Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australian data-linkage study.

BACKGROUND: Family violence is a leading social determinant of mental ill-health but its link to mental health-related emergency department presentations is poorly understood. Existing research has largely used retrospective designs with a focus on victimisation, typically among women. We examined whether police-reported family violence victimisation and perpetration were prospectively associated with mental health emergency department presentations in women and men. We also identified family violence risk and vulnerability characteristics associated with such presentations. METHODS: Demographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e., primary victims) and 1470 respondents (i.e., persons alleged to have perpetrated family violence) from family violence reports in 2016-17. Emergency mental health presentations 22-30 months post-family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations. RESULTS: Emergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45 + . Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents, respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics. CONCLUSIONS: Police-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term. Strengthened cross-sector collaboration is needed to identify, address, and refer individuals with overlapping family violence and mental health needs and to improve victims' and perpetrators' access to community mental health and related services. This should help prevent individuals from reaching a crisis point in their mental health.

The temporal relationship between mental health service use and stalking perpetration.

OBJECTIVE: Mental disorder is common among people who stalk. However, the nature of this association is unclear and it is not known whether the commencement of stalking is associated with symptoms of disorder. This study used a longitudinal design to examine the association between the onset and cessation of stalking behavior and indicators of mental disorder in the form of mental health service use. METHOD: Data linkage was used to explore public mental health service use among 157 people who engaged in stalking in Melbourne, Australia. Mental health service use across the lifetime, 5 months prior to stalking onset, between the onset and cessation of stalking (during stalking) and 5 months post-stalking was identified. Mixed regression models tested temporal associations between types of mental health service use (acute vs continuing care) and onset and cessation of stalking in a subsample of 130 participants where dates of the stalking episode were available. RESULTS: A total of 105 (67%) participants had lifetime use of public mental health services, while 15% accessed mental health services in the 5 months prior to (N = 19) or during the stalking (N = 20) and 22% (N = 29) used services in the 5 months after the stalking ceased. Odds of using acute mental health services and average monthly rate of use were highest during the stalking. Odds and average monthly rate of using continuing care were highest after the episode ceased. CONCLUSIONS: Most people who stalk have used public mental health services, but a minority access services immediately prior to or during the stalking episode. Acute service use was more common during the stalking, while use of continuing care services was more common after the stalking ceased. These findings provide preliminary support for a temporal relationship between acute mental disorder and stalking behavior.

A critical analysis of stalking theory and implications for research and practice.

This article comprehensively reviews and critiques theories providing an aetiological account of stalking. We evaluate applications of preexisting psychological theories to stalking (attachment theory, evolutionary theory, social learning theory, information processing models of aggression, coercive control theory, and behavioural theory) as well as the only novel theory of stalking to date: Relational goal pursuit theory. Our aim was to identify which are supported by research, identify gaps in theoretical scope and explanatory depth and examine how current theories might inform clinical practice. This evaluation suggests that theories of stalking are underdeveloped relative to other areas of forensic clinical psychology and the theoretical literature is relatively stagnant. Consequently, there is limited research into clinically meaningful constructs that can guide the assessment, formulation and treatment of this client group. We identify similarities across existing theories, discussing implications for future research and clinical practice with people who stalk.

Measuring stalking: the development and evaluation of the Stalking Assessment Indices (SAI).

Accurate measurement of stalking has proven difficult, partly because stalking is characterised by the cumulative effects of a pattern of behaviour. This study aimed to develop and evaluate a new measure of stalking that overcomes the observed shortcomings of existing tools. The Stalking Assessment Indices (SAI) were created using index development principles and evaluated in 244 Australian undergraduate students (M age= 33.7, 77% female). Seventy-three reported stalking victimisation (experiencing at least five intrusions over at least two weeks causing substantial fear or distress), and 51 reported stalking perpetration. Stalking behaviours reported by victims formed a two-component structure, which was also observed in multidimensional scaling analysis. The perpetration index showed good convergent validity with measures of rumination and aggression, and both indices had adequate test-retest reliability over four weeks. These results suggest that the SAI could provide a consistent and inclusive measure of stalking for use across different research settings.

Investigating the predictive validity of Static-99/99R scores in a sample of older sexual offenders.

