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Shrestha K, Atreya A. Adversarial Homicide-Suicide Perpetrated by Domestic Helper: A Case Report From Nepal. Cureus 2023; 15:e46847. [PMID: 37954703 PMCID: PMC10637292 DOI: 10.7759/cureus.46847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023] Open
Abstract
The majority of literature on homicide-suicide addresses the fact that victims are predominantly female, and offenders are typically adult males (older than the victims) who share a familial, marital, or consortial relationship with them. The probability of fatalities involving murder-suicides in the bedrooms of middle-class households is higher. We present a case where an adolescent domestic helper strangled his landlady, twice his age, only to commit suicide by hanging thereafter. We go on to discuss homicide-suicide by servants outside the consortial relationship and the possible reasons for it in the Nepalese context.
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Affiliation(s)
- Kaschev Shrestha
- Department of Forensic Medicine, College of Medical Sciences, Bharatpur, NPL
| | - Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, NPL
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2
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Shafti M, Taylor P, Forrester A, Handerer F, Pratt D. A systematic review of the co-occurrence of self-harm and aggression: Is dual harm a unique behavioural construct? Front Psychiatry 2023; 14:1083271. [PMID: 36873217 PMCID: PMC9978485 DOI: 10.3389/fpsyt.2023.1083271] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Dual harm is the co-occurrence of self-harm and aggression during an individual's lifetime. It is unclear whether sufficient evidence exists for dual harm as a unique clinical entity. This systematic review aimed to examine whether there are psychological factors that are uniquely associated with dual harm when compared to those who have engaged in sole harm (self-harm alone, aggression alone) and no harmful behaviours. Our secondary aim was to conduct a critical appraisal of the literature. Methods The review searched PsycINFO, PubMed, CINAHL, and EThOS on September 27, 2022, resulting in 31 eligible papers that represented 15,094 individuals. An adapted version of the Agency for Healthcare Research and Quality was used to assess risk of bias and a narrative synthesis was conducted. Results The included studies assessed differences in mental health problems, personality, and emotion related factors between the different behavioural groups. We found weak evidence that dual harm is an independent construct with unique psychological characteristics. Rather, our review suggests that dual harm results from the interaction of psychological risk factors that are associated with self-harm and aggression. Discussion The critical appraisal identified numerous limitations within the dual harm literature. Clinical implications and recommendations for future research are provided. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197323, identifier CRD42020197323.
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Affiliation(s)
- Matina Shafti
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Peter Taylor
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Andrew Forrester
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Fritz Handerer
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
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3
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Bjørkly S, Laake P, Douglas KS. The safe pilot study: A prospective naturalistic study with repeated measures design to test protective factors against violence in and after discharge from forensic facilities. Psychiatry Res 2023; 320:115017. [PMID: 36610319 DOI: 10.1016/j.psychres.2022.115017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/01/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
Assessing violence risk amongst forensic patients is a vital legal and clinical task. The field of violence risk assessment has developed considerably over the past two decades but remains primarily risk focused. Despite this, growing attention to and work on protective factors or strengths has occurred. In this prospective naturalistic study with repeated observer-rated measures of 27 forensic patients, we tested the role of three potentially important but understudied dynamic protective factors: hope, insight, and resilience, along with a history of criminality, in terms of their impact on violence. Main effects models indicated that higher hopelessness and past criminal convictions were predictive of violence acts; higher resilience was associated with lower violence. In interaction models, hopelessness remained predictive. Importantly, there were significant interactions between resilience and past criminal convictions, with higher levels of resilience leading to lower violence, most amongst those with criminal convictions, and between resilience and hopelessness related emotional distress, in that higher resilience at high levels of patient acknowledged emotional distress due to hopelessness led to lower violence. Findings indicate the importance of focusing on strengths or protective factors in the assessment of risk and treatment planning for forensic patients. Despite the small sample, the repeated measures design was feasible and informative.
