Nina Lindberg

Staff Attitudes Towards Seclusion and Restraint in Forensic Settings

Aggression on forensic wards occurs commonly, as 82 % of staff and 46 % of patients report having been targets of aggression (Pulsford et al. 2013). This high incidence of violence, the constant threat of violence and the knowledge of a patient’s criminal history affect nursing staff. Nurses therefore have to deal with fear on a daily basis; it affects nursing care, as nurses have to deal with both fear and situations in which they must maintain control. In such situations, seclusion and restraint serve as a means to control threatening and dangerous situations.

Firesetting and general criminal recidivism among a consecutive sample of Finnish pretrial male firesetters: a register-based follow-up study

The rate of criminal reoffending among firesetters varies greatly. Our aim was to investigate firesetting and general criminal recidivism in a consecutive sample of Finnish males who were sent for a forensic psychiatric examination (FPE)1 after committing firesetting offenses. We also wanted to evaluate the relationships between psychopathy and criminal recidivism, and between schizophrenia-spectrum disorders and criminal recidivism. The sample comprised 113 firesetters with a mean age of 32.8 years, and the average follow-up time was 16.9 years. The FPE statements of the firesetters were reviewed and psychiatric diagnoses were collected. The psychopathy assessments were based on the 20-item Hare Psychopathy Checklist-Revised (PCL-R). Information on reoffending was gathered from the Finnish National Police Register. During the follow-up 20 (18%) persons were registered for a new firesetting and 84 (74%) for any new offense. Firesetters with high traits (PCL-R ≥ 25) of psychopathy were more likely than those with low traits (PCL-R < 25) to reoffend with any crime during the follow-up. The risk of general criminal recidivism was lower among firesetters with a schizophrenia-spectrum disorder than among those with non-psychotic disorders. Conclusively, both firesetting and general criminal-recidivism rates were high in this sample of offenders.

High Beck Depression Inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style

Beck Depression Inventory (BDI) is widely used in assessing adolescents psychological wellbeing, but occasionally the result diverges from diagnostics. Our aim was to identify factors associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population. The study comprised 206 inpatients (13-17 years old) and 203 age and gender matched non-referred adolescents. Study subjects filled self-reports on depression symptoms (BDI-21), alcohol use (AUDIT), defense styles (DSQ-40) and self-image (OSIQ-R), and on background information and adverse life events. Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. We compared subjects who scored in BDI-21 either 0-15 points or 16-63 points firstly among subjects without current unipolar depression (nu202f=u202f284), secondly among those with unipolar depression (nu202f=u202f105). High BDI-21 scores in subjects without depression diagnosis (nu202f=u202f48) were associated with female sex, adverse life events, parents psychiatric problems, higher comorbidity, higher AUDIT scores, worse self-image and more immature defense styles. Low BDI-21 scores among subjects with depression diagnosis (nu202f=u202f23) were associated with male sex, more positive self-image and less immature defense style. In conclusion, high BDI-21 scores in the absence of depression may reflect a broad range of challenges in an adolescents psychological development.

Mediators between adverse childhood experiences and suicidality

We investigated whether psychiatric symptomatology, impulsivity, family and social dysfunction, and alcohol use mediate the relationship between adverse childhood experiences (ACEs) and suicidality. The study population comprised 206 adolescent psychiatric inpatients and 203 age- and gender-matched adolescents from the community. ACEs and suicidality were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version, the Life Events Checklist, and a structured background data collection sheet. Psychiatric symptomatology was measured using the Symptom Checklist -90. Impulsivity, social dysfunction, and family dysfunction were measured using the Offer Self-Image Questionnaire, and alcohol use was assessed with the Alcohol Use Disorders Identification Test. A simple mediation test and multiple mediation analyses were conducted. A positive direct effect of ACEs on suicidality was observed. Also seen was a positive indirect effect of ACEs on suicidality through psychiatric symptomatology, impulsivity, and family and social dysfunctions. Alcohol misuse did not, however, mediate the relationship between ACEs and suicidality. According to the multiple mediation analyses, psychiatric symptomatology was the most significant mediator, followed by impulsivity. Psychiatric symptoms, impulsivity, and family and social dysfunctions are factors that should be taken into consideration when assessing suicidality in adolescents.

