Factors And Predictors Of Length Of Stay In Offenders Diagnosed With Schizophrenia- A Machine-learning-based Approach

Abstract

Background Prolonged forensic psychiatric hospitalizations have raised ethical, economic, and clinical concerns. Due to the confounded nature of factors affecting length of stay of psychiatric offender patients, prior research has called for the application of a new statistical methodology better accommodating this data structure. The present study seeks to examine factors responsible for prolonged detentions of schizophrenic offenders referred to a Swiss forensic hospital using machine learning algorithms more apt to reveal non-linear interdependencies between variables.Methods In this retrospective file and registry study, multidisciplinary notes of 143 schizophrenic delinquents were reviewed by using a structured protocol on patients’ characteristics, criminal and medical history and course of treatment. Via a forward selection procedure, the most influential predictors for length of stay were preselected. Machine learning algorithms identified the most efficient model for predicting length-of-stay.Results/ Conclusions Ten factors prolonging forensic hospitalization were identified: Six were related to aspects of the index offence (index offence, number of crimes, extend of injury to the victim of the offence), two were related to psychopathology at admission or even prior to that (hallucinations in psychiatric history), one alluded to the course of therapy (self-harming during inpatient treatment), and one referred to biographical aspects (poverty during childhood/ adolescence). Results are discussed in light of earlier reports on the subject.

Temporal trends, predictors of blood transfusion and in‐hospital outcomes among patients with severe burn injury in the United States—A national database‐based analysis

“…Secondary outcomes included discharge disposition, health resource utilization as measured by the hospital length of stay (LOS) and total hospitalization charges between patients with and without blood transfusion. Longer LOS was defined as a LOS greater than or equal to the median for LOS, within the hospitalization for burn injury 21,22 . We also examined the trend of blood transfusion in patients with severe burn as a descriptive outcome.…”

“…Longer LOS was defined as a LOS greater than or equal to the median for LOS, within the hospitalization for burn injury. 21,22 We also examined the trend of blood transfusion in patients with severe burn as a descriptive outcome.…”

Escape and absconding among offenders with schizophrenia spectrum disorder – an explorative analysis of characteristics

“…Our extensive database has already been used in other studies and is part of a larger project in which the medical records of forensic inpatients have been analyzed in detail to obtain insights into the underresearched area of SSD and criminal behavior. Full details on data collection and processing can be found in Kirchebner et al [54] and Kirchebner et al [55].…”

The influence of changes in clinical factors on high‐security forensic custody dispositions

“…However, these studies also show that legal considerations, such as index offense severity, violence history, and being found not criminally responsible (NCR), are associated with longer forensic stays, and perhaps more strongly and consistently so (Huband et al., 2018). For example, in a study of 143 individuals (88% men) diagnosed with schizophrenia and hospitalized in a Swiss forensic unit, length of stay was largely determined by the severity of the index offense and victim injury, rather than treatable clinical factors (Kirchebner et al., 2020). These findings suggest a strong influence of public safety on forensic decisions.…”