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Affiliation(s)
- Stål Bjørkly
- Regional Centre for Research and Education in Forensic Psychiatry, Oslo University, Hospital, Norway; Faculty of Health and Social Sciences, Molde University College, Molde, Norway.
| | - Petter Laake
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway; Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, University of, Oslo, Norway
| | - Kevin S Douglas
- Regional Centre for Research and Education in Forensic Psychiatry, Oslo University, Hospital, Norway; Department of Psychology, Simon Fraser University, Vancover, Canada; Regional Centre for Research and Education in Forensic Psychiatry, Haukeland, University Hospital, Bergen, Norway
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4
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Ricarte JJ, Caravaca-Sánchez F, Barry TJ, Aizpurua E. Suicide behaviours in incarcerated males: Links to psychopathic traits, forms of aggression to others, personal characteristics, and current penitentiary variables. J Forensic Leg Med 2022; 89:102357. [DOI: 10.1016/j.jflm.2022.102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
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5
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Robinson WL, Whipple CR, Keenan K, Flack CE, Wingate L. Suicide in African American Adolescents: Understanding Risk by Studying Resilience. Annu Rev Clin Psychol 2021; 18:359-385. [PMID: 34762495 DOI: 10.1146/annurev-clinpsy-072220-021819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Historically, suicide rates for African American adolescents have been low,relative to rates for youth of other racial-ethnic backgrounds. Since 2001, however, suicide rates among African American adolescents have escalated: Suicide is now the third leading cause of death for African American adolescents. This disturbing trend warrants focused research on suicide etiology and manifestation in African American adolescents, along with culturally sensitive and effective prevention efforts. First, we revisit leading suicide theories and their relevance for African American adolescents. Next, we discuss health promotive and protective factors within the context of African American youth development. We also critique the current status of suicide risk assessment and prevention for African American adolescents. Then, we present a heuristic model of suicide risk and resilience for African American adolescents that considers their development within a hegemonic society. Finally, we recommend future directions for African American adolescent suicidology. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- W LaVome Robinson
- Department of Psychology, DePaul University, Chicago, Illinois, USA;
| | - Christopher R Whipple
- School of Behavioral Sciences and Education, Pennsylvania State University-Harrisburg, Harrisburg, Pennsylvania, USA
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA
| | - Caleb E Flack
- Department of Educational Psychology, University ofWisconsin-Madison, Madison, Wisconsin, USA
| | - LaRicka Wingate
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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6
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Furnes D, Gjestad R, Rypdal K, Mehlum L, Hart S, Oedegaard KJ, Mellesdal L. Suicidal and violent ideation in acute psychiatric inpatients: prevalence, co-occurrence, and associated characteristics. Suicide Life Threat Behav 2021; 51:528-539. [PMID: 33368501 DOI: 10.1111/sltb.12726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/07/2020] [Accepted: 09/18/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We studied the point prevalence of suicidal and violent ideation, as well as their co-occurrence and associated characteristics in inpatients with mental health disorders. METHODS Data on suicidal and violent ideation, and sociodemographic and clinical information, were gathered from 1,737 patients when admitted to the acute psychiatric ward. RESULTS The point prevalence was 51.9% for suicidal ideation and 19.8% for violent ideation. The point prevalence of co-occurring suicidal and violent ideation was 12.3%, which was significantly greater than expected by chance. Logistic regression analyses indicated that both suicidal and violent ideation were associated with young age and the absence of diagnoses of psychotic disorders; in addition, suicidal ideation was associated with female gender, violent ideation, and diagnoses of mood- neurotic and personality disorders, whereas violent ideation was associated with male gender, suicidal ideation, and diagnoses of mood and neurotic disorders. CONCLUSIONS Overall, the findings highlight the need for further research on suicidal and violent ideation in people with mental health problems including, but not limited to, their association with adverse behavioral outcomes, as well as the need to routinely assess both suicidal and violent ideation in clinical practice.
