violent offenses (N = 29), all who have been mandated to forensic clinical care. Drawing on data from a RCT-study among male forensic psychiatric inpatients with cluster B personality disorders from seven forensic hospitals in the Netherlands, the study explored potential differences in ACEs, and its relationship to treatability in the first year of forensic treatment. No significant differences were found in prevalence of childhood abuse and neglect among men convicted for sexual offenses versus those convicted for violent offenses. In our study, ACEs were not predictive of risk relating to treatability at the start of forensic treatment. Our findings suggest that taking into account trauma histories is of equal importance for both offending groups. Implications regarding trauma-informed forensic care are discussed.

Protective Factors in Forensic Practice: The Added Value of the SAPROF-Extended Version Pilot in Relation to Aggressive Incidents

Protective factors are now commonly included in comprehensive risk assessment. This study concerns an initial validation of the new SAPROF-Extended Version (SAPROF-EV) pilot, containing modifications and additions to the original SAPROF. For 139 forensic psychiatric inpatients, assessment results with the SAPROF-EV pilot and HCR-20V3 were compared with aggressive incidents. Results show good predictive validity for the SAPROF-EV pilot for all outcomes and incremental predictive validity for both the (modified) original SAPROF and the full SAPROF-EV pilot over the HCR-20V3. For the outcome aggression toward others, the additional SAPROF-EV factors provide incremental predictive validity over the (modified) original SAPROF. In addition, the user feedback from clinicians highlights experienced additional value of the new factors for treatment guidance. Based on the findings from this study, the SAPROF-EV pilot will be adjusted further into an improved and enhanced version of the SAPROF.

Assessing attribution in the criminal behavior of mentally disordered offenders: Developing a Japanese version of the Gudjonsson Blame Attribution Inventory-Revised.

Treating individuals with a mental disorder and a history of criminal behavior (mentally disordered offenders [MDOs]) aims to enable patients to maintain their health and facilitate social rehabilitation while preventing adverse outcomes, such as violent recidivism or suicide. Understanding and responding to their own insight on their criminal behavior is crucial to achieving this goal. This article aims to develop a Japanese version of the Gudjonsson Blame Attribution Inventory-Revised (GBAI-R) and investigate the reliability and validity of the scale for MDOs in Japan. In addition to developing the Japanese version of GBAI-R (GBAI-RJ), psychological data relevant to the Japanese study were collected and analyzed. Factor analysis was employed. Seventy-seven Japanese native participants were recruited from forensic psychiatric inpatients, outpatients, and medical prison inmates between 2020 and 2022. The results demonstrated that the dimensions on the GBAI-RJ had a similar factor structure to those reported in previous studies. The GBAI-RJ has both test/retest reliability and internal consistency. The three dimensions Guilt Factor, External Factor, and Mental Element Factor from the original version in English are applicable to the Japanese version for assessing attribution and comparing the findings with those of the previous studies.

Exploring the psychometric properties of the externalizing spectrum inventory-brief form in a Swedish forensic psychiatric inpatient sample

BackgroundThe Externalizing Spectrum Inventory-Brief Form (ESI-BF) [1] is a 160-item self-report instrument designed for the assessment of externalizing psychopathology, yet few studies to date have evaluated its psychometric properties, structural fit, and criterion validity in forensic psychiatric settings.MethodsHere, we investigated these aspects in a sample of forensic psychiatric inpatients (n = 77) from a maximum-security forensic psychiatric hospital in Sweden. We firstly investigated the reliability. Secondly, using confirmatory factor analysis, the structure of the ESI-BF. And thirdly, using a Bayesian approach, assessed how the three ESI-BF subfactors relate to criterion measures of antisocial behaviors, substance use, and lifetime externalizing spectrum diagnoses.ResultsThe ESI-BF demonstrated good to adequate reliability and internal consistency, with all but four facet scales exhibiting α and ω values ≥ 0.80. Average inter-item correlations for the facet scales ranged from 0.31 to 0.74. However, all structural models exhibited poor to mediocre fit, with model fit values for the CFI being 0.66, 0.79 and 0.87 and RMSEA values of 0.14, 0.12 and 0.09. for the unidimensional correlated factors and bifactor model, respectively. Regarding criterion validity, all subscales of the item-based ESI-BF three-factor model exhibited robust correlations with the Life History of Aggression total, aggression and antisocial/consequences subscales, with correlations ranging from 0.29 to 0.55. All ESI-BF subfactors demonstrated robust associations, yet with different externalizing outcomes, lending tentative support to its criterion validity.ConclusionDespite remaining ambiguities regarding its structural fit, the ESI-BF may be promising for assessing externalizing psychopathology in forensic psychiatric populations. However, further investigation of the ESI-BF is needed before any firm conclusions can be drawn about its appropriateness in forensic psychiatric settings.