Schizophrenia and induced abortions: A national register-based follow-up study among Finnish women born between 1965–1980 with schizophrenia or schizoaffective disorder

BACKGROUNDnThe objectives of this study were to investigate, in women with schizophrenia or schizoaffective disorder, the number and incidence of induced abortions (= pregnancy terminations performed by a physician), their demographic characteristics, use of contraceptives, plus indications of and complications related to pregnancy termination.nnnMETHODSnUsing the Care Register for Health Care, we identified Finnish women born between the years 1965-1980 who were diagnosed with either schizophrenia or schizoaffective disorder during the follow-up period ending 31.12.2013. For each case, five age- and place-of-birth- matched controls were obtained from the Population Register of Finland. Information about births and induced abortions were obtained from the Medical Birth Register and the Induced Abortion Register.nnnRESULTSnThe number and incidence of induced abortions per 1000 follow-up years did not differ between cases and their controls. However, due to fewer pregnancies, cases exhibited an over 2-fold increased risk of pregnancy termination (RR 2.28; 95% CI 2.20-2.36). Cases were younger, were more often without a partner at the time of induced abortion, and their pregnancies resulted more often from a lack of contraception. Among cases, the indication for pregnancy termination was more often mother-to-bes medical condition. Induced abortions after 12weeks gestation were more common among cases. However, cases had no more complications related to termination.nnnCONCLUSIONSnThe incidence of induced abortions among Finnish women with schizophrenia or schizoaffective disorder is similar to the general population, but their risk per pregnancy over two-fold. They need effective, affordable family planning services and long-term premeditated contraception.

Serious delinquency and later schizophrenia: A nationwide register-based follow-up study of Finnish pretrial 15- to 19-year-old offenders sent for a forensic psychiatric examination

BACKGROUNDnAggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15- to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989-2010.nnnMETHODSnThe sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender- and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care.nnnRESULTSnForty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53-32.39, P<0.001). Almost half of the pretrial adolescents with later schizophrenia were diagnosed within 5years of the forensic psychiatric examination, but latency was longer among the other half of the sample, reaching up to 20.5years.nnnCONCLUSIONSnThe study supports the previous research indicating a potential link between serious delinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquents risk of developing later schizophrenia.

Mortality of young offenders : a national register‑based follow‑up study of 15‑ to 19‑year‑old Finnish delinquents referred for forensic psychiatric examination between 1980 and 2010

BackgroundThe mortality rate of young offenders is high. Furthermore, mortality in young offenders is associated with psychiatric and substance use disorders. The primary aim of this national register-based follow-up study was to investigate the mortality rate of Finnish delinquents who underwent a forensic psychiatric examination between 1980 and 2010. As delinquency is not a solid entity, we further aimed to compare the risk of premature death among different subgroups of the delinquents; violent versus non-violent offenders, offenders with alcohol use disorders versus those with no such diagnoses, offenders with schizophrenia spectrum disorders versus conduct- and personality-disordered offenders, under-aged versus young adult offenders, and, finally, boys versus girls.MethodsWe collected the forensic psychiatric examination reports of all 15- to 19-year-old offenders who were born in Finland and had undergone the examination between 1.1.1980 and 31.12.2010 (nxa0=xa0606) from the archives of the National Institute of Health and Welfare and retrospectively reviewed them. For each delinquent, four age-, gender- and place of birth-matched controls were randomly selected from the Central Population Register (nxa0=xa02424). The delinquents and their controls were followed until the end of 2015. The median follow-up time was 23.9xa0years (interquartile range 15.3–29.5). We obtained the mortality data from the causes of death register. Deaths attributable to a disease or an occupational disease were considered natural, and those attributable to an accident, suicide or homicide were considered unnatural.ResultsBy the end of the follow-up period, 22.1% (nxa0=xa0134) of the delinquents and 3.4% (nxa0=xa082) of their controls had died (OR 8.11, 95% CI 6.05–10.86, pxa0<xa00.001). Among boys, 22.0% (nxa0=xa0121) of the delinquents and 3.7% (nxa0=xa081) of the controls had died (OR 7.38, 95% CI 5.46–9.95, pxa0<xa00.001). Male delinquents’ risk of unnatural death was almost 11-fold, of natural death more than twofold, and of unclear death more than fourfold compared to that of their controls. No girls had natural or unclear deaths, but 23.6% (nxa0=xa013) of the delinquents and 0.5% (nxa0=xa01) of the controls had died due to unnatural causes (OR 67.79, 95% CI 8.63–532.00, pxa0<xa00.001). The violent delinquents’ risk of premature death was twice that of the non-violent delinquents. The other comparisons demonstrated no statistically significant differences between subgroups.ConclusionsEven though the Finnish correction system prefers psychiatric treatment and rehabilitation over criminal sanctions, and the national health care system offers developmental-phase-specific psychiatric care, the mortality rate of delinquents, especially of those with a history of violent offences, is high. The excess mortality of offenders can be regarded as a specific public-health inequity that calls for more effective intervention procedures than those used thus far.