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Affiliation(s)
- Desiré Furnes
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Knut Rypdal
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - Stephen Hart
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Ketil J Oedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital, Haukeland, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Liv Mellesdal
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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7
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CHEN CHIUNGM, HARFORD THOMASC, GRANT BRIDGETF, CHOU SPATRICIA. Association between aggressive and non-fatal suicidal behaviors among U.S. high school students. J Affect Disord 2020; 277:649-657. [PMID: 32911215 PMCID: PMC7572741 DOI: 10.1016/j.jad.2020.08.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/08/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study quantified the association between aggressive and non-fatal suicidal behaviors (NFSB) among U.S. high school students and examined whether the association could be explained by substance use, bullying and sexual/dating violence victimization, and other potential risk factors. METHOD Data were based on self-reports from 14,765 students who responded to the 2017 National Youth Risk Behavior Survey. Confirmatory latent class analysis (LCA) identified two distinct, dichotomous latent class variables manifested by indicators of past-year NFSB (i.e., ideation, plan, and attempt) and aggressive behavior (i.e., physical fighting in general and on school property). The structural model estimated the odds ratios between NFSB, aggressive behavior, and their potential risk factors. RESULTS Without adjusting for covariates, the confirmatory LCA estimated an odds ratio (OR) of 2.55 (95% confidence interval [CI]: 1.93, 3.37) between two latent class variables for violence against self (NFSB) and others (physical fighting). The net association, however, was rendered nonsignificant (OR = 1.08 [95% CI: 0.88, 1.31]) when adjusted for covariates. Significant common risk factors included exposure to physical dating violence, being bullied on school property and/or electronically, being threatened or injured by someone with a weapon on school property, and lifetime illegal drug use and prescription opioid misuse. LIMITATIONS Cross-sectional data do not allow assessment of causal relationships. CONCLUSIONS Findings elucidated the association between NFSB and aggressive behavior, with serious implications for prevention and intervention. Targeting substance use, bullying, and sexual and dating violence will protect students from engaging in both types of violent behaviors.
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Affiliation(s)
- CHIUNG M. CHEN
- CSR, Incorporated, Arlington, Virginia,Correspondence may be sent to Chiung M. Chen at CSR, Incorporated, 901 N. Stuart Street, Suite 904-A, Arlington, VA 22203,
| | | | - BRIDGET F. GRANT
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - S. PATRICIA CHOU
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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8
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Wang L, Wu Q, Choi AWM. Negative Emotions as Risk Factors for Self-Directed Violence and Intimate Partner Violence in Chinese College Students. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:3886-3912. [PMID: 29294777 DOI: 10.1177/0886260517713225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this study, we examined the unique contributions of negative emotions (i.e., anger, depression, and shame) for two different types of self-directed violence (i.e., nonsuicidal self-injury [NSSI] and suicidality) and three different types of intimate partner violence perpetration (i.e., physical, sexual, and psychological violence) in a college sample. We investigated the moderating role of gender in any link between the negative emotions and the violent behaviors. We also examined an association between self-directed violence and intimate partner violence perpetration. We collected the survey data from a convenience sample of 752 Chinese college students (408 women and 344 men) ranging from 18 to 23 years of age. The questionnaires were filled out during class time. Analyses revealed that anger was associated with increased intimate partner physical, sexual, and psychological violence perpetration but not self-directed violence, underscoring its relevance for engaging in violence directed toward others. Our analyses also showed that, conversely, shame was associated with increased NSSI and suicidality but not intimate partner violence. Depression was associated with increased risk of engaging in self-directed violence as well as intimate partner physical and psychological violence. Moderation analysis showed that gender moderates the relationship of shame with NSSI. Women appear more susceptible to NSSI influenced by shame. Furthermore, the results found self-directed violence and intimate partner physical violence perpetration to be associated. The findings highlight the importance of targeting negative emotions in treatment with high-risk individuals. Integrated violence prevention programs would make it possible to treat co-occurring violence against self and intimate others in a more effective way.
