Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric
care
Sammanfattning
Background: Inpatient aggression among female forensic psychiatric patients has been shown to
be associated with self-harm, that is considered to be a historical risk factor for violence. Research
on associations between previous or current self-harm and different types of inpatient aggression is
missing.
Aim: The aim of this register study was to investigate the prevalence of self-harm and the type of
inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients’
self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression.
Methods: Female forensic psychiatric patients (n = 130) from a high security hospital were included.
Results: The results showed that 88% of the female patients had self-harmed at least once during
their life and 57% had been physically and/or verbally aggressive towards staff or other patients
while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or
repeated self-harm were not significantly associated with inpatient aggression, whereas self-harm
during care was significantly associated with physical and verbal aggression directed at staff.
Conclusions: These results pointed towards self-harm being a dynamic risk factor rather than a
historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether
self-harm is an individual risk factor or a part of the clinical risk factor ‘Symptom of major mental
illness’ within the HCR-20V3 must be further explored among women. Thus, addressing self-harm
committed by female patients during forensic psychiatric care seems to be important in risk
assessments and the management of violence, especially in reducing violence against staff in high-
security forensic psychiatric services.