Socio-demographic, clinical and offense-related characteristics of forensic psychiatric inpatients in Hunan, China: a cross-sectional survey

BackgroundThere is still a lack of comprehensive research on the profile of patients in forensic mental health hospitals in China. This study aims to investigate the socio-demographic, clinical, and offense-related characteristics of mentally ill offenders in the Hunan Provincial Forensic Psychiatric Hospital in China.MethodsThis study was conducted from November 1, 2018, to January 30, 2019. The data of socio-demographic, clinical, and offense-related characteristics of the patients were collected. The Brief Psychiatric Rating Scale (BPRS), the Modified Overt Aggression Scale (MOAS), and the Clinical Global Impression-Severity (CGI-S) scale were used to measure their psychiatric conditions.ResultsA total of 461 participants were enrolled in this study. Among them, 86.3% were males and 56.8% were unmarried; the average age of them was 44.7 ± 10.1 years, and the mean years of education were 7.51 ± 3.3 years. Before their current offense, a total of 345 patients (74.8%) had sought medical help for their mental illnesses. While 303 (87.8%) of these patients were prescribed antipsychotics, 254 (73.6%) failed to take them regularly. Of all the inpatients, 90.5% were diagnosed with schizophrenia; 385 (83.5%) engaged in homicidal offenses, with 54.0% of the victims being their family members. In homicide cases, the relatives were more likely to be victims of female patients. The mean length of stay in the forensic hospital was 8.02 ± 4.74 years, and over 80.0% of the patients had been hospitalized for over 5 years.ConclusionsTo our knowledge, this is the first study investigating the profile of forensic patients receiving compulsory treatments in a forensic psychiatric hospital in China. These results add to the world literature on the characteristics of forensic patients and can help identify common treatment and risk-related needs of this population.

Psychological factors predicting self-reported and observed aggression in male forensic psychiatric inpatients

The present study examined the psychological determinants of self-reported and observed aggression in male violent forensic psychiatric inpatients. Baseline data came from 232 inpatients referred to a cognitive–behavioral treatment program. Linear regression models were used to assess the relationship between the patients’ psychological characteristics and aggressive behavior. Self-reported aggression was studied with cross-sectional data, while the inpatients’ observed aggression in the ward was investigated with prospective data. The main factors contributing to the prediction of self-reported aggression were state anger, antisocial lifestyle and agreeableness, while the main factors contributing to the prediction of observed aggression were trait anger and agreeableness. The findings support the focus of treatment programs for forensic psychiatric inpatients on anger management.

Intelligence as a protective factor and risk factor for violence in a group of forensic psychiatric inpatients

In the research literature intelligence is commonly described as a risk or protective factor for crime and violence, depending on its level. In mostly exploratory analysis presented in this study, authors primarily focused on determining how socioeconomic factors and comorbidity disorders influence relationship between intelligence level and violence of risk. In total, 101 patients participated in the study, all of them were male, Polish detainees at three psychiatric hospitals with forensic psychiatry wards: the S. Kryzan Hospital for the Nervously and Mentally Ill in Starogard Gdański, the State Hospital for Mental Diseases in Rybnik, and the Józef Babiński Psychiatric Hospital in Kraków. Statistical analysis of the collected data confirmed positive relationship between level of intelligence and historical risk factors summary of HCR20v3. It was observed that no source of income is an important moderator between low intelligence and historical risk factors. Additionally, in the group of patients with primary or middle education, intelligence level above average is a significant factor that minimalizes historical risk. Comorbidity disorder was identified as aspect that minimalizes protective influence of medium or high level of intelligence in the dynamic, clinical scale of HCR-20v3. Besides that, intelligence level above average was a protective factor in the group of schizophrenic patients without personality disorders. Knowledge of the way in which analyzed moderators influence relationship between intelligence level and risk of violence can improve the risk management process by enabling the identification of protective factors that are specific to subtypes of perpetrators of violence with mental disorders.