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Affiliation(s)
- Ling Wang
- The University of Hong Kong, Pokfulam, Hong Kong
| | - Qinglu Wu
- The University of Hong Kong, Pokfulam, Hong Kong
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9
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Ghossoub E, Adib SM, Maalouf FT, Fuleihan GE, Tamim H, Nahas Z. Association between substance use disorders and self- and other-directed aggression: An integrated model approach. Aggress Behav 2019; 45:652-661. [PMID: 31418875 DOI: 10.1002/ab.21859] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 06/02/2019] [Accepted: 06/12/2019] [Indexed: 12/19/2022]
Abstract
Our study's objective is to determine whether substance use disorders' association with aggression differs according to the type of substance and/or the form of aggression, within the same population. We used data from the National Survey on Drug Use and Health across 2008-2014, with a pooled sample of 270,227 adult respondents. We used regression models to estimate the odds ratios for those having alcohol and/or drug use disorder(s) perpetrating (a) each form of aggression compared with no aggression and (b) other-directed compared with self-directed aggression. Alcohol use disorder alone and drug use disorder(s) alone were both associated with significantly increased odds of committing self-directed, other-directed, and combined aggression. Individuals with drug use disorder(s) alone were more likely to commit other-directed than self-directed aggression (adjusted odds ratio = 1.46, 95% CI = 1.04-2.05). Individuals with alcohol use disorder alone were not likely to commit one over the other (adjusted odds ratio = 1.20, 95% CI = 0.90-1.61). In conclusion, the integrated model of aggression based on the stress-diathesis model is a relevant framework to study risk factors for aggression. Further research is needed to identify longitudinal predictors of directionality of aggression.
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Affiliation(s)
- Elias Ghossoub
- Department of PsychiatryAmerican University of Beirut Medical Center Beirut Lebanon
- Department of Psychiatry and Behavioral NeuroscienceSaint Louis University Saint Louis Missouri
| | - Salim M. Adib
- Faculty of Health SciencesAmerican University of Beirut Medical Center Beirut Lebanon
| | - Fadi T. Maalouf
- Department of PsychiatryAmerican University of Beirut Medical Center Beirut Lebanon
| | - Ghada E.‐H. Fuleihan
- Department of Internal MedicineAmerican University of Beirut Medical Center Beirut Lebanon
| | - Hani Tamim
- Department of Internal MedicineAmerican University of Beirut Medical Center Beirut Lebanon
| | - Ziad Nahas
- Department of PsychiatryAmerican University of Beirut Medical Center Beirut Lebanon
- Department of PsychiatryUniversity of Minnesota Minneapolis Minnesota
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10
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Harford TC, Chen CM, Kerridge BT, Grant BF. Borderline Personality Disorder and Violence Toward Self and Others: A National Study. J Pers Disord 2019; 33:653-670. [PMID: 30307827 DOI: 10.1521/pedi_2018_32_361] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) is associated with violence toward self and others. This study aims to further identify which DSM-5 BPD criteria are independently related to violence, using data from National Epidemiologic Survey on Alcohol and Related Conditions-III, which included a total of 36,309 U.S. respondents ages 18 and older (n = 4,301 for BPD; n = 19,404 for subthreshold BPD). Multinomial logistic regression examined the associations between BPD criteria and violence categories, including suicide attempt (self-directed), violence toward others (other-directed), combined (self-/other-directed) violence, and no violence. In the total population, identity disturbance, impulsivity, and intense anger significantly characterized violence toward others, while avoidance of abandonment, self-mutilating behavior, feelings of emptiness, and intense anger significantly characterized violence toward self. These criteria (except identity disturbance) also significantly characterized combined self- and other-directed violence. Differential associations of the BPD criteria with violence among BPD and subthreshold BPD populations also are discussed.
