Self-reported violent ideation and its link to interpersonal violence among offenders with mental disorders and general psychiatric patients.

This study aims at comparing mentally disordered offenders and general psychiatric patients regarding violent ideation and at exploring its association with interpersonal violence. We recruited 200 detainees undergoing forensic psychiatric evaluation and 390 general psychiatric patients at discharge. At baseline, they were asked about violent ideation; at the 20-week follow-up, information about violent acts was gathered from crime conviction registry, interviews, and records. The lifetime prevalence of violent ideation was 32.5% for offenders and 35.6% for patients; the corresponding two-month prevalence was 22.5% and 21.0%, respectively. For the both samples combined, those with violent ideation in their lifetime were significantly more prone to commit violent acts during follow-up than those without such ideation, OR = 2.65. The same applied to the patient sample, OR = 3.41. In terms of positive predictive values, fewer than 25% of those with violent ideation committed violent acts. Contrary to our hypothesis, the prevalence of violent ideation did not differ significantly between offenders and patients. However, there was support for the hypothesized association between violent ideation and violent acts on a group level. On an individual level, the clinician should consider additional factors when assessing the risk for violent acts.

Violent victimization and health service utilization in a forensic psychiatric context: a comparison between offenders with mental disorders and matched controls.

BACKGROUND: Offenders with mental disorders constitute a particularly exposed group in society, with high rates of morbidity, mortality, and social deprivation. Often thought of primarily as perpetrators, these individuals may also be subjected to violence. Previous research indicates that violent victimization during lifespan is a risk factor for violent perpetration among psychiatric patients, but victimization studies on the group of offenders with mental disorders are scarce. Health services are pivotal to this group, but although most individuals do utilize these services, their vulnerability seems to remain. This study aimed at exploring the rates of victimization and health service utilization, including perceptions of unmet health care needs, among offenders with mental disorders. METHODS: Two hundred detainees undergoing a forensic psychiatric evaluation in Stockholm were asked about violent victimization and health service utilization. Each detainee was compared with three controls from the general population, matched regarding age, sex, and occupation. RESULTS: Victimization during the past year was reported by 52.3% of the detainees and 11.1% of the controls, with a corresponding risk ratio of 8.2. Health service utilization during the past three months was reported by 47.7 and 23.7%, respectively (risk ratio 2.0); and unmet health care needs by 42.2 and 16.7%, respectively (risk ratio 3.4). There was no distinct association between victimization and health service utilization among detainees. CONCLUSIONS: Offenders with mental disorders are at great risk of being victimized, and they experience impediments to receiving requisite health care. A possible way to reduce victimization and improve health service utilization may be to establish interdisciplinary yet specialized health centers with outreach teams but without complicated referral procedures.

Measuring the outcome of structured spousal violence risk assessments using the B-SAFER: risk in relation to recidivism and intervention.

In this study, 216 risk assessments conducted by law enforcement officers in a suburb of Stockholm using the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) were followed up and correlated to both recidivism and type of protective actions implemented by the police. The results showed high recidivism rates across all risk categories, except in the highest risk group, where the recidivism rate was significantly lower. This finding suggests a poor, and even negative, predictive power of the police risk assessments: the higher the police-assessed risk, the lower the recidivism rate. However, it was clear that the police did very little, or nothing, in cases not assessed as high risk. All resources appear to have been directed to the high-risk cases, which seems to have had a preventive effect. Our results point to the importance of studying the nature and extent of protective actions taken in response to risk assessment, before drawing conclusions about the predictive validity of risk assessment instruments.

Assessment and management of risk for intimate partner violence by police officers using the Spousal Assault Risk Assessment Guide.

Intimate partner violence (IPV) is a crime that is present in all countries, seriously impacts victims, and demands a great deal of time and resources from the criminal justice system. The current study examined the use of the Spousal Assault Risk Assessment Guide, 2nd ed. (SARA; Kropp, Hart, Webster, & Eaves, 1995), a structured professional judgment risk assessment and management tool for IPV, by police officers in Sweden over a follow-up of 18 months. SARA risk assessments had significant predictive validity with respect to risk management recommendations made by police, as well as with recidivism as indexed by subsequent contacts with police. Risk management mediated the association between risk assessment and recidivism: High levels of intervention were associated with decreased recidivism in high risk cases, but with increased recidivism in low risk cases. The findings support the potential utility of police-based risk assessment and management of IPV, and in particular the belief that appropriately structured risk assessment and management decisions can prevent violence.

Aggression and risk of future violence in forensic psychiatric patients with and without dyslexia.

Dyslexia does not cause criminal behaviour, but it may worsen aggressive behaviour tendencies. In this study, aggressive behaviour and risk of future violence were compared between forensic psychiatric patients with and without dyslexia. Dyslexia was assessed using the Swedish phonological processing battery 'The Pigeon'. The patients filled in the Aggression Questionnaire, and trained assessors performed the risk assessments using HCR-20 version 2. Patients with dyslexia self-reported more aggressive behaviour compared with those without dyslexia. There was only a nearly significant tendency (p = 0.06) for the patients with dyslexia to receive higher scores in the HCR-20 compared with the patients without dyslexia, and phonological processing skills did not significantly predict aggression or risk of future violence. However, regression analyses demonstrated that poor phonological processing skills are a significant predictor of anger, which in turn significantly predicts risk of future violence.

