Childhood adversity and psychosis in detained inpatients from medium to high secured units: Results from the Scottish census survey

Abstract

Background: There is limited data available regarding the most common forms of psychiatric illness, the occurrence of childhood adversity, and the link between childhood adversity and criminal and psychiatric outcomes amongst forensic inpatients. Aims: Using census data for all Scottish forensic inpatients, we investigated the most common primary psychiatric diagnoses in forensic settings, the occurrence of childhood adversity amongst forensic inpatients, and whether childhood adversity experiences significantly predict a range of criminal and psychiatric outcomes. Method: Data for the current study were drawn from 'The Scottish Forensic Network Inpatient Census' (N = 422). The Responsible Medical Officers and other members of the clinical team collected all data from official patient records. All forensic inpatients across high, medium, and low security sites were surveyed. Results: The majority of patients had a psychotic disorder as their primary diagnosis (86.4%), with schizophrenia being the most common (70.0%). Childhood adversity was highly prevalent (79.2%), with physical abuse being the most common adverse experience (40.1%). Increased levels of childhood adversity were significantly associated with an increased risk of criminal convictions, self-reported abuse of animals, suicidal and self-injurious behaviour, and problematic use of drugs or alcohol. Conclusions: Considering the association between adversity and psychosis, trauma informed care is essential for the mental health and forensic needs of this population. 1. Introduction Exposure to adversity during childhood is a well-established risk factor for diagnosis of psychiatric disorders (e.g. Bentall,

Troubled beginnings: the adverse childhood experiences and placement histories of a detained adolescent population with developmental disorders

“…The prevalence rates were comparable to those reported in the literature for adults with intellectual disabilities in secure services (Morris et al , 2019), although higher than those reported by O'Brien et al (2010) who report that 35% had experienced ACEs prior to admission. Prevalence rates were also higher than those reported previously in adolescent and adult prison (Ford et al , 2019) and forensic populations (Karatzias et al , 2019). Furthermore, the total number of ACEs for males in the study was comparable to the number of ACEs reported in a study in the Democratic Republic of the Congo (DRC) with adolescents (Mels et al , 2009), albeit without the comparative social, political and economic context of the DRC.…”

“…By contrast, large-scale US and UK studies consistently report prevalence rates of around 50% for exposure to one or more ACEs in neurotypical populations (Campbell et al , 2016; Ford et al , 2016). Further inflated rates of 80–90% have been reported for forensic (Karatzias et al , 2019) and prison populations (Ford et al , 2019).…”

Exploration of morbidity, suicide and all-cause mortality in a Scottish forensic cohort over 20 years

“…44 We suggest that something akin to the ‘Scottish effect’, specifically in terms of biopsychosocial stress and the resultant physiological stress response, is being observed among mainstream and forensic psychiatric populations. High levels of adverse life events observed among Scottish forensic patients 45 together with the dose–response association observed between adverse life events/psychological distress and a negative impact upon subjective and objective physical health 46 may be evidenced within our reported cohort. There is increasing physiological evidence of heightened levels of oxidative stress and inflammation within anxiety, depressive, bipolar disorder and schizophrenia.…”

Strong Associations Between Childhood Victimization and Community Violence in Male Forensic Mental Health Patients

“…High rates of various types of child victimization are reported also in forensic mental health patients, with maltreatment reported for 75-85% (19)(20)(21)(22)(23). A handful of studies have addressed the pertinent question of associations between child victimization and violent and criminal behavior in forensic patients.…”