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Affiliation(s)
| | | | - Bradley T Kerridge
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Bridget F Grant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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11
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Harford TC, Chen CM, Kerridge BT, Grant BF. Self- and other-directed forms of violence and their relationship with lifetime DSM-5 psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol Related Conditions-III (NESARC-III). Psychiatry Res 2018; 262:384-392. [PMID: 28939392 PMCID: PMC5849477 DOI: 10.1016/j.psychres.2017.09.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 11/26/2022]
Abstract
A combined history of violence toward self and others has been reported in clinical and incarcerated populations. Psychiatric disorders have been implicated as risk factors. This study examines the lifetime prevalence of this combined violence in the general population and its associations with DSM-5 psychiatric disorders in comparison with other- and self-directed violence. Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were analyzed, including 36,309 U.S. adults ages 18 and older. Violent behavior was defined by suicide attempts; recurrent suicidal behavior; gestures, threats, or self-mutilating behavior (self-directed); and multiple items of violence toward others (other-directed) in four categories: none, self-directed only, other-directed only, and combined self-/other-directed. Multinomial logistic regression examined these violence categories in association with sociodemographics and lifetime DSM-5 psychiatric disorders. Results show that approximately 18.1% of adults reported violent behavior, including self-directed only (4.4%), other-directed only (10.9%), and combined self- and other-directed violence (2.8%). DSM-5 psychiatric disorders significantly associated with the violence typology include alcohol, tobacco, cannabis, and other drug use disorders; mood disorders; posttraumatic stress disorder; and schizotypal, antisocial, and borderline personality disorders. Findings extend the clinical literature regarding the co-occurrence of self- and other-directed violent behaviors to the general population.
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Affiliation(s)
- Thomas C. Harford
- CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA,
22203, United States
| | - Chiung M. Chen
- CSR, Incorporated, 4250 N. Fairfax Dr., Suite 500, Arlington, VA,
22203, United States,Corresponding author: CSR, Incorporated, 4250 N. Fairfax Dr.,
Suite 500, Arlington, VA 22203. Tel.: + 1 703 741 7125; fax: + 1 703 312
5230
| | - Bradley T. Kerridge
- Department of Psychiatry, Columbia University, New York State
Psychiatric Institute, 1051 Riverside Drive, Unit 69, New York, NY, 10032,United
States
| | - Bridget F. Grant
- Epidemiology and Biometry Branch, Division of Epidemiology and
Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National
Institutes of Health, Room 3077, 5635 Fishers Lane, M.S. 9304, Bethesda, MD,
20892-9304, United States
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12
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Snir A, Itzhaky L, Solomon Z. The Double-Edged Sword - Outward and Inward Directed Aggression among War Combatants. Arch Suicide Res 2017; 21:595-609. [PMID: 27673557 DOI: 10.1080/13811118.2016.1227740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Inspired by the two-stage model of countervailing forces, we explored the mechanism underlining inward and outward aggression among ex-combatants. Israeli veterans (N = 230) reported their partner's violence (outward aggression), suicidal ideation (inward aggression), aggressive impulses, posttraumatic stress disorder (PTSD), paranoid ideation and guilt. Suicidal ideation was related to aggressive impulses only in the presence of PTSD, or under high guilt; whereas paranoid ideation buffered these effects. Violence towards the partner, on the other hand, was related to aggressive impulses under low guilt and in the absence of PTSD. Aggressive impulses underline both suicidal ideation and partner violence. The inter-relations between PTSD, guilt, and paranoid ideation influence the manifestation of aggression and the direction it takes.
