Clinical Characteristics and Self-Harm in Forensic Psychiatric Patients

Self-harm, comprising non-suicidal self-injury, and suicide attempts, is a serious and potentially life-threatening behavior that has been associated with poor life quality and an increased risk of suicide. In forensic populations, increased rates of self-harm have been reported, and suicide is one of the leading causes of death. Aside from associations between self-harm and mental disorders, knowledge on self-harm in forensic psychiatric populations is limited. The purpose of this study was to characterize the clinical needs of a cohort of forensic psychiatric patients, including self-harm and possible risk factors thereof. Participants (N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden from 2016 to 2020. Data were collected through file information, self-reports, and complemented with semi-structured interviews. Results showed that self-harm was common among the participants, more than half (68.4%) of whom had at some point engaged in self-harm. The most common methods of non-suicidal self-injury were banging one's head or fist against a wall or other solid surface and cutting, and the most common method of suicide attempt was hanging. The most prominent functions of non-suicidal self-injury among the participants were intrapersonal functions such as affect regulation, self-punishment, and marking distress. Self-harm in general was associated to neurodevelopmental disorders (p = 0.014, CI = 1.23–8.02, OR = 3.14) and disruptive impulse-control and conduct disorders (p = 0.012, CI = 1.19–74.6, OR = 9.41), with reservation to very wide confidence intervals. Conclusions drawn from this study are that self-harm was highly prevalent in this sample and seems to have similar function in this group of individuals as in other studied clinical and non-clinical groups.

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Emotion Regulation and Self-Harm Among Forensic Psychiatric Patients

Frontiers in Psychology ◽

10.3389/fpsyg.2021.710751 ◽

2021 ◽

Vol 12 ◽

Author(s):

Natalie Laporte ◽

Stéphanie Klein Tuente ◽

Andrejs Ozolins ◽

Åsa Westrin ◽

Sofie Westling ◽

...

Keyword(s):

Emotion Regulation ◽

Psychiatric Patients ◽

Self Report ◽

Medium Effect ◽

Psychiatric Clinic ◽

Self Injury ◽

Forensic Psychiatric Patients ◽

Significant Difference ◽

Self Harm ◽

Forensic Psychiatric

Emotion regulation has been specifically linked to both non-suicidal self-injury (NSSI) and attempted suicide. It is also known that self-harm is disproportionally higher (30–68.4%) in forensic samples than in the general population, yet knowledge about the association between emotion regulation and self-harm in forensic settings is scarce. The purpose of this study was to describe emotion regulation in a sample of forensic psychiatric patients, to explore dimensions and levels of emotion regulation between forensic psychiatric patients with and without self-harm, and to explore associations between forensic psychiatric patients’ self-reported emotion regulation and self-reported functions of NSSI. A cohort of forensic psychiatric inpatients (N=98) was consecutively recruited during 2016–2020 from a high-security forensic psychiatric clinic in Sweden. Data were collected through the self-report measures Difficulties in Emotion Regulation Scale (DERS) and Inventory of Statements About Self-injury (ISAS). In relation to the first aim, median total and subscales scores for DERS were reported. Results showed a statistically significant difference in emotion regulation between participants with and without self-harm (p=0.004), with a medium effect size (Cohen’s d=0.65) for the DERS total scale. The DERS subscales returned large differences for Impulse (p=0.001, d=0.86), Goals (p=0.014, d=0.58), and Strategies (p=0.012, d=0.54) between participants with and without self-harm. Finally, DERS scores were correlated with both the interpersonal (rs=0.531, p<0.001, n=43) and intrapersonal factors (rs=0.503, p<0.001, n=43) of NSSI as reported on the ISAS. Participants with self-harm (NSSI and/or suicide attempts) demonstrated significantly more difficulties with emotion regulation than those without self-harm. Emotion dysregulation was associated with both interpersonal and intrapersonal functions of NSSI in the participants. We suggest further studies on forensic psychiatric patients’ maladaptive behaviors that focus on substance abuse, self-harm, and aggressive behaviors in relation to the regulation and expression of emotion.