How to execute research projects in clinical practice in a large medium secure forensic psychiatric facility

IntroductionWhile effective project planning is crucial for the success of a clinical research project, being able to execute the plan is even more important. In Denmark, approval for health research projects is applied for at regional or national committees on health research ethics, which have been reluctant to approve clinical research projects involving forensic psychiatric in-patients, due to the admission usually being pursuant to treatment sanctions. However, recently we received approval for a clinical research project exclusively targeted towards inpatients at a large medium secure forensic psychiatric facility in Denmark.ObjectivesDescribing the process of project execution from planning to submitting the manuscript which is inherently multi-faceted and inundated with stress factors. How to connect theory, knowledge, project with clinical practice, with clinical research?MethodsQualitative data collecting while undertaking an exploratory, open-label, non-randomised weight reducing trial with a glucagon-like peptide-1 receptor agonist.ResultsChallenges in finding, screening, motivating, recruiting, obtaining valid confirmed consent from potential study participants and other stakeholders, team communication, responsibilities and accountabilities within the team, Pareto Principle, scope creep, building project reports manually, real-time data gathering, unpredictable and other project deliverables will be presentedConclusionsExperiences of the hospital staff (psychiatrists, doctors and nurses) in execution process of the project investigation performed and made possible through participation of their forensic psychiatric in-patients.DisclosureNo significant relationships.

Can measures of cognitive flexibility and inhibition distinguish forensic psychiatric inpatients from prisoners?

ABSTRACT We investigated whether forensic psychiatric inpatients can be distinguished from prisoners and healthy controls on the basis of their performance on cognitive tasks measuring cognitive flexibility (with a reversal learning task) and inhibition (with a stop signal task). Forensic psychiatric inpatients were expected to perform worse compared to prisoners. This study was based on pre-existing data from N = 241 males (119 forensic psychiatric inpatients, 57 prisoners and 65 healthy controls). We fitted logistic generalized linear models to group membership data using outcome measures from a stop signal task and a reversal learning task to examine whether deficiencies in inhibition and cognitive flexibility predict membership of the group of forensic psychiatric inpatients. Neurocognitive measures of cognitive flexibility, but not inhibition, had predictive value for group membership. This suggests that the capacity for cognitive flexibility may help differentiate between forensic subpopulations and healthy controls. Furthermore, our results highlighted substantial heterogeneity in cognitive performance in inhibition and cognitive flexibility within different offender groups. This study indicates that forensic subpopulations can be adequately differentiated based on neurocognitive measures of cognitive flexibility. In a broad sense, this study is an example of how neurocognitive approaches can contribute to refining diagnosis in forensic psychiatry.

Lying awake in forensic hospitals: a multicenter, cross-sectional study on the prevalence of insomnia and contributing factors in forensic psychiatric patients

ABSTRACT Insomnia has a negative impact on mental health and is a potential risk factor for impulsive and problematic behavior. This multicenter, cross-sectional study investigated the prevalence of insomnia and underlying and maintaining factors in a group of forensic psychiatric inpatients (N = 281). Insomnia severity, subjective sleep quality, sleep hygiene and erroneous cognitions about sleep were measured with the Insomnia Severity Index, Pittsburgh Sleep Quality Index, Sleep Hygiene questionnaire and Dysfunctional Beliefs and Attitudes about Sleep, respectively. Impulsivity was derived from risk assessment instruments routinely completed by trained professionals. Almost half of the patients (48.7%) appeared to suffer from insomnia. Particularly moderate-severe insomnia (26.7%) was significantly associated with worse sleep quality, poorer sleep hygiene, stronger endorsement of dysfunctional sleep cognitions and higher impulsivity scores. It can be concluded that insomnia is rather common in forensic psychiatric patients. Insomnia appears related to various sleep hygiene behaviors and sleep-related cognitions, and probably also to diverse situational and environmental factors as well as a lack of autonomy. Cognitive behavioral therapy for insomnia, with some adjustments specific for this population, may be an effective intervention, ameliorating sleep problems and possibly also emotional and behavioral dysregulation.