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13
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Johnson KL, Desmarais SL, Tueller SJ, Grimm KJ, Swartz MS, Van Dorn RA. A longitudinal analysis of the overlap between violence and victimization among adults with mental illnesses. Psychiatry Res 2016; 246:203-210. [PMID: 27721058 PMCID: PMC5161544 DOI: 10.1016/j.psychres.2016.09.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 09/09/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
Prior research suggests considerable overlap of violence perpetration and victimization among adults with mental illnesses. However, there has been no examination of how the likelihood of being a victim and/or perpetrator of violence may change over time, nor consideration of clinically-relevant factors affecting these transitions. In a pooled sample of adults with mental illnesses (N=3,473) we employed latent transition analysis to: (a) determine prevalence of four violence and victimization classifications (i.e., non-victim/non-perpetrator, victim only, perpetrator only, and victim-perpetrator) over a 6-month period; (b) calculate the likelihood that adults with mental illnesses will remain in or transition between these classifications over time; and (c) assess the effects of recent substance use, psychiatric symptoms, and suicidal behaviors on transitions over time. At each time point, the majority of participants identified as non-victim/non-perpetrators, followed by victim-perpetrators, victims only, and perpetrators only. Analyses also revealed many individuals transitioned between classifications over time. These distinct pathways towards, and away from, violent outcomes were, in part, a function of recent violence and/or victimization, as well as substance use, psychiatric symptoms, and suicidal behaviors. Findings inform the identification of adults with mental illnesses at risk of violence and victimization and highlight points of intervention.
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Affiliation(s)
- Kiersten L. Johnson
- Behavioral and Urban Health Program, RTI International,Author Contact Information: Kiersten L. Johnson, PhD, Behavioral and Urban Health Program, RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, Phone: 919-485-2639,
| | | | | | | | - Marvin S. Swartz
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center
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14
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Nicholls TL, Brink J, Desmarais SL, Webster CD, Martin ML. The Short-Term Assessment of Risk and Treatability (START). Assessment 2016; 13:313-27. [PMID: 16880282 DOI: 10.1177/1073191106290559] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A new assessment scheme-the Short-Term Assessment of Risk and Treatability (START)- presents a workable method for assessing risks to self and others encountered in mentally and personality disordered clients. This study aimed to demonstrate (a) prevalence and severity of risk behaviors measured by the START, (b) psychometric properties of START, (c) similarities and differences in START scores across different mental health professionals, and (d) concurrent validity of START with diverse negative outcomes. Treatment team members completed the 20-item, dynamically focused START for 137 forensic psychiatric inpatients. Prevalence and severity of START risk domains were measured for 51 patients detained in the hospital for 1 year. Results revealed high rates of generally low-level adverse events. With some exceptions, START scores were meaningfully associated with outcomes measured by a modified Overt Aggression Scale.
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Affiliation(s)
- Tonia L Nicholls
- British Columbia Mental Health and Addictions, Simon Fraser University, Canada.
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15
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O'Donnell O, House A, Waterman M. The co-occurrence of aggression and self-harm: systematic literature review. J Affect Disord 2015; 175:325-50. [PMID: 25665494 DOI: 10.1016/j.jad.2014.12.051] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidemiological research supports an association between aggression and self-harm through data on the frequency with which individuals exhibit both behaviours. Unbiased evidence, however, is needed to draw conclusions about the nature and extent of co-occurrence. METHOD Systematic review of published studies was undertaken to evaluate whether or not the frequency with which aggression and self-harm co-occur is beyond that which would be expected by chance. Outcome measures included: (a) between-group differences on a standardised aggression/self-harm measure - the groups defined by scores on a measure of the other behaviour; (b) correlations between the two behaviours; (c) co-occurrence rates in populations defined by the presence of either behaviour; (d) co-occurrence rates in populations not defined by either behaviour. Odds ratios were calculated for studies presenting complete frequency data. RESULTS 123 studies, some yielding more than one type of result, met the inclusion criteria. Most case-control studies found elevated levels of aggression in self-harming populations (or self-harm in aggressive populations) compared to controls. The majority of correlational, co-occurrence rate, and odds ratio data found aggression and self-harm to be associated. LIMITATIONS Results were subject to descriptive synthesis only and thus, unable to report an overall effect size. CONCLUSIONS Evidence suggests that aggression and self-harm frequently co-occur. Such evidence necessitates more theoretical discussion and associated research on the source and nature of co-occurrence. Nonetheless, individuals who present with one behaviour may be considered an 'at-risk' group in terms of exhibiting the other. Such evidence holds implications for practice (e.g. risk assessment).
