Historical, clinical and situational risk factors for post-discharge recidivism in forensic psychiatric patients – A Swedish registry study

Noland, Ebba; Strandh, Mattias

doi:10.1016/j.ijlp.2021.101749

Cited by 12 publications

(20 citation statements)

References 26 publications

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“…It could be hypothesized that the risk of re-offending is not so much causal for the existence of a social network at the time of discharge, but rather that it is the other way around: Clinicians and forensic psychiatric experts evaluate the risk of re-offending constantly during the course of the institutionalization as well as prior to the patients’ release, based on various established risk assessment tools, which often include the presence of social contacts as a protective factor (e.g., SAPROF) ( 53 , 54 ). In fact, successful cooperation with relatives or other social contacts during the therapeutic process is associated with lower rates of criminal recidivism ( 55 ). Just as with insight into wrongfulness of the offense, another explanation for this finding may very well be that healthier patients are labeled as less likely to re-offend and are also more capable of maintaining social contacts.…”

Section: Discussionmentioning

confidence: 99%

Maintaining social capital in offenders with schizophrenia spectrum disorder—An explorative analysis of influential factors

Machetanz

Lau²,

Kirchebner³

2022

Front. Psychiatry

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The importance of “social capital” in offender rehabilitation has been well established: Stable family and community relationships offer practical assistance in the resettlement process after being released from custody and can serve as motivation for building a new sense of self off the criminal past, thus reducing the risk of re-offending. This also applies to offenders with severe mental disorders. The aim of this study was to identify factors that promote or hinder the establishment or maintenance of social relationships upon release from a court-ordered inpatient treatment using a modern statistical method—machine learning (ML)—on a dataset of 369 offenders with schizophrenia spectrum disorder (SSD). With an AUC of 0.73, support vector machines (SVM) outperformed all the other ML algorithms. The following factors were identified as most important for the outcome in respect of a successful re-integration into society: Social integration and living situation prior to the hospitalization, a low risk of re-offending at time of discharge from the institution, insight in the wrongfulness of the offense as well as into the underlying psychiatric illness and need for treatment, addressing future perspectives in psychotherapy, the improvement of antisocial behavior during treatment as well as a detention period of less than 1 year emerged as the most predictive out of over 500 variables in distinguishing patients who had a social network after discharge from those who did not. Surprisingly, neither severity and type of offense nor severity of the psychiatric illness proved to affect whether the patient had social contacts upon discharge or not. The fact that the majority of determinants which promote the maintenance of social contacts can be influenced by therapeutic interventions emphasizes the importance of the rehabilitative approach in forensic-psychiatric therapy.

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Section: Discussionmentioning

confidence: 99%

Maintaining social capital in offenders with schizophrenia spectrum disorder—An explorative analysis of influential factors

Machetanz

Lau²,

Kirchebner³

2022

Front. Psychiatry

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“…Two recent studies performed using a Swedish dataset have investigated time estimates for and rates of reconviction after termination of forensic psychiatric treatment, as well as risk factors associated with reconviction, including length of stay, age, and substance misuse ( 13 , 14 ). However, it turns out that these studies have both ignored errors in the registry from which the dataset was derived and failed to exclude individuals who were not included in the dataset prospectively; thus, further studies—in which these errors are amended and the cohort is more stringently defined—are needed.…”

Section: Introductionmentioning

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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“…Among offenders with ID, young age and being male were not variables associated with greater risk of reconviction. This finding can be interpreted as a feature distinguishing ID offenders from other offenders with mental disorders ( 21 , 33 , 34 ) and from general adult offenders ( 58 ), where being young and male is typically associated with a greater risk of recidivism. However, a recent meta-analysis of 28 studies investigating predictors of criminal recidivism among forensic outpatients did not replicate the findings of Bonta el al.…”

Section: Discussionmentioning

confidence: 93%

“…Previous meta-analyses ( 14 , 33 ) and more recent studies ( 21 , 34 ) suggest that the strongest predictors of criminal recidivism among offenders with mental disorders are criminogenic variables (i.e., criminal history and deviant lifestyle including substance abuse and antisocial behavior); far exceeding the predictive value of potential clinical variables such as psychiatric comorbidity, prior hospital admissions and psychiatric treatment. A more limited number of studies have focused specifically on factors related to criminal recidivism specifically in ID.…”

Section: Introductionmentioning

confidence: 96%

Criminal recidivism in offenders with and without intellectual disability sentenced to forensic psychiatric care in Sweden—A 17-year follow-up study

et al. 2022

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BackgroundOffenders with intellectual disability (ID) constitute a distinct subgroup of offenders with mental disorders. Regarding criminal recidivism, it is unclear whether or not offenders with ID in forensic psychiatric settings differ from offenders without ID. Factors associated with criminal recidivism among offenders with ID have been scarcely investigated.AimTo investigate the association between ID and criminal recidivism among offenders sentenced to forensic psychiatric care and to explore the impact of clinical, sociodemographic and offense variables.Materials and methodsWe conducted a retrospective cohort study based on Swedish nationwide registers. A total of 3,365 individuals being sentenced to forensic psychiatric care in Sweden in 1997–2013 were followed from the forensic psychiatric assessment until first reconviction, death, emigration, or 31 December 2013, whichever occurred first. Cox regression models compared rates of recidivism in individuals with and without ID. Impact of clinical, sociodemographic, and offense variables on risk of criminal recidivism was presented as hazard ratios (HRs) with 95% confidence intervals (CIs).ResultsOut of 3,365 offenders sentenced to forensic psychiatric care, 259 (7.7%) were diagnosed with ID. During follow-up (0–17 years, median 6 years), one third (n = 1,099) of the study population relapsed into criminality, giving a recidivism rate of 50.5 per 1,000 person-years. We observed an association between ID and a decreased risk of recidivism (HR 0.8, 95% CI 0.6–1.0, p = 0.063), although this reached statistical significance only for the subgroup of male offenders (HR 0.8, 95% CI 0.6–1.0, p = 0.040) and not females (HR 1.0, 95% CI 0.6–1.8). ID offenders with concurrent ADHD tended to have a higher rate of recidivism (73.9 per 1,000 person-years, HR 1.2, 95% CI 0.6–2.4) than ID offenders without ADHD (42.5 per 1,000 person-years, HR 0.8, 95% CI 0.6–1.1). Amongst ID offenders, concurrent autism spectrum disorder, young age or male sex were not associated with recidivism, while previous criminal convictions were strongly associated with recidivism.ConclusionA diagnosis of ID was associated with a lower risk of criminal recidivism among male offenders sentenced to forensic psychiatric care. The association between ADHD and recidivism among ID offenders highlights eligible focus areas in the management of offenders with ID.

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Historical, clinical and situational risk factors for post-discharge recidivism in forensic psychiatric patients – A Swedish registry study

Cited by 12 publications

References 26 publications

Maintaining social capital in offenders with schizophrenia spectrum disorder—An explorative analysis of influential factors

Maintaining social capital in offenders with schizophrenia spectrum disorder—An explorative analysis of influential factors

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

Criminal recidivism in offenders with and without intellectual disability sentenced to forensic psychiatric care in Sweden—A 17-year follow-up study

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