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Stoliker BE, Balogun T, Wangler H, Mela M, Jewell LM, Nixon B, Nwachukwu K. Medical Chart Review to Explore Suicidal and Self-Harm Thoughts and Behavior Among Psychiatric Inpatients. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241272653. [PMID: 39099082 DOI: 10.1177/00302228241272653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Suicide and self-harm events are elevated in psychiatric inpatient populations. In this study, health data were retrospectively collected from the medical records of 183 patients (97 civil and 86 forensic) who had resided in, or been admitted to, a public psychiatric hospital in Saskatchewan, Canada from April 1 to December 31, 2021. Descriptive and inferential analyses were conducted to estimate prevalence and correlates of (non-fatal) suicide and self-harm events, including recent and lifetime occurrences, according to patients' health information. Nearly two-thirds (62%) of patients had any record of non-fatal suicide or self-harm events, including a lifetime history of self-harm (42%) and suicidal behavior (37%) as well as recent self-harm (24%) and suicidal (31%) thoughts or behaviors. Forensic patients were significantly more likely to have a record of suicide and self-harm events. This study emphasizes the need for further research into the course of suicidality and self-harm in psychiatric inpatients.
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Affiliation(s)
- Bryce E Stoliker
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Temilola Balogun
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Haile Wangler
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mansfield Mela
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lisa M Jewell
- Centre for Forensic Behavioural Science and Justice Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brent Nixon
- Saskatchewan Health Authority, Saskatchewan Hospital, North Battleford, SK Canada
| | - Kingsley Nwachukwu
- Saskatchewan Health Authority, Saskatchewan Hospital, North Battleford, SK Canada
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Kaggwa MM, Chaimowitz GA, Erb B, Moulden H, Prat S, Davids A, Olagunju AT. Adverse childhood events and self-harming behaviours among individuals in Ontario forensic system: the mediating role of psychopathy. BMC Psychiatry 2024; 24:332. [PMID: 38693475 PMCID: PMC11064378 DOI: 10.1186/s12888-024-05771-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Adverse childhood events (ACEs), psychopathy, and self-harming behaviours are prevalent among individuals in the forensic psychiatry system. While existing literature suggests that ACEs, self-harm, and psychopathy are interrelated, little is known about the interplay of psychopathic traits in this relationship. The present study aimed to determine the mediating role of psychopathy in the relationship between ACEs and self-harming behaviours in forensic patients. METHODS This was a retrospective study of patients under the Ontario Review Board (ORB) between 2014 and 2015. In the analysis, we included patients with complete data on ACEs, self-harming behaviours, and a Psychopathy Checklist-Revised (PCL-R) score - a measure of psychopathic traits and their severity conducted during the reporting period. Mediation analysis was based on the Baron and Kenny approach, and sensitivity analysis was performed based on the types of ACEs. RESULTS The sample population (n = 593) was made up of adults, with a mean age of 41.21 (± 12.35) years and were predominantly males (92.37%). While there was a partial mediating effect of psychopathy on the relationship between ACEs and incidents of self-harming behaviours in the past year, the mediation was complete in the relationship between ACEs and a lifetime history of self-harming behaviours. Following sensitivity analysis based on the types of ACE, the mediating effects were more attributed to specific ACEs, especially having experienced child abuse or having an incarcerated household member before 18 years. CONCLUSION Among forensic patients in Ontario, psychopathy mediates the relationship between experiencing ACEs and engaging in self-harming behaviours. Effective intervention to mitigate self-harming behaviours in this population should consider the potential role of psychopathy, especially among individuals who have experienced ACEs involving a history of child abuse and a family who was incarcerated.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada.