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Self-injurious behaviour in forensic mental health care: a study into the prevalence and characteristics of incidents of self-injury

Journal of Forensic Practice ◽

10.1108/jfp-12-2020-0053 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Vivienne de Vogel ◽

Nienke Verstegen

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Suicide Attempts ◽

Psychiatric Patients ◽

Forensic Mental Health ◽

Content Type ◽

Self Injury ◽

Forensic Psychiatric ◽

The Impact

Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.

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“Trapped in their Shame”: A Qualitative Investigation of Moral Injury in Forensic Psychiatry Patients

Criminal Justice and Behavior ◽

10.1177/00938548211039877 ◽

2021 ◽

pp. 009385482110398

Author(s):

Sophia L. Roth ◽

Aamna qureshi ◽

Heather M. Moulden ◽

Gary A. Chaimowitz ◽

Ruth A. Lanius ◽

...

Keyword(s):

Criminal Behavior ◽

Psychiatric Patients ◽

Moral Injury ◽

Future Research ◽

Care Providers ◽

Structured Interviews ◽

Forensic Psychiatric Patients ◽

Not Criminally Responsible ◽

Forensic Psychiatric ◽

Insight Into

Individuals who engage in criminal behavior for which they are found not criminally responsible (NCR) may be at increased vulnerability to experience moral pain and, in extreme circumstances, moral injury after regaining insight into the consequences of their behavior. Yet, almost no research exists characterizing the nature, severity, or impact of moral pain in this population. Semi-structured interviews were conducted with nine forensic psychiatric patients and 21 of their care providers. Narratives were explored using thematic analysis. Findings demonstrate that NCR patients endorse symptoms consistent with moral injury, including feelings of guilt toward victims, shame for one’s behavior, and a loss of trust in one’s morality. Moral pain is a strong driver of behavior and must be understood as part of a constellation of factors influencing criminality, risk, and recovery. Future research must develop adequate tools to measure and characterize offense-related moral injury to understand its impact on this population.

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Urine drug screening in women's forensic mental health services: is current practice meeting guidelines?

BJPsych Open ◽

10.1192/bjo.2021.903 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S344-S345

Author(s):

Jeremy Rampling ◽

Shay-Anne Pantall ◽

Ravinder Mann

Keyword(s):

Drug Screening ◽

Substance Misuse ◽

Psychiatric Patients ◽

Care Plan ◽

Drug Screen ◽

Care Plans ◽

Forensic Psychiatric Patients ◽

Increased Risk ◽

Urine Drug ◽

Forensic Psychiatric

AimsTo investigate adherence to Trust guidelines for urine drug screening amongst female forensic psychiatric inpatients.BackgroundThe use of illicit substances is an important risk factor which needs to be considered in the management and treatment of forensic psychiatric patients. Research has demonstrated that a high proportion of women admitted within secure services in the UK have a history of substance use. Substance misuse amongst this population can lead to an increased risk of violence, re-offending and mental health relapse; which can pose a significant threat to the safety of other patients, staff and the public. It is therefore important that regular drug screening is carried out to minimise such risks. Ardenleigh is a blended female secure unit in Birmingham. The service has established specific substance use guidelines, outlining the need for each patient to have a personalised drug screen care plan in place. Here we present the findings of an audit completed in 2019.MethodA six month retrospective electronic case note audit for female inpatients admitted to Ardenleigh as of 1st September 2019 (n = 27). We compared drug screen care plans and frequency of urine drug screens over 6 months with the recommendations of the current service-specific Trust guidelines. Care plans should include: information regarding random drug screening; frequency of random drug screening; triggers for increased risk of substance misuse; and consequences for a positive test result to be contained within inpatient care plans.ResultPatient aged between 20 and 56 years old (median age 31). Fewer than half of inpatients (41%) had a documented random drug screen completed within the review period. In terms of care-planning, only 52% of patients had random drug screening mentioned in their care plan. 22% of patient care plans reported the actions/consequences for a positive test result. Not a single care plan mentioned how frequently patients should be being tested or potential triggers for increased risk of drug misuse amongst inpatients.ConclusionCurrent practice and recording of drug screening amongst female forensic psychiatric patients is poor compared to expected standards. The lack of consistency in drug screening raises concerns regarding whether potential substance misuse amongst inpatients may be going undetected, and therefore impacting the recovery of patients. Improvements to drug screening practice should be considered in order to ensure optimal recovery and safety to patients and others.

