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Noland E, Klötz Logan F, Sjöström S, Strandh M. What happens after forensic psychiatric care? A latent class analysis of dimensions of welfare for former forensic psychiatric patients. BMC Psychiatry 2023; 23:937. [PMID: 38087234 PMCID: PMC10714544 DOI: 10.1186/s12888-023-05428-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions. METHODS Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009-2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership. RESULTS The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors. CONCLUSIONS This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.
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Affiliation(s)
- Ebba Noland
- Department of Social Work, Umeå University, Umeå, 901 87, Sweden.
- Sundsvall Forensic Psychiatric Centre, Region Västernorrland, Box 880, Sundsvall, 851 24, Sweden.
| | - Fia Klötz Logan
- Sundsvall Forensic Psychiatric Centre, Region Västernorrland, Box 880, Sundsvall, 851 24, Sweden
| | - Stefan Sjöström
- Department of Sociology, Center for social work, Uppsala University, Box 624, Uppsala, Sweden
| | - Mattias Strandh
- Department of Social Work, Umeå University, Umeå, 901 87, Sweden
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Frowijn I, Masthoff E, Bogaerts S. Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes. BMC Psychiatry 2023; 23:502. [PMID: 37438815 DOI: 10.1186/s12888-023-04994-4] [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: 02/13/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future - Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class. METHOD A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure. RESULTS Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge. DISCUSSION Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.
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Affiliation(s)
- Iris Frowijn
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands.
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands.
| | - Erik Masthoff
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, the Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, the Netherlands
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Berlin J, Wallinius M, Nilsson T, Karlén MH, Delfin C. Exploring the psychometric properties of the externalizing spectrum inventory-brief form in a Swedish forensic psychiatric inpatient sample. BMC Psychiatry 2023; 23:184. [PMID: 36944949 PMCID: PMC10031895 DOI: 10.1186/s12888-023-04609-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 02/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The Externalizing Spectrum Inventory-Brief Form (ESI-BF) [1] is a 160-item self-report instrument designed for the assessment of externalizing psychopathology, yet few studies to date have evaluated its psychometric properties, structural fit, and criterion validity in forensic psychiatric settings. METHODS Here, we investigated these aspects in a sample of forensic psychiatric inpatients (n = 77) from a maximum-security forensic psychiatric hospital in Sweden. We firstly investigated the reliability. Secondly, using confirmatory factor analysis, the structure of the ESI-BF. And thirdly, using a Bayesian approach, assessed how the three ESI-BF subfactors relate to criterion measures of antisocial behaviors, substance use, and lifetime externalizing spectrum diagnoses. RESULTS The ESI-BF demonstrated good to adequate reliability and internal consistency, with all but four facet scales exhibiting α and ω values ≥ 0.80. Average inter-item correlations for the facet scales ranged from 0.31 to 0.74. However, all structural models exhibited poor to mediocre fit, with model fit values for the CFI being 0.66, 0.79 and 0.87 and RMSEA values of 0.14, 0.12 and 0.09. for the unidimensional correlated factors and bifactor model, respectively. Regarding criterion validity, all subscales of the item-based ESI-BF three-factor model exhibited robust correlations with the Life History of Aggression total, aggression and antisocial/consequences subscales, with correlations ranging from 0.29 to 0.55. All ESI-BF subfactors demonstrated robust associations, yet with different externalizing outcomes, lending tentative support to its criterion validity. CONCLUSION Despite remaining ambiguities regarding its structural fit, the ESI-BF may be promising for assessing externalizing psychopathology in forensic psychiatric populations. However, further investigation of the ESI-BF is needed before any firm conclusions can be drawn about its appropriateness in forensic psychiatric settings.
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Affiliation(s)
- Johan Berlin
- Lund Clinical Research on Externalizing and Developmental Psychopathology (LU-CRED), Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden.