There is limited information regarding the use of risk assessment tools with aging offender populations. It is known that the likelihood of offending behaviour decreases with age, a small group of men either continue or begin to offend sexually in the later decades of life. The current study investigated the predictive validity of the Static-99 and the Static-99R, in a sample of convicted Australian sex offenders aged 50 and older. A sample of 118 participants was identified, of which 17 (14.4%) re-offended within a follow-up period ranging from four months to 20 years (M = 9.07 years). There were seven recidivists (13.46%) above the age of 60 years (n = 52) and 10 aged 40 to 59.9 years (n = 66). Both the Static-99 and Static-99R demonstrated moderate predictive validity with both age groups. The limitations of this study are discussed as well as recommendations for future research.

A comparison of psychopathology and reoffending in female and male convicted firesetters.

Little is known about the psychopathological or criminal history characteristics of female firesetters, or how often women reoffend by firesetting. The current study is one of the few large-scale longitudinal investigations to compare key psychiatric and offending variables in female and male firesetters who are not incarcerated or known to be mentally disordered. In addition, the study aimed to identify the base rate of recidivism for female firesetters compared with males. The study compared all 143 female and 909 male firesetters convicted of arson and fire-related offenses between 2000 and 2009 in Victoria, Australia. The study employed a data linkage approach to compare the psychiatric and criminal histories of participants and reoffending in the sample. Firesetters of both sexes reoffended by firesetting at similar rates (males 5.1%, females 7.0%), and reoffenders shared many characteristics. Compared with male firesetters, female firesetters were found to be less criminally versatile, to have offended less overall, and were less likely to have violent offenses. Females were more often diagnosed with depression, substance misuse, and personality disorder than men. The findings indicate that female firesetters might be suitable for assessment approaches and treatment programs offered to men, but tailored to take account of the personality and psychopathological characteristics seen more often in this group. (PsycINFO Database Record

Australian Psychiatrists' Support for Psychiatric Advance Directives: Responses to a Hypothetical Vignette.

This study examines whether Australian psychiatrists would support requests in a psychiatric advance directive (PAD) and the reasons underlying their decisions in response to a hypothetical vignette. An online survey was completed by 143 psychiatrists. Fewer than 3 out of 10 psychiatrists supported the patient to create a PAD which requested cessation of pharmacotherapy (27%) or remaining out of hospital and not being subject to an involuntary treatment order (24%) should their depression condition deteriorate. A thematic analysis showed that patient autonomy was the strongest theme among those who supported the patient to create a PAD, whereas the clinical profile of and risk to the patient and the professional or ethical imperative of the psychiatrist were strongest among those who were unsure about supporting the patient or who did not support the patient. These findings provide a challenge about how to fulfil obligations under the United Nations Convention on the Rights of Persons with Disabilities (2006).

The role of psychopathology in stalking by adult strangers and acquaintances.

OBJECTIVE: Individuals who stalk strangers and acquaintances are under-studied, although there is some evidence suggesting a greater prevalence of psychopathology than is present in those who stalk former partners. This study investigated the nature and prevalence of psychopathology in a sample of stranger and acquaintance stalkers and whether psychopathology was associated with increased duration or serial stalking in this group. It was hypothesised that mental illness, and specifically psychosis, would be more prevalent among strangers and acquaintances than among ex-intimate stalkers. METHOD: Two hundred and eleven stalkers (10% female; mean age = 35, SD = 10.8; 71 ex-intimates) were recruited between 2002 and 2007 from a specialist service in Melbourne, Australia. Each underwent psychiatric and psychological assessment and disorders were diagnosed according to DMS-IV-TR criteria. Non-parametric independent sample tests were used to examine associations between relationship type and psychopathology, and to identify individual and stalking-related characteristics associated with increased duration and serial stalking. RESULTS: Axis I disorders were significantly more prevalent among strangers and acquaintances than ex-intimates (71% vs 48%, OR = 2.6, 95% CI = 1.4 to 4.7), as were psychotic disorders (29% vs 9%, OR = 4.4, 95% CI = 1.8 to 10.9). Psychosis was significantly associated with increased duration of stalking behaviour (U = 3043, p < 0.001). Those with a personality disorder were twice as likely to have stalked multiple times (OR = 2.4, 95% CI = 1.2 to 5.0). CONCLUSIONS: Those who stalk strangers and acquaintances are often mentally ill and psychopathology is associated with more persistent and recurrent stalking behaviour. Although limited by the use of clinical interview rather than structured assessment, these findings strongly support the argument for routine mental health assessment of stranger and acquaintance stalkers who become involved with the criminal justice system.

Mental illness and psychiatric treatment amongst firesetters, other offenders and the general community.