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Gary A Chaimowitz
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Bailea Erb
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Heather Moulden
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Sebastien Prat
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Arianna Davids
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, Australia
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Kaggwa MM, Chaimowitz GA, Erb B, Prat S, Davids A, Moulden H, Robbins A, Bradford J, Mamak M, Olagunju AT. Self-harming behaviors and forensic system-related factors: an analysis of the Ontario review board database. BMC Psychiatry 2023; 23:913. [PMID: 38057757 PMCID: PMC10698976 DOI: 10.1186/s12888-023-05394-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In Canada, ensuring public safety, and the safety and well-being of accused individuals under the jurisdiction of the provincial review board are very important. While previous studies have reported a significant risk of self-harming behaviors (non-suicidal self-injury and suicide attempt) in forensic psychiatric settings, no large population study has assessed any relationship between forensic system-related factors and self-harming behaviors. A better understanding of these factors can help clinicians implement protective measures to mitigate self-harming behaviors or actions. METHODS Using the Ontario Review Board (ORB) database covering 2014-2015 period (n = 1211, mean age = 42.5 ± 13.37 years, males = 86.1%), we analyzed the prevalence and factors associated with self-harming behaviors, emphasizing the characterization of the forensic system-related factors (ORB status, legal status, type of offense, previous criminal history, and victim relationship). The relationships between the forensic system-related factors and self-harming behaviors were explored using five separate logistic regression models, controlling for clinical and sociodemographic characteristics. RESULTS Approximately 4% of the individuals in the forensic system over the study period engaged in self-harming behaviors Among the studied patients, individuals determined to be unfit to stand trial and inpatients were significantly more likely to have self-harming behaviors. There was no significant relationship between the type of offence, victim relationship, and previous criminal history with self-harming behavior. CONCLUSION Forensic psychiatry inpatients should have close observation, screening, monitoring, and individual tailored management strategies for self-harming behaviors. The findings of this study indicate that forensic system-related factors, especially those that pertain to the status of individuals in the forensic system (i.e., unfit to stand trial and being an inpatient) are more responsible for self-harming behaviors among forensic patients in Ontario.
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Affiliation(s)
- Mark Mohan Kaggwa
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada.
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada.
- Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Gary Andrew Chaimowitz
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Bailea Erb
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Sébastien Prat
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Arianna Davids
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Heather Moulden
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Amara Robbins
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - John Bradford
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Division of Forensic Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Mini Mamak
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
| | - Andrew Toyin Olagunju
- Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, 5000, Australia
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Lassen S, Heintz T, Pedersen T, Jentz C, Nathanielsen N, Heilmann P, Sørensen LU. Nationwide study on antipsychotic polypharmacy among forensic psychiatric patients. Int J Circumpolar Health 2023; 82:2218654. [PMID: 37300837 DOI: 10.1080/22423982.2023.2218654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
This nationwide retrospective cross-sectional study examines the prevalence of antipsychotic polypharmacy (APP) and demographic, forensic, and clinical factors associated with its practice among Greenlandic forensic psychiatric patients. We collected data from electronic patient files, court documents, and forensic psychiatric assessments. We defined APP as two or more concurrent prescriptions of antipsychotic medication. The study population of 74 patients had a mean age of 41.4 years, and 61 were men. All included patients had either schizophrenia or another ICD-10 F2-diagnosis. We used unpaired t-tests and Chi2 or Fisher's exact test. The prevalence of APP was 35% (n = 26), and there was a significant association between APP and a prescription of clozapine (Chi2, p = 0.010), olanzapine (Fisher's test, p = 0.003), and aripiprazole (Fisher's test, p = 0.013). Furthermore, we found a significant association between APP and prescription of a first-generation antipsychotic (FGA) (Chi2, p = 0.011). Despite recommendations in guidelines, the use of APP is common practice. The majority of forensic psychiatric patients suffer from severe psychiatric disorders, often with other comorbidities, including substance use disorder. The severity and complexity in mental health render forensic psychiatric patients at high risk of APP treatment. Further knowledge on APP use is crucial to secure and further improve the psychopharmacological treatment for this group of patients.
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Affiliation(s)
- Stine Lassen
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Thale Heintz
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Tilde Pedersen
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Christian Jentz
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
| | - Naaja Nathanielsen
- The Directorate of Correctional Services, Prison and Probation Service, Nuuk, Greenland
| | | | - Lisbeth Uhrskov Sørensen
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Denmark
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Upfold C, Jentz C, Heilmann P, Nathanielsen N, Chaimowitz G, Sørensen LU. Forensic psychiatry patients, services, and legislation in Nunavut and Greenland. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101921. [PMID: 37690360 DOI: 10.1016/j.ijlp.2023.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/27/2023] [Accepted: 08/26/2023] [Indexed: 09/12/2023]
Abstract
Circumpolar regions face unique challenges in establishing and maintaining mental health care systems, including forensic psychiatry services. The scarcity of data and lack of evidence concerning the forensic psychiatry patient (FPP) populations of Nunavut and Greenland exacerbates the challenges of informing best practices and healthcare planning. By comparing the prevalence of forensic psychiatry patients, the mental health care services, and the legislation in these two relatively similar but unique regions, insight may be gained that can help inform healthcare planning. This cross-sectional study includes all forensic psychiatry in- and outpatients in one year from Nunavut (2018) and on February 29, 2020, in Greenland. The Greenland sample (n = 93) was nearly four times larger than the Nunavut sample (n = 15) at the population level. Despite considerable differences in forensic legislation and service supply, the forensic psychiatry patients in the two areas share several similarities. A total of 87% (n = 13) in the Nunavut sample were diagnosed with a DSM-5 schizophrenia spectrum disorder or other psychotic disorder. In Greenland, 82% (n = 76) were diagnosed with an ICD-10 F2 diagnosis (schizophrenia, schizotypal and delusional disorders). Approximately 2/3 of the patients in both populations were diagnosed with substance use disorder, and 60% of the Nunavut FPP received long-acting antipsychotic injections versus 62% in Greenland. Nearly half of the FPPs in both populations had never been convicted prior to entering the forensic psychiatry system; Nunavut 45% versus Greenland 47%. A substantial proportion of Greenlandic FPPs were outpatients compared to Nunavut (83% versus 47%). This study is an essential first step toward describing a Model of Care for forensic psychiatry patients in circumpolar regions; furthermore, the clinical similarities between the two populations provide support for future joint Arctic research and the inclusion of artic forensic patients in international studies.
