Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care.
BACKGROUND
Inpatient aggression among female forensic psychiatric patients has been shown to be associated with self-harm, that is considered to be a historical risk factor for violence. Research on associations between previous or current self-harm and different types of inpatient aggression is missing.


AIM
The aim of this register study was to investigate the prevalence of self-harm and the type of inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients' self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression.


METHODS
Female forensic psychiatric patients (n = 130) from a high security hospital were included.


RESULTS
The results showed that 88% of the female patients had self-harmed at least once during their life and 57% had been physically and/or verbally aggressive towards staff or other patients while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or repeated self-harm were not significantly associated with inpatient aggression, whereas self-harm during care was significantly associated with physical and verbal aggression directed at staff.


CONCLUSIONS
These results pointed towards self-harm being a dynamic risk factor rather than a historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether self-harm is an individual risk factor or a part of the clinical risk factor 'Symptom of major mental illness' within the HCR-20V3 must be further explored among women. Thus, addressing self-harm committed by female patients during forensic psychiatric care seems to be important in risk assessments and the management of violence, especially in reducing violence against staff in high-security forensic psychiatric services.
['Selenius|Heidi|H|', 'Leppänen Östman|Sari|S|', 'Strand|Susanne|S|']
D000293:Adolescent D000328:Adult D000374:Aggression D003134:Commitment of Mentally Ill D005260:Female D006801:Humans D007297:Inpatients D001523:Mental Disorders D008875:Middle Aged D012307:Risk Factors D016728:Self-Injurious Behavior D055815:Young Adult
self-harm risk factor inpatient aggression women Forensic psychiatry