OBJECTIVE: Firesetting is often reported to be associated with psychopathology, but frequently these conclusions are based on studies reliant on selective forensic psychiatric samples without the use of comparison groups. The aim of the study was to examine the rates of mental illness, substance use disorders, personality pathology and psychiatric service usage in a population of convicted firesetters compared with other offenders and community controls. METHOD: Using a data-linkage design, the study examined the psychiatric histories and usage of public mental health services by 1328 arsonists convicted between 2000 and 2009 in Victoria, Australia. These were compared with 1328 matched community controls and 421 non-firesetting offenders. RESULTS: Firesetters were significantly more likely to have been registered with psychiatric services (37%) compared with other offenders (29.3%) and community controls (8.7%). The firesetters were also more likely to have utilised a diverse range of public mental health services. Firesetters attracted psychiatric diagnoses more often than community controls and other offenders, particularly affective, substance use, and personality disorders. CONCLUSIONS: This study confirms that there is a link between firesetting and psychopathology, suggesting that there is a role for the psychiatric screening of known firesetters, and a need to consider psychopathology in formulating the risk for further firesetting.

The Role of Situational Factors in Child-to-Parent Abuse: Implications for Assessment, Management, and Intervention.

Situational factors are relevant to the initiation and maintenance of violent behavior yet are infrequently examined in relation to family violence. Content analysis was used to conduct an inductive thematic analysis of police narratives to identify and quantify the occurrence of situational factors among Australian young people (10-24 years) reported to police for using violence toward a parent (n = 82). Descriptive information about demographics (e.g., age and sex), background characteristics (e.g., victimization history, employment/school issues, mental health issues, and neurodevelopmental conditions), and features of the index incident (e.g., type of aggression) were also extracted from police records. Interpersonal conflict and parental limit-setting were the most common situational antecedents of child-to-parent abuse, with additional situational factors including use of weapons, role of third parties, mental health concerns, and substance abuse issues. Families experiencing child-to-parent abuse showed heightened levels of intrafamilial violence and neurodevelopmental conditions. Implications for risk assessment, management, and intervention are discussed.

The Role of Cognition in Youth Intimate Partner Abuse.

Research investigating how cognition influences youth intimate partner abuse (IPA) remains limited. Understanding cognitive risk markers is theoretically important and can inform intervention to maximize the chance of behavior change. The current article investigated cognition regarding general antisociality, relationships, and gender-role attitudes on youth IPA perpetration among 275 (123 female) 14- to 18-year-olds. Theoretically derived relationships (based on social information processing theory and the General Aggression Model) were hypothesized, which furthered understanding of how cognition contributes to relationship aggression in adolescents, while controlling for common behavioral correlates. Results showed that, overall, other experiences of aggressive behavior more strongly related to youth IPA perpetration than cognitive correlates. Among boys, general antisocial cognition was more strongly associated with youth IPA perpetration than relationship-specific cognition, with the reverse being true for girls. These findings suggest there is value in exploring theoretically indicated cognitive risk markers for youth IPA in a gender-sensitive and dynamic manner. Findings also provide direction for future studies considering cognition and youth IPA in a more predictive manner and areas for consideration in intervention.

The role of grievance in fatal family violence and implications for the construct of lone actor grievance-fuelled violence.

Introduction: The concept of lone actor grievance fuelled violence assumes that homicides that occur in very different contexts can be thought about in a consistent manner because they share common motivations and resultant emotional states like resentment, outrage or revenge. Fatal family violence has been largely excluded from discussions of lone actor grievance-fuelled homicide, based on the assumption that it is conceptually different. This scoping review examines similarities and discrepancies between the characteristics and motivations of perpetrators of fatal family violence and those who have engaged in lone actor grievance-fuelled homicide outside the family context, and the relevance of the concept of grievance-fuelled violence to fatal family violence. Methods: This study reviewed published case studies and case series, resulting in a dataset of 102 homicide cases from 36 studies, of which there were 38 fatal family violence cases and 64 categorised as lone actor grievance-fuelled homicide. Results: Twenty of the 38 fatal family violence cases were identified as being grievance-fuelled, based on the presence of motivations consistent with definitions in the grievance literature. Whilst there were some offence similarities between the fatal family violence cases (e.g., location of offence), those driven by grievance were more similar to lone actor grievance-fuelled homicide in other ways (e.g., offender's gender and offence methods). In both these categories violence was predominantly motivated by grievance and a desire for revenge, whereas non-grievance fatal family violence cases were predominantly motivated by altruism. Discussion: The motivations that defined behaviour as lone actor grievance-fuelled homicide were equally apparent in a sub-group of fatal family violence, implying that some family violence cases can be integrated into the construct of lone actor grievance-fuelled homicide in future research and theorising.