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Affiliation(s)
| | | | - Mitch Waterman
- Institute of Psychological Sciences, Faculty of Medicine and Health, University of Leeds, UK
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Yusainy C, Lawrence C. Relating mindfulness and self-control to harm to the self and to others. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014. [DOI: 10.1016/j.paid.2014.02.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Autism plus psychosis: A ‘one-two punch’ risk for tragic violence? Med Hypotheses 2013; 81:404-9. [DOI: 10.1016/j.mehy.2013.05.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/16/2013] [Accepted: 05/23/2013] [Indexed: 11/30/2022]
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Abstract
The Care Quality Commission recently acknowledged the use of mechanical restraint/s as an intervention for the management of self-harm. I implemented the use of mechanical restraint for a female patient in life-threatening circumstances. This involved an exploration of the defining characteristics as well as the history and ethics of mechanical restraint. Informed consent and examining the legal, ethical and organizational frameworks supporting the use of this intervention in the clinical setting were critical to implementation. Ultimately the outcome not only proved to be life saving, but also a 'catalyst for change'.
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Desmarais SL, Van Dorn RA, Telford RP, Petrila J, Coffey T. Characteristics of START assessments completed in mental health jail diversion programs. BEHAVIORAL SCIENCES & THE LAW 2012; 30:448-469. [PMID: 22807034 DOI: 10.1002/bsl.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Many different instruments have been developed to assist in the assessment of risk for violence and other criminal behavior. However, there is limited evidence regarding how these instruments work in the 'real world'. Even less is known about how these instruments might work for assessing risk in jail diversion populations, whether in research or practice. To address these knowledge gaps, the present study examined the characteristics of risk assessments completed by program staff (n=10) on 96 mental health jail diversion clients (72 men and 24 women) using the Short-Term Assessment of Risk and Treatability (START). The findings provide preliminary support for the reliability and validity of START assessments completed in jail diversion programs, the first evidence of the transportability of START outside psychiatric settings, and further evidence regarding the reliability and validity of START assessments completed in the field. They additionally support the consideration of an eighth, general offending risk domain in START assessments.
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Affiliation(s)
- Sarah L Desmarais
- Department of Psychology, North Carolina State University, Box 7650, Raleigh, NC 27695, USA.
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21
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Liem M, de Vet R, Koenraadt F. Filicide followed by parasuicide: a comparison of suicidal and non-suicidal child homicide. CHILD ABUSE & NEGLECT 2010; 34:558-562. [PMID: 20627299 DOI: 10.1016/j.chiabu.2010.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 12/21/2009] [Accepted: 01/04/2010] [Indexed: 05/29/2023]
Affiliation(s)
- Marieke Liem
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht University, The Netherlands
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22
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Boxer P. Covariation of self- and other-directed aggression among inpatient youth: continuity in the transition to treatment and shared risk factors. Aggress Behav 2010; 36:205-17. [PMID: 20309848 DOI: 10.1002/ab.20343] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although other- and self-directed aggression covary in very high-risk youth, these forms of aggression infrequently are studied simultaneously. Understanding better their covariation is an important task for improving services to high-risk youth. In this study, data from the clinical records of 476 youth admitted to secure inpatient treatment were analyzed to examine relations among self- and other-directed aggression exhibit before and during inpatient treatment. Analyses tested the hypotheses that self- and other-directed aggression would tend to covary and display continuity from pre-treatment to in-treatment. Also tested were the hypotheses that youth with histories of co-occurring self- and other-directed aggression would show the highest levels of aggression during treatment and the greatest degree of personal and contextual risk on entering treatment. These hypotheses were largely supported. Exploratory analyses revealed interesting discontinuities in aggression (aggression emitted only before or during treatment) with critical implications for research and practice with youth receiving clinical care, especially those in institutional placements.
