Joakim Sturup

Field Reliability of the Psychopathy Checklist-Revised Among Life Sentenced Prisoners in Sweden

Although typically described as reliable and valid, the Psychopathy Checklist-Revised (PCL-R) has come under some criticism by researchers in the last half-decade due to evidence of poor interrater reliability and adversarial allegiance being reported in applied settings in North America. This study examines the field reliability of the PCL-R using a naturalistic test-retest design among a sample of Swedish life sentenced prisoners (N = 27) who had repeatedly been assessed as part of their application to receive a reduced prison term. The prisoners, who were assessed by a team of forensic evaluators retained by an independent government authority, had spent on average 14 years in prison with a mean time from Assessment 1 to Assessment 2 of 2.33 years. The overall reliability of the PCL-R (ICC(A1)) was .70 for the total score and .62 and .76 for Factor 1 and 2 scores, respectively. Facet 1-3 scores ranged from .54 to .60, whereas Facet 4 was much higher (.90). Reliability of individual items was quite variable, ranging from .23 to .80. In terms of potential causes of unreliability, both high and low PCL-R scores at the initial assessment tended to regress toward the mean at the time of the second evaluation. Our results are in line with previous research demonstrating concerns regarding the reliability of the PCL-R within judicial settings, even among independent evaluation teams not retained by a particular side in a case. Collectively, these findings question whether the interpersonal (Facet 1) and affective (Facet 2) features tapped by the PCL-R are reliable enough to justify their use in legal proceedings.

Child Homicides in Sweden: A Descriptive Study Comparing the 1990s and the 2000s

The objective of the study was to examine the change in child homicides in Sweden between the 1990s and the 2000s based on a study of all cases registered during the periods 1990-1996 and 2002-2008. The results show a significant annual 4% decrease in the number of child homicides, with the main decline being due to a decrease in cases of filicide–suicide among both fathers and mothers. One possible explanation for the decrease may be the increases in the general prescription of antidepressant medication. However, other factors may also have played a significant role in the decline as well.

Unsolved homicides in Sweden: a population-based study of 264 homicides

The clearance rates for homicides have decreased internationally. This retrospective population-based study of all Swedish homicide incidents between 2007 and 2009 (n=264) aims to investigate factors associated with solvability in homicides. Victims were identified in an autopsy registry and offenders in a criminal-conviction registry. Autopsy reports, police files, court verdicts and criminal records were systematically collected and linked. The clearance rate was 86.4% (n=228), and almost three quarters of cases (71.9%) were solved within the first week. Nine factors were significantly associated with the case status; however, only four factors remained significant in the multivariate logistic-regression model. Cases were more likely to be solved if there was an eyewitness and if the victim was intoxicated with alcohol. Moreover, cases were less likely to be solved if the victim had a criminal record in the past five years and was killed by a firearm. In the final model, a Cox proportional-hazards model, where time to arrest was taken into account, only alcohol intoxication were positively and firearms negatively significantly associated with clearance status. The study concludes that cases involving these factors should be granted extra, intensive and lasting resources.

A population-based study on toxicological findings in Swedish homicide victims and offenders from 2007 to 2009

BACKGROUND AND OBJECTIVES Previous research on the toxicology of homicide has shown that about half of offenders and victims have psychoactive substances in their blood. The purpose of this study was to examine this topic in a Swedish setting. METHODS Toxicological data were sought in a database for all victims (n=273) and perpetrators (n=257) of homicide in Sweden from 2007 to 2009. Sufficient tests were identified for 97.1% of all victims (n=265) and 46.7% of all offenders (n=120). Additional information was obtained from court records and police reports. RESULTS A majority of individuals involved in homicides displayed positive toxicology (57.0% of victims and 62.5% of offenders). The most commonly detected substances, in both victims and offenders, were ethanol (44.9% vs. 40.8%) and benzodiazepines (8.3% vs. 19.2%). The difference between offenders and victims concerning benzodiazepines was statistically significant (OR 2.6; p=0.002). Perpetrators of homicide–suicide had a lower prevalence of positive toxicology (30.8%) than other homicide offenders (67.3%; p = 0.01) [corrected] and victims in unsolved cases more often exhibited positive drug toxicology compared to victims in solved cases (36.1% vs. 8.3%; p < 0.001) corrected. CONCLUSIONS The results of the study support the notion that substance abuse is firmly linked to committing homicide and to becoming a victim thereof.

Violent behavior and gender of swedish psychiatric patients: a prospective clinical study

OBJECTIVE This study was designed to investigate the base rate of violent behavior, the predictive validity of the Classification of Violence Risk (COVR) software, and specific risk factors for violence among nonforensically involved psychiatric patients in Sweden. METHODS On discharge from two psychiatric hospitals in Stockholm, 331 patients were interviewed. Telephone interviews with the patients and supportive others, as well as data from a national criminal register, were used to measure violent behavior 20 weeks after discharge. After the baseline interview, patients were assigned to different risk groups by the COVR software. Predicted risk was compared with the occurrence of actual acts of violence during the follow-up. RESULTS Gender differences in base rates of violent behavior among the general psychiatric population were not found during the 20 weeks of follow-up after discharge. Violent behavior was significantly predicted by young age of males and by level of anger, violent thoughts, and victimization of females. The predictive validity of the COVR software was comparable between females (area under the curve [AUC]=.78) and males (AUC=.76). CONCLUSIONS Violent behavior was uncommon for all patients. Although several risk factors were significantly associated with violence by each gender, the COVR software could predict violence equally well for both genders.