A Social-Cognitive Investigation of Young Adults Who Abuse Their Parents.

Within the past decade, there has been an increase in research focusing on young people who abuse their parents. However, most research has narrowly focused on adolescent children, neglecting to investigate the nature, pattern, and factors related to child-to-parent abuse perpetrated by young adults. This article integrated two complementary social-cognitive theories of aggression to explore factors associated with perpetration of child-to-parent abuse among university students (N = 435, aged 18-25 years). Participants completed the Abusive Behavior by Children-Indices, a self-report measure that was designed to differentiate abusive and normative child-to-parent behavior. The results highlight that abuse is not limited to adolescent children, as one in seven young adults were categorized as abusive toward a parent over the previous 12 months. Sons were more likely than daughters to report abusing their parents. Specifically, sons disclosed greater rates of father abuse than daughters, but similar rates of mother abuse. Hierarchical logistic regression found that exposure to marital violence, parent-to-child aggression, trait anger, and aggressive scripts were significant predictors of both mother and father abuse. However, other factors related to abuse differed according to which parent was the target of abuse. For instance, male sex was a significant predictor of father abuse, whereas rumination and impulsive emotional regulation were significant predictors of mother abuse. Overall, father abuse was better explained by the model than mother abuse. The results suggest that although factors related to general aggressive behavior may be good predictors for father abuse, additional factors may be needed to explain mother abuse.

Same-gender stalking in Sweden and Australia.

This study examined the phenomenon of same-gender stalking and sought to identify differences between same- and opposite-gender stalking cases. Ninety-four same-gender and 160 opposite-gender stalking cases from Sweden and Australia were compared on demographic, offense, clinical, and behavioral characteristics. The groups were largely similar, differing mainly in the nature of the prior relationship between stalker and victim and the stalker's motivation. The most notable distinction was the significantly greater prevalence of ex-intimate partner stalkers in the opposite-gender group (65%) versus the same-gender group (32%), leading to the exclusion of ex-intimates from the subsequent analysis to remove this potentially confounding variable. Amongst non-ex-intimates, same-gender stalkers were significantly more likely to be female and to stalk out of a sense of resentment and grievance. The results showed that the gender of the victim and perpetrator was less important to the course and conduct of a stalking episode than were the stalker's motivation and the nature of the prior relationship to the victim.

Advances in stalking risk assessment.

Over the past 15 years, forensic mental health has become more concerned with the concepts of violence prevention, management, and treatment. The development of specialist tools to aid in the assessment of a range of risks reflects this concern. This article explores contemporary thinking on violence risk assessment and how this knowledge can be applied to the relatively newer field of stalking risk assessment. The role of risk state and risk status are discussed, in addition to the way that standard structured professional judgment procedures need to be adapted to reflect the variety of risks present in stalking situations. The authors go on to describe the development and format of the Stalking Risk Profile, a set of structured professional judgment guidelines for assessing risk in stalkers. Suggestions are made for future research to enhance knowledge and improve practice in the field of stalking risk assessment.

Australian Adolescents' Experiences of Aggression and Abuse by Intimate Partners.

International research has shown that intimate partner abuse affects many young people throughout adolescence. Despite a recent focus on family and intimate partner violence in Australia, there is almost no Australian data on the frequency or nature of youth intimate partner abuse (YIPA). The current study sought to better understand the frequency and nature of YIPA in Australian adolescents. To this end, 423 participants aged between 14 and 18 from Victorian (Australian) high schools completed an anonymous questionnaire regarding experiences of perpetration and victimization in their most difficult intimate relationship. Results showed high rates of both YIPA victimization and perpetration among boys and girls who had been in intimate relationships. As was expected, verbally and psychologically aggressive behaviors were reported more frequently than physically or sexually aggressive actions. Mutual YIPA was detected more frequently than unidirectional YIPA, and most commonly involved high severity reciprocal aggression. The current study further confirmed that YIPA is a complex and heterogeneous issue, involving a range of behaviors, patterns of use, and severities. A gender-sensitive approach to the current study allowed for consideration of the similarities and differences between male and female experiences of YIPA. The current study provides a novel method of ascertaining both the frequency and severity of YIPA experiences in a sample of young people, expands on both Australian and international literature, and identifies important gender considerations for future research.