- Rättspsykiatriska regionkliniken, Box 1223, 351 12, Växjö, Sweden.
| | - Märta Wallinius
- Lund Clinical Research on Externalizing and Developmental Psychopathology (LU-CRED), Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - Thomas Nilsson
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department for Forensic Psychiatry, The National Board of Forensic Medicine, Gothenburg, Sweden
- Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Malin Hildebrand Karlén
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department for Forensic Psychiatry, The National Board of Forensic Medicine, Gothenburg, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- Institute for Globally Distributed Open Research and Education (IGDORE), Gothenburg, Sweden
| | - Carl Delfin
- Lund Clinical Research on Externalizing and Developmental Psychopathology (LU-CRED), Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
- Centre of Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
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Pelizza L, Paulillo G, Maestri D, Paraggio C, De Amicis I, Mammone E, Scarci M, Leuci E, Pupo S, Pellegrini P. Psychometric properties of the Parma Scale for the treatment evaluation of offenders with mental disorder: A new instrument for routine outcome monitoring in forensic psychiatric settings. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 84:101828. [PMID: 35933892 DOI: 10.1016/j.ijlp.2022.101828] [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: 05/14/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Routine Outcome Monitoring (ROM) is still poorly implemented in the routine forensic psychiatric practice. As reliable ROM instruments are lacking, the aims of this research was to assess the psychometric properties of the Parma Scale (Pr-Scale) and its sensitivity to measure scores' longitudinal changes. METHODS Interrater and test-retest reliability, internal consistency and concurrent validity were investigated in offenders with mental disorder. Scores' longitudinal changeability was examined after a 3-month period using the Wilcoxon test for repeated measure. RESULTS Sixty male adult patients were recruited in this study. Our findings showed good to excellent interrater and test-retest reliability, concurrent validity and internal consistency for the Pr-Scale. Pr-Scale scores also display a moderate to large changeability over time. CONCLUSIONS Our results support the clinical use of the Pr-Scale in forensic psychiatric settings as reliable ROM instrument.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, PR, Italy.
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, PR, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, PR, Italy
| | - Cecilia Paraggio
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, PR, Italy
| | - Ilaria De Amicis
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, PR, Italy
| | - Elena Mammone
- Department of Humanities, Social Science and Cultural Industries, Università di Parma, Borgo Carissimi n.12, 43100 Parma, PR, Italy
| | - Melania Scarci
- Department of Humanities, Social Science and Cultural Industries, Università di Parma, Borgo Carissimi n.12, 43100 Parma, PR, Italy
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, PR, Italy
| | - Simona Pupo
- Division of Pain Medicine, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci n.14, Parma, PR, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, PR, Italy
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Janković M, Masthoff E, Spreen M, de Looff P, Bogaerts S. A Latent Class Analysis of Forensic Psychiatric Patients in Relation to Risk and Protective Factors. Front Psychol 2021; 12:695354. [PMID: 34354640 PMCID: PMC8329083 DOI: 10.3389/fpsyg.2021.695354] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/29/2021] [Indexed: 01/06/2023] Open
Abstract
Forensic psychiatric patients form a very heterogeneous population regarding psychopathology, criminal history, and risk factors for reoffending. Therefore, the present study aimed to investigate whether there are more homogeneous classes of forensic patients based on DSM-IV-TR Axis I and II diagnoses and previously committed offenses, by means of explorative latent class analysis (LCA). It was also investigated which risk and protective factors are significantly more prevalent in one class compared to other classes. The study sample contained 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from high-security forensic clinics. Data were retrospectively derived from electronic patient files. Five distinctive patient classes emerged: class with only Axis II diagnosis, class with multiple problems, antisocial class, psychotic class, and intellectually disabled class. These classes differed significantly in risk and protective factors. This study contributes to the understanding of patient classes and provides directions for future, class-tailored interventions.