Homicide offenders 32 years later – A Swedish population-based study on recidivism

BACKGROUND The literature on recidivism by homicide offenders is scarce despite its importance for individuals and for society. AIMS To establish the rate of seriously violent re-offending among homicide offenders and identify risk factors for such recidivism. METHODS A 1970s incident cohort of all homicide offenders, sane and insane, from two regions of Sweden (N = 153) was followed up until 2007 using data from the national crime register. RESULTS Ten per cent of the cohort (n = 15) re-offended. The mean time from index offence to recidivism was 9.4 years. Five people (3%) committed a further homicide, and it was established that another five (3%) offenders had killed before the index offence. Prospective risk factors for violent recidivism were young age, psychotic disorder, male victim, acquainted victim and intoxicated victim. CONCLUSIONS The prevalence of repeated homicide is higher than previously reported. Victim variables and mental disorder in conjunction with substance abuse appear to be two domains of particular significance for recidivism.

Psychosis and Homicide in Sweden—A Time Trend Analysis 1987—2006

Few studies have examined temporal changes in the contribution of psychosis to homicide offending. This research examines whether the incidence and the proportion of people with schizophrenia spectrum disorders, compared to all homicide offenders, have changed over a 20-year period in Sweden. All homicide offenders in Sweden from 1987 through 2006 were identified in the National Register for Criminal Convictions and linked on an individual level to the Central Archive of the National Board of Forensic Medicine, where data concerning individuals subjected to a forensic psychiatric examination in Sweden are registered. Offenders with a diagnosis of a schizophrenia spectrum disorder (F20-F29) formed the subgroup of offenders with psychosis. While the overall incidence of homicide did not change over time, both the incidence and the proportion of offenders with schizophrenia spectrum disorders decreased somewhat in relation to all homicide offenders. Although offenders with a schizophrenia spectrum disorder still comprise a disproportionately large share of all homicide offenders, their contribution to the overall incidence of homicide is at least not increasing in Sweden. Yet, it remains a significant problem that needs to be addressed by clinicians and researchers.

Violent behaviour by general psychiatric patients in Sweden - validation of Classification of Violence Risk (COVR) software

The objectives of the study are to report the 20-week base rate of violent behaviour in the community among a general psychiatric patient population from Stockholm and to establish the validity of a violence risk assessment software program, Classification of Violence Risk (COVR), in a European setting. Three hundred and thirty one patients at two psychiatric hospitals in Stockholm were interviewed upon discharge. Telephone interviews with the patients and collaterals were conducted 10 and 20 weeks later. The violent behaviour was also measured through a national criminal register. The allocation of patients into different risk groups according to COVR software was compared with the occurrence of actual acts of violence during the follow-up. The base rate of violent behaviour was 5.7% and a ROC-analysis showed that the AUC for COVR was 0.77. Since there were few patients in the high risk groups, the 95% confidence interval for the proportion of violent patients was wide. The base rate of violent behaviour is relatively low in Sweden and prediction is therefore difficult. The predictive validity of COVR software is comparable to other risk assessment tools.

Intra- and extra-familial child homicide in Sweden 1992-2012: A population-based study.

Previous studies have shown decreasing child homicide rates in many countries - in Sweden mainly due to a drop in filicide-suicides. This study examines the rate of child homicides during 21 years, with the hypothesis that a decline might be attributable to a decrease in the number of depressive filicide offenders (as defined by a proxy measure). In addition, numerous characteristics of child homicide are presented. All homicide incidents involving 0-14-year-old victims in Sweden during 1992-2012 (n = 90) were identified in an autopsy database. Data from multiple registries, forensic psychiatric evaluations, police reports, verdicts and other sources were collected. Utilizing Poisson regression, we found a 4% annual decrease in child homicides, in accordance with prior studies, but no marked decrease regarding the depressive-offender proxy. Diagnoses from forensic psychiatric evaluations (n = 50) included substance misuse (8%), affective disorders (10%), autism-spectrum disorders (18%), psychotic disorders (28%) and personality disorders (30%). Prior violent offences were more common among offenders in filicides than filicide-suicides (17.8% vs. 6.9%); and about 20% of offenders in each group had previously received psychiatric inpatient care. Aggressive methods of filicide predominated among fathers. Highly lethal methods of filicide (firearms, fire) were more commonly followed by same-method suicide than less lethal methods. Interestingly, a third of the extra-familial offenders had an autism-spectrum disorder. Based on several findings, e.g., the low rate of substance misuse, the study concludes that non-traditional risk factors for violence must be highlighted by healthcare providers. Also, the occurrence of autism-spectrum disorders in the present study is a novel finding that warrants further investigation.

Differentiating Male and Female Intimate Partner Homicide Perpetrators: A Study of Social, Criminological and Clinical Factors

Abstract It is recognized that the majority of intimate partner homicide (IPH) victims are female; simultaneously, when females do commit homicide, they are more likely to perpetrate against an intimate partner. To date, there are only a few studies that discuss IPH across gender, leading to a gap of knowledge with regard to gender aspects of perpetration. The present nationwide study has a retrospective design, based on registries of all female (n = 9) and stratified male (n = 36) IPH committed in Sweden between 2007 and 2009. Our study suggests that female perpetrators are more likely to be unemployed, to have suffered from a substance abuse disorder at some point in life and to have been victimized by the victim. In other words, scrutiny of these characteristics reveals that females who commit partner-related homicides are qualitatively and clinically different from their male counterparts. Furthermore, the prevailing feature of intoxication in connection to the crime, both in male and female perpetrators, indicates that perpetrators might benefit from elements of substance abuse treatment in interventions targeting partner violence.