Patient Experiences of Victimization during Mandatory Psychiatric Treatment: A Qualitative Study

ABSTRACT Forensic psychiatric inpatients are frequently exposed to aggression from fellow patients during their treatment, but research on how this impacts patients’ well-being and treatment progress is lacking. In this study, we interviewed nine patients on their experiences of victimization during mandatory psychiatric treatment. The interviews were analyzed using a Grounded Theory approach combined with elements from Consensual Qualitative Research and Interpretative Phenomenological Analysis. Three main themes emerged from the data, namely situational descriptives, intrapersonal and interpersonal consequences. Patients were not only exposed to both physical violence and verbal aggression by other patients, but also to a more ubiquitous flow of micro-aggressive comments. Options to escape these situations were limited. This means that victimization processes, which for most patients started much earlier in life, continue during forensic psychiatric treatment. Intrapersonal consequences include fear, hypervigilance, reactive aggression, flashbacks and avoidance and withdrawal. Interpersonal consequences include increased power differences between patients and adverse treatment consequences, such as difficulties with self-esteem. Victimization processes are not always timely noticed in an environment that focuses on risks and treatment of delinquent behavior. A higher level of trauma sensitivity in forensic mental health care is thus required. Recommendations for the implementation of trauma informed care are provided.

Are Women Really Different? Comparison of Men and Women in a Sample of Forensic Psychiatric Inpatients.

BackgroundWomen in detention remain a widely understudied group. Although the number of studies in women in prison has grown in the past decade, research on female forensic psychiatric inpatients has not increased, and women are in the minority in forensic psychiatry not only as patients but also as examinees. Consequently, most treatment manuals and risk assessments were developed in male samples and apply to male offenders. However, the same treatment and risk assessment rationale can be applied in male and female mentally ill offenders only if evidence shows that no relevant sex differences exist.AimsThe aim of the present study was to examine a sample of male and female forensic psychiatric inpatients with substance use disorders and to compare the socio-demographic, legal, and clinical characteristics between the sexes.MethodsThe sample included 115 male and 61 female patients. All patients were in mandatory inpatient forensic psychiatry treatment according to section 64 of the German penal code.ResultsWe found no significant differences between men and women in terms of educational status and vocational training. However, women were more often single and less likely to be employed full time, and they reported adverse childhood experiences more often than men. Regarding clinical variables, women appeared to be less likely to have a substance use disorder due to alcohol use and had more previous psychiatric treatments than men. Male patients were significantly younger on first conviction and detention, had more criminal records and served longer total penalties than female patients. Furthermore, men committed more violent crimes and women, more narcotics-related crimes.ConclusionsThe study identified sex-specific differences in forensic psychiatric patients that should be considered in the context of forensic therapy.

Effects of Implementing the Short-Term Assessment of Risk and Treatability for Mechanical Restraint in a Forensic Male Population: A Stepped-Wedge, Cluster-Randomized Design.