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Psychotic experiences and psychological distress predict contemporaneous and future non-suicidal self-injury and suicide attempts in a sample of Australian school-based adolescents

Psychological Medicine ◽

10.1017/s0033291714001615 ◽

2014 ◽

Vol 45 (2) ◽

pp. 429-437 ◽

Cited By ~ 44

Author(s):

G. Martin ◽

H. Thomas ◽

T. Andrews ◽

P. Hasking ◽

J. G. Scott

Keyword(s):

Psychological Distress ◽

Suicide Attempts ◽

General Health Questionnaire ◽

Diagnostic Interview ◽

Psychotic Experiences ◽

Cross Sectional ◽

School Based ◽

Self Injury ◽

Increased Risk ◽

Self Harm

BackgroundRecent cross-sectional studies have shown psychotic experiences (PEs) are associated with suicidal ideation and behaviours. We aimed to examine associations between psychotic experiences (including persistent PE), and contemporaneous and incident non-suicidal self-injury (NSSI) and suicide attempts.MethodParticipants were from an Australian longitudinal cohort of 1896 adolescents (12–17 years). NSSI and suicide attempts were measured using the Self-Harm Behaviour Questionnaire. Items from the Diagnostic Interview Schedule for Children were used to assess psychotic experiences, and the General Health Questionnaire-12 measured psychological distress.ResultsAdolescents both psychologically distressed and endorsing psychotic experiences had increased odds of contemporaneous and incident NSSI and attempted suicide. Psychotic experiences alone did not predict future risk. Persistent psychotic experiences were associated with increased risk of NSSI and suicide attempts.ConclusionsPsychological distress with accompanying psychotic experiences and persistent psychotic experiences are important predictors of NSSI and suicide attempts. Screening these phenotypes in adolescents will assist in discerning those adolescents most at risk, providing opportunities for targeted suicide prevention strategies.

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Protocol: A two-wave cross-sectional study in England investigating suicidal behaviour and self-harm amongst healthcare workers during the Covid-19 pandemic

10.1101/2021.09.16.21263255 ◽

2021 ◽

Author(s):

Prianka Padmanathan ◽

Danielle Lamb ◽

Hannah Scott ◽

Simon Wessely ◽

Paul Moran

Keyword(s):

Suicidal Ideation ◽

Cumulative Incidence ◽

Suicidal Behaviour ◽

Healthcare Workers ◽

Online Survey ◽

Suicide Attempts ◽

Self Injury ◽

Increased Risk ◽

Self Harm ◽

The Impact

AbstractIntroductionThere have been longstanding concerns regarding an increased risk of suicide amongst healthcare workers. The Covid-19 pandemic has placed an additional burden on staff, yet few studies have investigated the impact of the pandemic on their risk of suicide and self-harm. We aimed to investigate the cumulative incidence, prevalence and correlates of suicidal ideation, suicide attempts and non-suicidal self-injury amongst healthcare workers during the Covid-19 pandemic.Methods and AnalysisNHS Check is an online survey that was distributed to all staff (clinical and non-clinical), students, and volunteers in 18 NHS Trusts across England during the Covid-19 pandemic. Data collected in wave 1 (collected between April 2020 and January 2021) and wave 2 (collected 6-month after wave 1) will be analysed. The full cohort of wave 1 participants will be weighted to represent the age, sex, ethnicity, and roles profile of the workforce at each Trust, and the weighted prevalence and cumulative incidence of suicidal ideation, suicide attempts and non-suicidal self-injury will be described. Two-level random effects logistic regression models will be used to investigate the relationship between suicidal behaviour and self-harm, and demographic characteristics (age, sex, ethnicity) and workplace factors (concerns regarding access to personal protective equipment, re-deployment status, moral injury, confidence around raising and the management of safety concerns, support by supervisors or managers, satisfaction with standard of care provided). Results will be stratified by role (clinical/non-clinical).