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Affiliation(s)
- Casey Upfold
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Canada
| | - Christian Jentz
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark; Institute of Clinical Medicine, Health, Aarhus University, Denmark
| | | | | | - Gary Chaimowitz
- Forensic Psychiatry Program, St. Joseph's Healthcare Hamilton, Canada; McMaster University, Department of Psychiatry and Behavioural Neurosciences, Canada.
| | - Lisbeth Uhrskov Sørensen
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Denmark; Institute of Clinical Medicine, Health, Aarhus University, Denmark.
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Zheng W, Gao L, Fan Y, Wang C, Liu Y, Tian F, Yi M, Peng X, Liu C. Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide. Front Public Health 2023; 11:1106454. [PMID: 36969682 PMCID: PMC10031109 DOI: 10.3389/fpubh.2023.1106454] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
PurposeSuicide is a global concern, especially among young people. Suicide prediction models have the potential to make it easier to identify patients who are at a high risk of suicide, but they have very little predictive power when there is a positive value for suicide mortality. Therefore, the aim of the study is to uncover potential risk factors associated with suicide by self-poisoning and further to provide a trustworthy nomogram to predict self-poisoning suicide among poisoned patients.MethodsThis study prospectively enrolled 237 patients who were treated for poisoning at the Fifth Medical Center of PLA General Hospital (Beijing) between May 2021 and May 2022. Patient's basic characteristics, daily activities, mental health status, and history of psychological illnesses were gathered to examine their predictive power for self-poisoning suicide. On developing a prediction model, patients were split 8:2 into a training (n = 196) group and a validation (n = 41) group at random via computer. The training group worked on model development, while the validation group worked on model validation. In this study, the Hosmer and Lemeshow test, accuracy, and area under the curve were the primary evaluation criteria. Shapley Additive exPlanations (SHAP) was determined to evaluate feature importance. To make the prediction model easy for researchers to utilize, it was presented in nomogram format. Two risk groups of patients were identified based on the ideal cut-off value.ResultsOf all poisoned patients, 64.6% committed suicide by self-poisoning. With regard to self-poisoning attempted suicide, multivariate analysis demonstrated that female gender, smoking, generalized anxiety disorder-7 (GAD-7), and beck hopelessness scale-20 (BHS-20) were significant risk factors, whereas married status, relatively higher education level, a sedentary time of 1–3 h per day, higher sport frequency per week, higher monthly income were significant protective features. The nomogram contained each of the aforementioned nine features. In the training group, the area under curve (AUC) of the nomogram was up to 0.938 (0.904–0.972), whereas in the validation group, it reached a maximum of 0.974 (0.937–1.000). Corresponding accuracy rates were up to 0.883 and 0.927, respectively, and the P-values for the Hosmer and Lemeshow test were 0.178 and 0.346, respectively. SHAP demonstrated that the top three most important features were BHS-20, GAD-7, and marital status. Based on the best cut-off value of the nomogram (40%), patients in the high-risk group had a nearly six-time larger likelihood of committing suicide by self-poisoning than patients in the low-risk group (88.68 vs. 15.38%, P < 0.001). The dynamic nomogram was made available at the following address: https://xiaobo.shinyapps.io/Nomogramselfpoisoningsuicide/.ConclusionsThis study proposes a prediction model to stratify patients at a high risk of suicide by self-poisoning and to guide individual preventive strategies. Patients in the high-risk group require further mental health counseling to alleviate anxiety and hopelessness, healthy lifestyle like quitting smoking and exercising more, and restriction of access to poison and psychiatric drugs.
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Affiliation(s)
- Wenjing Zheng
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Le Gao
- Department of Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yanna Fan
- Department of Radiation Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Chunyan Wang
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yanqing Liu
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Fei Tian
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Min Yi
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaobo Peng
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Xiaobo Peng
| | - Chunzi Liu
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Chunzi Liu
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