Risk factors of violent offending in mentally ill prisoners with autism spectrum disorders

Autism Spectrum Disorders in forensic psychiatric investigations-patterns of comorbidity and criminality

Background

There are contradictory research findings regarding whether individuals with Autism Spectrum Disorders (ASDs) are more or less likely to commit crimes. The aims of the current study were to: (1) Describe psychiatric and crime-related characteristics of a large group of offenders with ASD who had undergone a Forensic Psychiatric Investigation (FPI). (2) Identify clinical subgroups among this group of offenders. (3) Investigate associations between the identified clinical subgroups and (a) psychiatric comorbidity (b) types of crimes and (c) criminal responsibility.

Methods

The study cohort consists of all subjects (n = 831) who received an ASD-diagnosis at an FPI between 2002 and 2018 in Sweden. Descriptive and clinical, as well as crime related variables were obtained from the FPIs. Non-parametric (Pearson χ2, Fisher's exact and Mann-Whitney U-test) inferential statistics were used for analyses of between-group differences and effect sizes were reported. A Latent Class Analysis was used to identify homogeneous subgroups (or classes) from categorical characteristics.

Results

The cohort consisted of 708 men and 123 women, aged 18 to 74 yrs. Two-thirds (66.7%) of the cohort had at least one other psychiatric diagnosis, the most prevalent was substance use disorder (SUD). A severe mental disorder, equivalent to lack of criminal responsibility, was most often reported among offenders with a comorbid diagnosis of schizophrenia spectrum disorder. The most common type of crime was violent crime. Three person-oriented clinical subgroups were identified; (1) ASD with few other diagnoses; (2) ASD and very high levels of SUDs, plus moderate levels of other externalizing disorders and psychotic psychopathology and (3) ASD and moderate to high levels of personality disorders (other than ASPD) and SUDs.

Conclusion

Our results highlight the importance of all parts of the CJS to be prepared to handle offenders with ASD, often with high levels of additional psychiatric problems. Traditional approaches in treatment or other psychosocial interventions for ASD may need to be adapted to at least three general clinical profiles- one with mainly neurodevelopmental problems, one with a spectrum of externalizing problems and one with complex personality related difficulties.

Trauma, post-traumatic stress disorder and violence in the prison population: prospective cohort study of sentenced male prisoners in the UK

BACKGROUND

Violence is a common problem in prisons. Post-traumatic stress disorder (PTSD), a prevalent disorder in prison populations, has been identified as a risk factor for violent behaviour in community and military populations. Although cross-sectional associations between PTSD and prison violence have been documented, prospective cohort studies are required.

AIMS

To investigate whether PTSD is an independent risk factor for prison violence, and examine the potential role of PTSD symptoms and other trauma sequelae on the pathway from trauma exposure to violent behaviour in prison.

METHOD

A prospective cohort study was conducted in a large, medium security prison in London, UK. A random sample of sentenced prisoners arriving into custody (N = 223) took part in a clinical research interview, which assessed trauma histories, mental disorders including PTSD, and other potential sequelae of trauma (anger, emotion dysregulation). Incidents of violent behaviour were measured with prison records covering the 3 months after reception into custody. Stepped binary logistic regression and a series of binary mediation models were performed.

RESULTS

Prisoners who met current (past month) criteria for PTSD were more likely to engage in violent behaviour during the first 3 months of imprisonment, after adjusting for other independent risk factors. The relationship between lifetime exposure to interpersonal trauma and violent behaviour in custody was mediated by total PTSD symptom severity. Hyperarousal and negatively valenced cognitive and emotional appraisal symptoms were particularly implicated in this pathway.

CONCLUSIONS

The identification and treatment of PTSD has the potential to reduce violence in prison populations.

Prevalence of violence by people living with severe mental illness against their relatives and its associated impacts: A systematic review

INTRODUCTION

Violence perpetration by adults with severe mental illness (SMI) specifically towards their relatives is a sensitive topic and a largely neglected area that has consequences and implications for different stakeholders, including healthcare providers. This paper sought to systematically review the relevant literature, to identify the types and rates of violence by people with SMI against their relatives, and to develop a detailed understanding of its reported impacts.

METHODS

A systematic review, registered with PROSPERO (registration number CRD42019150784), was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review comprised searches of Medline, Embase, PsycInfo and CINAHL databases, supplemented by manual searches. Data from 38 papers using mixed methodologies were reviewed.

RESULTS

Key findings highlighted that relatives experienced different types of violence, including physical, verbal, psychological, financial violence, and violence directed towards property. Different types often co-occurred. Mothers were the group most likely to report being victims, compared with other relatives. Reported impacts of violence on relatives included mental ill health (e.g., psychological distress, post-traumatic stress symptoms) and the deterioration, and in some cases the permanent breakdown, of family relationships and the family unit. However, relatives often continued to provide a framework of support for patients, despite risks to their own safety.

CONCLUSION

Findings speak to the importance of future research extending the focus beyond the identified victimised relative or perpetrator, to also consider the impacts of violence at the family-wide level, and to improve the outcomes of families exposed to and dealing with violence by individuals living with SMI.