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The role of psychosocial treatment in decreasing of future violence behavior risk in forensicly treated psychiatric patients

European Psychiatry ◽

10.1016/s0924-9338(11)72488-9 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 783-783

Author(s):

S. Jonovska ◽

V.Š. Jengić ◽

L. Safner ◽

G. Bošković ◽

S. Zudenigo

Keyword(s):

Psychiatric Patients ◽

Violent Behavior ◽

Psychosocial Treatment ◽

Violence Risk ◽

Forensic Psychiatric Patients ◽

Forensic Treatment ◽

Aggression Questionnaire ◽

Schizophrenic Group ◽

Forensic Psychiatric ◽

In The Beginning

The main aim of this study was to establish to what extent psychosocial treatment as a part of complex, multicomponent forensic treatment has an influence on decreasing of the future violence behavior risk in population of forensic psychiatric patients. We examinated 13 patients treated on Department of Forensic Psychiatry of Psychiatric Hospital Rab in Rab, Croatia. 9 of them were males and 4 of them females, 25–60 years of age, all of them were compulsory hospitalized because of committed criminal act connected with violent behavior. All of them have diagnosis of schizophrenic group of diseases with different duration of forensic treatment (from few months to few years). During 2010. all of them participated in psychosocial programe workshops once a week, for 6 months.MethodsViolence Risk Screening-10 (V-RISK-10), subjective measure of the programme chairmen performed in the beginning and in the end of the programme. The Aggression Questionnaire and Daily Spiritual Experience Scale as self-assesment scales were performed in the end of the programme. Results point on decreasing of V-RISK-10 results in the end of the programe in all participants. Interested observation was that mentioned results and those on self-assesment scales were not always been correlated positively. We also proved negative correlation between aggressivity and spirituality. As a conclusion, we have indications to believe that is real to expect that comining psychosocial treatment with targeted psuchopharmacological interventions could leed to decreasing the risk of future violent bihevior in forensicly treated psuchiatric patients.

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Forensic Psychiatric Patients’ Perspectives on Their Care: A Narrative View

Perspectives In Psychiatric Care ◽

10.1111/ppc.12201 ◽

2016 ◽

Vol 54 (1) ◽

pp. 64-73 ◽

Cited By ~ 7

Author(s):

Riitta Askola ◽

Merja Nikkonen ◽

Eija Paavilainen ◽

Päivi Soininen ◽

Hanna Putkonen ◽

...

Keyword(s):

Psychiatric Patients ◽

Forensic Psychiatric Patients ◽

Forensic Psychiatric

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Clinical Characteristics of Non-Suicidal Self-Injury and Suicide Attempts among Psychiatric Patients in Korea: A Retrospective Chart Review

Psychiatry Investigation ◽

10.30773/pi.2019.0269 ◽

2020 ◽

Vol 17 (4) ◽

pp. 320-330

Author(s):

Yubeen Bae ◽

Yoanna Seong ◽

Seok Hyeon Kim ◽

Sojung Kim

Keyword(s):

Clinical Characteristics ◽

Chart Review ◽

Suicide Attempts ◽

Medical Center ◽

Psychiatric Patients ◽

Retrospective Chart Review ◽

The Other ◽

Novelty Seeking ◽

Medical Chart Review ◽

Self Injury

Objective Limited data exist on non-suicidal self-injury (NSSI) and suicide attempts among psychiatric patients in Korea. In this study, we investigated the clinical characteristics of patients who engaged in NSSI and/or suicide attempts.Methods We performed a retrospective medical chart review of patients with NSSI and/or suicide attempts at the psychiatric department of a university medical center in Seoul between 2017 and 2019. According to their history, patients were allocated to one of three groups: NSSI only, suicide attempts only and NSSI and suicide attempts group. Groups were compared based on sociodemographic characteristics and psychological assessments.Results Overall, 80 patients with NSSI and/or suicide attempts were evaluated. Patients with NSSI and suicide attempts were more likely to be female than the other two groups. Patients with NSSI and suicide attempts were more likely to suffer from Cluster B personality disorder than the other groups. And patients with NSSI and suicide attempts scored significantly higher on novelty-seeking in TCI and RC8, RC9 in MMPI-2.Conclusion Patients with NSSI and/or suicide attempts were more likely to be female, younger, and showed higher levels of psychological disturbances. These findings highlight the importance of early detection and intervention for patients with NSSI.

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