The assessment and formulation of the risk of violence and other unwanted behaviors at forensic psychiatric facilities have been attempted for decades. Structured professional judgment tools, such as the Short-Term Assessment of Risk and Treatability (START), are among the recent attempts to overcome the challenge of accomplishing these goals. This study examined the effect of implementing START in clinical practice for the most serious adverse events among the target group of severely mentally ill forensic psychiatric inpatients. Results were based on the use of mechanical restraints as an outcome. This study is a pragmatic, stepped-wedge, cluster-randomized controlled trial and was conducted over 5 years. It included eight forensic psychiatric units. Fifty out of 156 patients who had a basic aggression score of more than 0 were included in the study. We found that the rate of mechanical restraint use within the START period were 82% [relative risk (RR) = 0.18], lower than those outside of the START period. Patients evaluated within the START period were also found to have a 36% (RR = 0.64) lower risk of having higher Brøset Violence Checklist scores than patients evaluated outside the START period. Previous studies on START have primarily focused on validation, the predictive capability of the assessment, and implementation. We were only able to identify one study that aimed to identify the benefits and outcomes of START in a forensic setting. This study showed a significant reduction in the chance for inpatients in a forensic psychiatric facility to become mechanically restrained during periods where the START was used as risk assessment.

Gender differences in a sample of Romanian forensic psychiatric inpatients

Objectives. To gain insight into the characteristics of female forensic psychiatric patients in Romania and to identify the potential differences between female and male forensic inpatients. Material and method. Data on all patients admitted according to art. 110 of the Romanian Penal code to Sapoca Psychiatry and Safety Measures Hospital between 2008 and 2018 were collected from hospital records (electronic records, clinical files, social assessment forms and legal files). The final sample comprised 650 individuals: 84% were men and 16% were women. Results and discussion. There were few socio-demographic differences. Both men and women had a psychiatric history, and schizophrenia spectrum disorders were the most frequent main diagnosis in both groups. Women were more likely to have committed arson, homicide and attempted homicide and to be hospitalized for a shorter period of time. Conclusions. Consistent with previous studies, we concluded that men and women admitted to forensic psychiatric hospitals differ in a number of ways. Our study highlights the need to continue and expand the research into the Romanian forensic psychiatric inpatient population.

Self-Harm History, Anxiety-Depression, Severity of Disease, and Insight Are Significantly Associated With Suicide Risk in Forensic Psychiatric Inpatients of China.

Background: Forensic psychiatric patients have higher suicide risk than the general population. This study aimed to evaluate the extent of suicide risk and to explore the associated factors in forensic psychiatric inpatients in China.Methods: We conducted a cross-sectional study from 1st November, 2018 to 30th January, 2019 in the Forensic Psychiatric Hospital of Hunan Province, China. Patient's information on socio-demographic, clinical, and criminological characteristics was collected. The suicidality subscale of the MINI-International Neuropsychiatric Interview (M.I.N.I.), the Brief Psychiatric Rating Scale (BPRS), and the Severity of Illness of Clinical Global Impressions Scale (CGI-SI) were used to measure present suicide risks, psychiatric symptoms, and the severity of the patient's disease, respectively. Binary logistic regression models were used to examine factors associated with suicide risk.Results: Twenty-one percent (84/408) of the forensic psychiatric inpatients reported suicide risk. Logistic regression analysis suggested that self-harm history (OR:3.47, 95% confidence interval CI: 1.45–8.33), symptoms of anxiety-depression (OR:1.15, 95% CI:1.04–1.27), and more severe mental disorder (OR:1.42, 95% CI:1.08–1.87) were associated with elevated suicide risk, while insight disorder (OR:0.81, 95% CI:0.65–0.99) was related to decreasing suicide risk.Conclusion: The study supplied useful clinical information to recognize high suicide risk in forensic psychiatric inpatients and may aid the development of valuable strategies for preventing and reducing suicide events.

“You Should Just Keep Your Mouth Shut and Do As We Say”: Forensic Psychiatric Inpatients’ Experiences of Risk Assessments

This study presents findings of forensic inpatients’ experiences of their role in the risk assessment process. Eleven patients, recruited from two forensic psychiatric clinics in Sweden, participated in semi-structured interviews which were analyzed using qualitative content analysis. The analysis of their experiences resulted in the information of three categories: Taking responsibility for one’s own situation, in terms of taking responsibility for aspects of one’s care, taking charge of the present, emphasizing potential challenges in grasping reality, and being involved and having impact, which concerns feelings of being involved in discussions related to one’s care and treatment versus feelings of being an outsider.