Cause-specific mortality in Finnish forensic psychiatric patients

Ojansuu, Ilkka; Putkonen, Hanna; Tiihonen, Jari

doi:10.1080/08039488.2018.1467965

Cited by 5 publications

(2 citation statements)

References 22 publications

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“…Additionally, international comparisons between legal and clinical approaches to treatment and their effect on risk of relapse in crime are warranted, as criminal recidivism in mentally ill offenders appears to differ considerably between countries. Finally, a more detailed and comprehensive analysis of specific aspects of forensic psychiatric care ( 29 , 30 ) and aftercare ( 31 , 32 )—which, at the same time, takes into consideration patient characteristics ( 33 – 35 )—in relation to subsequent recidivism could also provide guidance for clinicians in their daily practice, as well as for policymakers engaged in deliberations on legal treatment of mentally ill offenders.…”

Section: Discussionmentioning

confidence: 99%

Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019

2023

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BackgroundThe duration of forensic psychiatric care is in Sweden not determined at the time of sentencing; instead, offenders are regularly evaluated, often with regard to risk of criminal recidivism. The length and justifiability of such a sanction have been greatly debated; however, previous estimates of treatment duration based on datasets delimited to discharged patients—have provided an uncertain groundwork for these deliberations. The aim of this study was to use a more suitable approach to calculate average duration of forensic psychiatric care and to examine the relationship between length of treatment and subsequent recidivism after discharge.MethodsThis retrospective cohort study focused on offenders sentenced to forensic psychiatric care in Sweden between 2009 and 2019 and registered in the Swedish National Forensic Psychiatric Register (n = 2064), with a follow-up period until May 2020. We used Kaplan–Meier estimator to calculate and visualize treatment duration including analyses comparing levels of relevant variables, and then evaluated criminal recidivism in patients discharged from treatment between 2009 and 2019 (n = 640), after stratification for the same variables and dichotomization by treatment duration.ResultsThe median duration of forensic psychiatric care was estimated to 89.7 months (95% CI 83.2–95.8). Treatment was longer in offenders who committed violent crimes, suffered from psychosis, or had a history of substance use disorder, and in offenders whose sentences included special court supervision. The cumulative incidence of recidivism in patients discharged from treatment was estimated to 13.5% at 12 months (95% CI 10.6–16.2) and 19.5% at 24 months (95% CI 16.0–22.8). Corresponding cumulative incidence of violent crime post discharge was 6.3% at 12 months (95% CI 4.3–8.3) and 9.9% at 24 months (95% CI 7.3–12.4). Among other findings, in patients without a history of substance use disorder and patients whose sentences did not include special court supervision, recidivism was significantly higher in those with a shorter treatment duration.ConclusionUsing the entirety of a suitable, contemporary, prospectively enrolled cohort of mentally ill offenders, we were able to estimate—with greater accuracy than previous studies—the average duration of Swedish forensic psychiatric care and rate of subsequent criminal recidivism.

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Section: Discussionmentioning

confidence: 99%

Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019

2023

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“…In a Finnish study, the mortality among forensic psychiatric patients was found to be up to three-fold higher than the general population, but somewhat comparable to that of other schizophrenia spectrum patients (4, 9). When the causes of death were further examined, most of the deaths in the forensic psychiatric patients were due to somatic illnesses, although the largest difference, i.e., as much as seven-fold elevated risk, was attributable to suicide (10).…”

Section: Introductionmentioning

confidence: 99%

Substance Abuse and Excessive Mortality Among Forensic Psychiatric Patients: A Finnish Nationwide Cohort Study

et al. 2019

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Background: Forensic psychiatric patients are known to have reduced life expectancy. The aim of this study was to explore to what extent substance abuse disorders account for this increased mortality. Methods: Data up to December 31, 2016 for mortality (causes of death register) and substance abuse (forensic psychiatric examinations) were collected for all of the 950 patients committed to involuntary forensic psychiatric hospital care in Finland during 1980–2009 and discharged no later than December 31, 2016. Patients were then classified as suffering or not suffering from substance abuse disorders and their causes of death were examined. The standardized mortality ratio was then calculated for these groups on the basis of sex-, age-, and calendar-period-specific mortality rates for the general Finnish population. Results: During the follow-up time (mean 13.4 years), 354 (320 men, 34 women) patients died, resulting in a standardized mortality ratio of 3.5. The standardized mortality ratio for the patients with a history of substance abuse disorders was 4.1 compared to 2.8 for those with no such history. Among men, but not women, the age-adjusted proportion of death was significantly higher for those with a history of substance abuse disorders. In addition, in patients with a history of substance abuse disorders, the male age-adjusted competing risk of mortality was higher for unnatural causes, but not natural causes. Furthermore, a prominent proportion (16%) of all deaths and a majority of the accidental deaths (64%) occurred under the influence of some substance. Conclusions: Substance abuse is a major factor causing excessive mortality among forensic psychiatric patients. The management of substance abuse problems should be one cornerstone of the treatment of patients with both severe mental disorders and substance abuse disorders during their time in hospital and this should be extended to outpatient care.

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Mortality and suicide rates in patients discharged from forensic psychiatric wards in Japan

Takeda

Sugawara

Matsuda

et al. 2019

Comprehensive Psychiatry

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Cause-specific mortality in Finnish forensic psychiatric patients

Cited by 5 publications

References 22 publications

Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019

Duration of forensic psychiatric care and subsequent criminal recidivism in individuals sentenced in Sweden between 2009 and 2019

Substance Abuse and Excessive Mortality Among Forensic Psychiatric Patients: A Finnish Nationwide Cohort Study

Mortality and suicide rates in patients discharged from forensic psychiatric wards in Japan

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