Facets on the psychopathy checklist screening version and instrumental violence in forensic psychiatric patients.

BACKGROUND: There is a recognised relationship between psychopathy and instrumental violence, but not all violence by people who meet the criteria for psychopathy is instrumental. AIMS: Our aims were to compare offence types among forensic psychiatric patients with and without the Psychopathy Checklist: Screening Version (PCL: SV) criteria for psychopathy. Our specific questions were whether factor 1 - the interpersonal affective dimension - was related to instrumentality and on severity of the violent crime. Our hypothesis was that the relationship between psychopathy and instrumental violence would be dependent on the severity of the violent crime. METHODS: Sixty-five male patients at the forensic psychiatric hospital in Sundsvall, all with a violent criminal history, were assessed for psychopathy through interview and records using the PCL: SV. Severity and the instrumentality of their previous violence were coded using the Cornell coding guide for violent incidents. RESULTS: The interpersonal features of psychopathy (the interpersonal facet), and only the interpersonal features were significantly associated with instrumentality and severity of violence. Instrumentality was also significantly related to the severity of the violence, independent of psychopathy score. CONCLUSIONS: The results indicated that, at least among forensic psychiatric patients, planning is more likely than not with respect to serious crimes. The specific link between interpersonal features of psychopathy and instrumental and severe violence suggests potential clinical value in recognising subtypes of psychopathy.

Gender differences in psychopathy in a Swedish offender sample.

In this study we examined gender differences in the PCL:SV employing a variety of statistical methods with two subsets of psychopathic individuals drawn from larger samples of 129 female and 499 male Swedish offenders. The larger samples included forensic psychiatric patients, forensic psychiatric evaluees and criminal offenders. We found gender differences in antisocial behavior, as defined in factor 2 of the PCL:SV, with female psychopaths (PCL:SV>or=18) displaying significantly more lying, deceitfulness and lack of control, while male psychopaths were more antisocial as measured by the PCL:SV. We conclude that it might be meaningful to use gender specific definitions in the assessment of psychopathy or, alternatively, slightly revise the diagnostic tools. Our results support the use of the three-factor model of the PCL-R and PCL:SV introduced by Cooke and Michie (2001) in female populations.

Reliability and Validity Evaluation of the Psychopathy Checklist: Screening Version (PCL:SV) in Swedish correctional and forensic psychiatric samples.

This study evaluated the structural reliability, construct-related validity, and cultural validity generalization of the Hare Psychopathy Checklist: Screening Version (PCL:SV) in a sample of more than 560 male and female Swedish forensic psychiatric treatment patients, forensic evaluation patients, and criminal offenders. Structural reliability was excellent for most indices. PCL:SV scores were higher for males than females for total and Part 1 scores (interpersonal/affective features) but not for Part 2 (behavioral features). With some exceptions, PCL:SV scores were meaningfully related to aggression to others, a measure of risk for violence, substance use problems, personality disorder (positive), and psychosis (negative). Correlations between PCL:SV and aggression were larger for females than males, although the difference was smaller when personality disorder was held constant. The structural reliability and pattern of validity coefficients were comparable in these Swedish samples to other non-North American samples. Implications for the cross-cultural manifestation and correlates of psychopathy are discussed.

Characteristics of spousal homicide perpetrators: a study of all cases of spousal homicide in Sweden 1990-1999.

BACKGROUND: In Sweden 20 000 cases of assault against women are reported to the police every year. METHOD: All data on the perpetrators of spousal homicide in Sweden between 1990 and 1999 were investigated (n = 164). A control group of all other perpetrators of homicide in Sweden during the same period, i.e. cases of homicide not committed in the context of spouse violence (n = 690) was used. All verdicts, as well as all material in the police investigations, including interviews with all of the police investigators, were analysed. Copies of police examinations of the suspects, and forensic reports from the autopsies, were also examined. Data on all registered criminality were collected from the National Police Register, and in cases where the perpetrators had been subject to forensic psychiatric examinations, those reports were obtained from the Swedish National Board of Forensic Medicine. In addition, the Psychopathy Checklist: Screening Version scores were rated from the forensic psychiatric examinations. RESULTS: There was a four times higher suicide rate among the spousal homicide perpetrators (24%, n = 40) compared with the perpetrators in the control-group (6%, n = 39, chi-squared = 55,42 df = 1, p < 0.001). Consequently, suicidal ideation must be considered as an important risk factor for spousal homicide. In 79% of the cases the spousal homicide perpetrators were subject to forensic psychiatric examinations. All except 5% were diagnosed with at least one psychiatric diagnosis, and 34% were sentenced to forensic psychiatric treatment. If it is assumed that the psychiatric morbidity was high in the 24% of the perpetrators who committed suicide, then 80% of all perpetrators of spouse homicide during the study period can be characterized as mentally disordered. 'Psychopathic' perpetrators, who generally are over-represented in most violent criminality, were comparatively uncommon. Only seven (4%) in the study group met the diagnostic criteria for psychopathy as measured with the PCL:SV. DISCUSSION: The group of spouse killers studied here fits the dysphoric/borderline group of spouse assaulters. This is a group that may benefit from treatment. Perhaps police officers could help identify this kind of spouse assaulter before a fatality occurs.