Forensic psychiatric inpatients and aggression: An exploration of incidence, prevalence, severity, and interventions by gender

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Abstract

Background

Previous investigations suggest that women judged to be not criminally responsible on account of mental disorder (NCR-MD) differ markedly from their male counterparts in important ways, underscoring the necessity of subsequent study.

Objective

The goal of the present study was to inform our understanding of the presenting profile of female forensic psychiatric patients and contrast their risk of inpatient aggression with their male counterparts.

Method

The population of patients assessed and/or treated at a secure Canadian forensic psychiatric hospital were available for study. In total, 527 patients had complete data and were part of intensive retrospective file reviews; inpatient aggression was evaluated using the Overt Aggression Scale.

Results

Women were no less likely than men to have a violent index offence and to perpetrate inpatient aggression. Examining the range of aggressive behaviours and severity levels did little to increase the relevance of gender to inpatient risk.

Discussion

Female forensic patients represent a highly selected subgroup of women with exceptional clinical and behavioural challenges and associated treatment needs.

Section snippets

Participants

Between January 1st and December 31st 2004, a total of 548 patients were assessed and/or treated at the Forensic Psychiatric Hospital (FPH) in Port Coquitlam, British Columbia. Due to incomplete files and missing data, a total of 527 patients were available for the present study. Socio-demographic, mental health, and criminological patient information is presented in Table 1, Table 2, Table 3, Table 4. Patients were predominantly male (88%), most had prior mental health contacts (88%), and a

Psychosocial characteristics

The psychosocial characteristics of the participants are described in Table 1. The age range for female patients (18–55 years) was substantially tighter than for male patients (17–78 years) though there was no gender difference in the mean age at the time of the index offence (M = 34.32, SD = 9.76; M = 33.77; SD = 11.53, respectively; t[516] =  0.37, p = .71). The women were more likely than the men to be from a minority group, however, a comparison did not reach significance (χ2[6, N = 506] = 11.22, p = .08, Phi

Comparing risks and needs between male and female forensic psychiatric patients

This study offers a rare glimpse into the characteristics of Canadian forensic psychiatric inpatients by providing a comprehensive snapshot of the entire population of patients at a secure hospital, with a focus on gender differences and similarities. A standardized means of evaluating inpatient aggression (OAS) was used for the population of patients in order to provide a reliable and valid measure of inpatient aggression. Our primary finding is that the prevalence and frequency of aggression

Acknowledgements

The authors are grateful for the financial support provided by BC Mental Health and Addiction Services. The first author is a Michael Smith Foundation for Health Research Career Scholar. We are indebted to our team of research assistants and the BC Forensic Psychiatric Services Commission.

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