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Affiliation(s)
- Marija Janković
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Marinus Spreen
- Department of Social Work, NHL Stenden University of Applied Sciences, Leeuwarden, Netherlands
| | - Peter de Looff
- Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
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Janković M, van Boxtel G, Masthoff E, Caluwé ED, Bogaerts S. The Long-Term Changes in Dynamic Risk and Protective Factors Over Time in a Nationwide Sample of Dutch Forensic Psychiatric Patients. Front Psychiatry 2021; 12:737846. [PMID: 34603110 PMCID: PMC8481688 DOI: 10.3389/fpsyt.2021.737846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
The long-term changes of dynamic risk and protective factors have rarely been studied in forensic psychiatric patients. We utilized a latent growth curve analysis to investigate trajectories of risk and protective factors over time in all 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from any of 12 Dutch forensic psychiatric centers (FPCs). The study covered the period from juridical observation until unconditional release. Moreover, we investigated whether these trajectories differ between patients depending on their psychiatric diagnosis namely substance use disorders (SUD), psychotic disorders, and cluster B personality disorders (PDs). In addition, we also investigated whether SUD may influence changes in risk and protective factors in a group of psychotic and cluster B PDs patients, respectively. Overall, findings suggest that all changes in dynamic risk and protective factors could be depicted by two phases of patients' stay in the FPCs. Specifically, most changes on dynamic risk and protective factors occurred at the beginning of treatment, that is, from the time of juridical assessment up to the time of unguided leave. Moreover, the moment of unguided leave could be considered the 'turning point' in the treatment of offenders. We also found that SUD and psychotic patients changed the most in the first phase of their stay, while cluster B PDs patients changed the most in the second phase. However, SUD did not modify changes in risk and protective factors in psychotic and cluster B PDs patients. These findings may help improve offender treatment and crime prevention strategies.
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Affiliation(s)
- Marija Janković
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation (FARID), Rotterdam, Netherlands
| | - Geert van Boxtel
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, Netherlands
| | - Elien De Caluwé
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation (FARID), Rotterdam, Netherlands
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van der Veeken FCA, Lucieer J, Bogaerts S. Routine Outcome Monitoring and Clinical Decision-Making in Forensic Psychiatry Based on the Instrument for Forensic Treatment Evaluation. PLoS One 2016; 11:e0160787. [PMID: 27517721 PMCID: PMC4982625 DOI: 10.1371/journal.pone.0160787] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background Rehabilitation in forensic psychiatry is achieved gradually with different leave modules, in line with the Risk Need Responsivity model. A forensic routine outcome monitoring tool should measure treatment progress based on the rehabilitation theory, and it should be predictive of important treatment outcomes in order to be usable in decision-making. Therefore, this study assesses the predictive validity for both positive (i.e., leave) and negative (i.e., inpatient incidents) treatment outcomes with the Instrument for Forensic Treatment Evaluation (IFTE). Methods Two-hundred and twenty-four patients were included in this study. ROC analyses were conducted with the IFTE factors and items for three leave modules: guided, unguided and transmural leave for the whole group of patients. Predictive validity of the IFTE for aggression in general, physical aggression specifically, and urine drug screening (UDS) violations was assessed for patients with the main diagnoses in Dutch forensic psychiatry, patients with personality disorders and the most frequently occurring co-morbid disorders: those with combined personality and substance use disorders. Results and Conclusions Results tentatively imply that the IFTE has a reasonable to good predictive validity for inpatient aggression and a marginal to reasonable predictive value for leave approvals and UDS violations. The IFTE can be used for information purposes in treatment decision-making, but reports should be interpreted with care and acknowledge patients’ personal risk factors, strengths and other information sources.
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Affiliation(s)
- Frida C. A. van der Veeken
- KARID, Fivoor W&BI, FPC de Kijvelanden, Poortugaal, The Netherlands
- FPC2landen, Utrecht, The Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
- * E-mail:
| | - Jacques Lucieer
- KARID, Fivoor W&BI, FPC de Kijvelanden, Poortugaal, The Netherlands
- FPC2landen, Utrecht, The Netherlands
| | - Stefan Bogaerts
- KARID, Fivoor W&BI, FPC de Kijvelanden, Poortugaal, The Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
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