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Affiliation(s)
- Paul Boxer
- Department of Psychology, Rutgers University, Newark, New Jersey, USA.
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23
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Liem M, Nieuwbeerta P. Homicide followed by suicide: a comparison with homicide and suicide. Suicide Life Threat Behav 2010; 40:133-45. [PMID: 20465348 DOI: 10.1521/suli.2010.40.2.133] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Homicide-suicides are a rare yet very serious form of lethal violence which mainly occurs in partnerships and families. The extent to which homicide-suicide can be understood as being primarily a homicide or a suicide event, or rather a category of its own is examined. In total, 103 homicide-suicides were compared to 3,203 homicides and 17,751 suicides. These are all events that took place in the Netherlands in the period 1992 to 2006. Logistic regression analyses show that homicide-suicides significantly differ from both homicides and suicides with regard to sociodemographic and event characteristics. The findings suggest that homicide-suicide might be considered as a distinct phenomenon from both homicide and suicide.
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Affiliation(s)
- Marieke Liem
- Willem Pompe Institute for Criminal Law and Criminology, Utrecht, the Netherlands.
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Liem M, Hengeveld M, Koenraadt F. Domestic homicide followed by parasuicide: a comparison with homicide and parasuicide. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2009; 53:497-516. [PMID: 19380454 DOI: 10.1177/0306624x09334646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Homicide-suicides are a rare yet very serious form of interpersonal violence that occur mainly in partnerships and families. As both perpetrator and victim die in a homicide- suicide, data sources in previous studies typically lack detailed information. This study overcomes this limitation by making use of homicides followed by a suicide attempt of the perpetrator (homicide-parasuicides). The authors examine to what extent these homicide-parasuicides can be understood as being primarily an expression of homicidal or of suicidal behavior. In total, 77 homicide-parasuicides are compared to 430 homicides and 161 parasuicides. The results show that homicide-parasuicides constitute a different category of lethal violence with regard to demographic, individual, and event-related characteristics. Subanalyses of homicide-parasuicides involving women and children reveal similar differences. The finding that a large majority of the perpetrators were mentally ill, dependent on the victim, and killed when faced with separation from the victim may suggest that increased monitoring of this group might have preventive value.
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Webster CD, Nicholls TL, Martin ML, Desmarais SL, Brink J. Short-Term Assessment of Risk and Treatability (START): The case for a new structured professional judgment scheme. BEHAVIORAL SCIENCES & THE LAW 2006; 24:747-66. [PMID: 17171764 DOI: 10.1002/bsl.737] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The Short-Term Assessment of Risk and Treatability (START) is a new structured professional judgment scheme intended to inform multiple risk domains relevant to everyday psychiatric clinical practice (e.g. risk to others, suicide, self-harm, self-neglect, substance abuse, unauthorized leave, and victimization). The article describes the processes involved in establishing an interdisciplinary approach to risk assessment and management. The authors present a review of the rationale for START, including the value of dynamic variables, the importance of strengths, and the extent to which clinicians must be attentive to multiple risk domains, reflecting theoretical and scientific evidence of the overlap among risks. Using the development, validation, and implementation of START as an example, the authors describe the processes by which other researchers, clinicians, and administrators could adapt existing assessment schemes or create new ones to bridge some remaining gaps in the risk assessment and management continuum.
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Affiliation(s)
- Christopher D Webster
- Forensic Psychiatric Services Commission, British Columbia Mental Health and Addiction Services, University of Toronto/Simon Fraser University, Canada.
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