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

Abstract

Background: Childhood abuse and neglect increase the risk of both mental disorders and violent behavior. Associations between child relational adversities and violent behavior have not been extensively investigated in forensic mental health settings. We asked whether the extent of child adversities predicts the extent of violence in the community in forensic mental health patients.Methods: We included 52 male patients at a medium security forensic mental health ward, with diagnoses of predominantly paranoid schizophrenia and other schizophrenia and psychotic disorders. Seventy-five percent had comorbid substance abuse. We extracted information on six types of child adversities based on clinicians' administrations of the Historical Clinical Risk Management 20 version 3 (HCR 20) scale and summary notes in electronic patient journals. These same sources were used to extract information on war trauma and interpersonal violence in the community. We established cumulative scales for exposure to number of types of child adversities and number of incidents of community violence.Results: Physical and emotional abuse, emotional and physical neglect, and bullying were associated with higher levels of community violence. We observed a linear, significant increase in the frequency of community violence with cumulative numbers of child adversity types.Conclusions: Cumulative exposure to child adversities may be associated with higher degrees of violence in forensic mental health patients, with the most violent patients having the most extensive exposures to adversities. An enhanced focus on child adversities in risk assessment and management of violence may be considered in forensic inpatient settings.

Intergeneration Transmission of Violence in Forensic Patients With a Diagnosis of Schizophrenia and Psychosis: Was Parental Alcoholic Abuse a Significant Factor?

“…The results indicated statistically insignificant differences between PSCH-V and Non-V-PSCH in having a family history of mental illness; however, the p-value could be considered as marginal (χ 2 = 3.472, p = 0.062). On the other hand, family history of mental illness was less present in healthy controls, compared to offenders (χ 2 = 24.238, p < 0.001) and non-offenders (χ 2 = 14.456, p < 0.001).…”

“…The results indicated statistically insignificant differences between PSCH-V and Non-V-PSCH in having a family history of mental illness. On the other hand, family history of mental illness was less present in HC compared to PSCH-V (χ 2 = 24.238, p < 0.001) and Non V-PSCH (χ 2 = 14.456, p < 0.001). The presence of parental alcohol abuse was predominantly present in the PSCH-V group (60%) while a significantly lower presence was found in the Non-V PSCH group (35%) and HC (5.5%).…”

“…Research has shown that violent behavior is often associated with psychotic symptoms, decreased impulse control and substance abuse, but also traumatic childhood events such as physical, sexual, and emotional abuse ( 1 ). There is a lack of research of violent behavior in psychiatric forensic patients ( 2 ).…”

“…Bruce and Laporte reported that hospitalized forensic patients diagnosed with schizophrenia and schizoaffective disorder who were victims of childhood physical violence were 170% more likely to engage in violent behavior within their community before admission to the hospital ( 7 ). Also, studies that investigated different types of childhood abuse have shown the phenomenon of polyvictimization, that is, that there has been an association of multiple forms of abuse ( 2 ). Previous studies of child abuse according to the CTQ scale have shown a significant percentage of those who have had a high degree of childhood trauma in general among patients with psychotic disorders.…”

“…Results: Statistically significant differences were obtained for total scores (χ 2 = 28.522, p < 0.001) as well as for (1) major upheaval between the parents (χ 2 = 20.739, p < 0.001), (2) being victim of violence-other than sexual (χ 2 = 12.701, p < 0.01), and (3) other major upheaval that may have shaped life or personality significantly (χ 2 = 30.920, p < 0.001). PSCH-V, compared to HC, had greater exposure to all of the three domains of childhood trauma (U = 396.500, 436.500, and 376.000, respectively; p < 0.001).…”