A Systematic Review of Interpersonal Violence Perpetration and Victimization Risk Examined Within Single Study Cohorts, Including in Relation to Mental Illness

Rates of both violent victimization and violence perpetration are known to be elevated among individuals with mental illness compared with those in the general population, though the relative risk of each outcome is less well established. In this systematic review, PubMed, Embase, Web of Science, PsycINFO, and Criminal Justice Abstracts were searched for articles published any time before October 2021 that reported the prevalence or incidence of both violent victimization and perpetration. We performed two searches to identify studies using samples or cohorts of (1) persons with mental illnesses and (2) persons in the general population. A total of 25 studies (9 examining persons with mental illnesses, 13 examining persons in the general population, and 3 examining both sample/cohort types) were identified and data was extracted to describe the type and size of cohort or sample, definitions and terminology (i.e., mental illness, violence victimization, violence perpetration), data source(s), observation period, prevalence/incidence of victimization, and prevalence/incidence of perpetration. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data was used to conduct a quality assessment of all included studies. Due to marked study heterogeneity, results were presented using a narrative synthesis approach. Across studies, findings were mixed, and the methodological approaches varied greatly. Broadly, the review provides evidence for (1) higher rates of victimization than perpetration for both individuals with mental illness and those in the general population and (2) higher rates of both victimization and perpetration for those with mental illness compared to those in the general population

Childhood maltreatment and adulthood domestic and sexual violence victimisation among people with severe mental illness

PURPOSE: To investigate the association between childhood maltreatment and adulthood domestic and sexual violence victimisation among people with severe mental illness (SMI), and to explore this association in terms of gender differences and potential mediators. METHOD: A cross-sectional survey of 318 people living in the community who were receiving care from Community Mental Health Teams. Associations were assessed using logistic regression of multiply imputed data. RESULTS: 63 % (95 % CI 55–71 %) of men and 71 % (95 % CI 63–79 %) of women reported childhood maltreatment, 46 % (95 % CI 37–54 %) of men and 67 % (95 % CI 59–76 %) of women reported adulthood domestic violence victimisation, and 22 % (95 % CI 15–28 %)of men and 62 % (95 % CI 53–70 %)of women reported adulthood sexual violence victimisation. Men and women with SMI who reported experiences of childhood maltreatment were two to five times more likely to report domestic and sexual violence victimisation in adulthood after adjusting for confounders. The associations held for each of emotional, physical and sexual childhood abuse. CONCLUSION: People with severe mental illness have high prevalence of experiences of childhood maltreatment and adulthood domestic and sexual violence victimisation. Childhood maltreatment appears to be an independent risk factor for adulthood victimisation among men and women with SMI

Predictors of Mental Health Review Tribunal (MHRT) outcome in a forensic inpatient population:a prospective cohort study

Abstract Background Previous studies have investigated factors associated with outcome at Mental Health Review Tribunals (MHRTs) in forensic psychiatric patients; however, dynamic variables such as treatment compliance and substance misuse have scarcely been examined, particularly in UK samples. We aimed to determine whether dynamic factors related to behaviour, cooperation with treatment, and activities on the ward were prospectively associated with outcome at MHRT. Methods At baseline, demographic, clinical, behavioural, and treatment-related factors were ascertained via electronic medical records and census forms completed by the patient\u2019s clinical team. Data on MHRTs (i.e., number attended, responsible clinician\u2019s recommendation, and outcome) were collected at a 2-year follow-up. Logistic regression analyses were performed to determine factors associated with outcome among those who attended a MHRT within the follow-up period. Of the 135 forensic inpatients examined at baseline, 79 patients (59%) attended a MHRT during the 2-year follow-up period and therefore comprised the study sample. Of these 79 patients included in the current study, 28 (35%) were subsequently discharged. Results In univariable analyses, unescorted community leave, responsible clinician\u2019s recommendation of discharge, and restricted Mental Health Act section were associated with a greater likelihood of discharge at MHRT; whilst inpatient aggression, a recent episode of acute illness, higher total score on the Historical Clinical Risk \u2013 20 (HCR-20), higher HCR-20 clinical and risk scores, and agitated behaviour were negatively associated with discharge ( p \u2009<\u20090.05). In multivariable analyses, HCR-20 clinical scale scores and physical violence independently predicted outcome at tribunal after controlling for other dynamic variables. Conclusion By identifying dynamic factors associated with discharge at tribunal, the results have important implications for forensic psychiatric patients and their clinical teams. Our findings suggest that by reducing levels of agitated behaviour, verbal aggression, and physical violence on the ward, achieving unescorted community leave, and targeting specific items on the HCR-20 risk assessment tool, patients may be able to improve their changes of discharge at a MHRT

Self-harm and suicidal ideation among young people is more often recorded by child protection than health services in an Australian population cohort

OBJECTIVE: We investigated patterns of service contact for self-harm and suicidal ideation recorded by a range of human service agencies - including health, police and child protection - with specific focus on overlap and sequences of contacts, age of first contact and demographic and intergenerational characteristics associated with different service responses to self-harm.METHODS: Participants were 91,597 adolescents for whom multi-agency linked data were available in a longitudinal study of a population cohort in New South Wales, Australia. Self-harm and suicide-related incidents from birth to 18 years of age were derived from emergency department, inpatient hospital admission, mental health ambulatory, child protection and police administrative records. Descriptive statistics and binomial logistic regression were used to examine patterns of service contacts.RESULTS: Child protection services recorded the largest proportion of youth with reported self-harm and suicidal ideation, in which the age of first contact for self-harm was younger relative to other incidents of self-harm recorded by other agencies. Nearly 40% of youth with a health service contact for self-harm also had contact with child protection and/or police services for self-harm. Girls were more likely to access health services for self-harm than boys, but not child protection or police services.CONCLUSION: Suicide prevention is not solely the responsibility of health services; police and child protection services also respond to a significant proportion of self-harm and suicide-related incidents. High rates of overlap among different services responding to self-harm suggest the need for cross-agency strategies to prevent suicide in young people.</p

Long term outcomes and causal modelling of compulsory inpatient and outpatient mental health care using Norwegian registry data: protocol for a controversies in psychiatry research project

Objectives: Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry‐ based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency. Methods: By using the natural variation in health providers' preference for compulsory care as a source of quasi‐randomisation we will estimate causal effects of compulsory care on short‐ and long‐term trajectories. Conclusions: This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group