Clinical Characteristics and Self-Harm in Forensic Psychiatric Patients

Abstract

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.

Emotion Regulation and Self-Harm Among Forensic Psychiatric Patients

“…It is known that suicide attempts are disproportionally higher among forensic samples than among the general population (Liebling, 1993). A 2002 study by Brooker et al (2002) and data from the current sample (detailed in Laporte et al, 2021) show prevalence rates of self-harm and/ or suicide attempts ranging from 30% in prison settings to 68.4% in forensic mental health settings. However, although various NSSIs may seem to be similar in their methods and intentions, a deeper investigation may reveal varying underlying mechanisms and motivations that are not immediately obvious.…”

“…The aim was to collect 100 participants, but due to the COVID-19 pandemic, inclusion of participants was terminated in November 2020 after 98 patients had participated (56% participation rate). The participants mean age was 34.9 years (range 19-62, SD = 10.7), and the majority were male (86.7%; n = 85) and had been born in Sweden (71.4%; n = 70; Laporte et al, 2021). The most common, current mental disorders were within the spectrum of schizophrenia or other psychotic disorders, with substance-related and addictive disorders as common comorbidity.…”

“…The criminological background of the participants consisted of different violent offenses, with repeated occasions of drug offenses and theft or robbery along with other crimes. For detailed information on inclusion, length of stay, previous forensic psychiatric care, and psychosocial and clinical characteristics of this sample, see Laporte et al (2021). During data collection, nine participants chose to terminate their participation before all data had been collected, and one self-report was assessed as unreliable.…”

“…Information on suicide attempts (any attempt, age at onset, violent attempts, and risk of completed suicide at most serious attempt) was collected separately. In total, more than half of the participants (n = 67; 68.4%) had at some point engaged in some kind of self-harm, with banging one's head or fist against a wall or other solid surface and cutting as most common method of NSSI, and hanging as most common method for attempted suicide (Laporte et al, 2021). Thus, two groups were established: forensic psychiatric patients with self-harm (n = 67) and forensic psychiatric patients without self-harm (n = 31).…”

“…However, existing research on the functions of NSSI is based mostly on clinical observations and self-reports from self-harming clients; researchers have previously described the difficulties of categorizing the functions of NSSI (Gratz, 2003). In a recent study of forensic psychiatric patients, intrapersonal functions, such as self-punishment, affect regulation, and marking distress, were the most relevant to the participants (Laporte et al, 2021).…”