Assessing the Link Between Intimate Partner Violence and Postrelationship Stalking: A Gender-Inclusive Study.

The link between intimate partner violence (IPV) during a relationship and postrelationship stalking (PRS) is poorly understood. The vast majority of relevant studies focus either on male perpetration or female victimization and use highly selective samples. The current study aimed to illuminate the link between IPV and PRS perpetration and victimization, respectively. To this end, heterosexual male and female university students (n = 422) retrospectively self-reported on IPV during their most conflicted relationship and a wide range of pursuit behavior after the dissolution of this romantic relationship. Using empirical criteria, participants were classified as stalkers or nonstalkers based on their responses. A relationship between male-perpetrated IPV and PRS perpetration was detected. There was no systematic relationship between IPV and PRS perpetration in women. In contrast, there was a link between IPV and stalking victimization that followed a similar, linear trend in both male and female victims. A larger proportion of participants were classified as stalking victims as IPV severity increased. Implications for research (e.g., the importance of gender-inclusive studies), clinical practice (e.g., how to prevent stalking after an abusive relationship), and future directions (e.g., the need for prospective studies using more diverse samples) are discussed.

The effects of social desirability response bias on STAXI-2 profiles in a clinical forensic sample.

OBJECTIVES: This study investigated the proposition that the 'State-trait anger expression inventory' (2nd ed.; STAXI-2) is susceptible to impression management (IM) and Self-Deceptive Enhancement (SDE) in clinical forensic populations. It was hypothesized that individuals engaging in IM would report significantly lower levels of trait anger, external expression of anger, and internal expression of anger on the STAXI-2. Those reporting above average SDE were predicted to claim higher levels of anger control. DESIGN: A between-groups design was used, comparing STAXI-2 scores of individuals who reported high levels of IM and SDE to those who did not. METHOD: One-hundred and fifty-nine male patients of a community forensic mental health service, referred for assessment of stalking behaviours, completed the STAXI-2 and Paulhus Deception Scales (PDS). Individuals engaging in high levels of IM and SDE were compared to low scorers in regard to STAXI-2 scales using Mann-Whitney U tests. RESULTS: Individuals engaging in IM had significantly lower levels of reported trait anger, outward expression of anger, and inward expression of anger, and higher levels of anger control. Similar results were found with the SDE scale, although the magnitude of the effect was smaller and not apparent on all subscales. CONCLUSIONS: The STAXI-2 was vulnerable to social desirability response bias in this sample of forensic clients. Where the STAXI-2 is used as a basis for treatment recommendations and decisions, it should be administered and interpreted in conjunction with a recognized measure of such bias to improve validity.

A study of the predictors of persistence in stalking situations.

Stalkers engaging in persistent campaigns of harassment have the potential to cause immense harm to their victims and themselves. Being able to estimate which stalkers are likely to persist longest is important to clinicians dealing with both perpetrators and victims. This study of 200 stalkers investigated characteristics of the stalkers and their behaviour that were associated with increased persistence. Logistic regression models were developed to predict low, moderate, and highly persistent stalking. The results supported previous research indicating that the type of prior relationship between stalker and victim is strongly associated with persistence, with prior acquaintances the most persistent, and strangers least. Being aged over 30, sending the victim unsolicited materials, and having an intimacy seeking or resentful motivation was also associated with greater persistence, as was the presence of psychosis.

Mentally Disordered Firesetters: An Examination of Risk Factors.

OBJECTIVE: In this study, we examined the risk-related characteristics of mentally disordered patients who had either been (1) involved in a firesetting incident or (2) involved in a nonfiresetting comparison incident while under the care of the National Health Service (NHS). METHOD: A total of 132 participants were recruited from an NHS Care Group in England (66 mentally disordered firesetters, 66 mentally disordered comparisons). Logistic regression was used to model the ability of static, dynamic, and incident-related factors in predicting whether a patient had set a fire (including gender-sensitive subanalyses), whether a patient firesetter was male or female, and a one-time or repeat firesetter. RESULTS: We identified a cluster of variables that predicted firesetting status. We also identified key factors that predicted female patient firesetters relative to female patient controls who engaged in other undesirable behaviors and male patient firesetters. A cluster of variables predictive of repeat versus one-time firesetting also emerged. CONCLUSIONS: Findings are discussed in relation to further development of risk-related firesetting theory.