Criminal recidivism and mortality among patients discharged from a forensic medium secure hospital.
BACKGROUND
One of the goals in forensic psychiatric care is to reduce the risk of recidivism, but current knowledge about the general outcome of forensic psychiatric treatment is limited.


OBJECTIVE
To analyse the rate of criminal recidivism and mortality after discharge in a sample of patients sentenced to forensic psychiatric treatment in a Swedish county.


METHODS
All offenders in Örebro County, Sweden, sentenced to forensic psychiatric treatment and discharged during 1992-2007 were included: 80 males and eight females. Follow-up data was retrieved from the Swedish National Council for Crime Prevention, the National Cause-of-Death register and clinical files. Mean follow-up time was 9.4 years.


RESULTS
The mean age at discharge was 40 years. Schizophrenia, other psychoses and personality disorders were the most prevalent diagnoses. Thirty-eight percent of those still alive and still living in the country re-offended and were sentenced to a new period of forensic psychiatric treatment or incarceration during follow-up. Four male re-offenders committed serious violent crimes. Substance-related diagnosis was significantly associated with risk of recidivism and after adjustment for diagnoses, age and history of serious violent crime, the Hazard Ratio was 4.04 (95% CI 1.51-10.86, P = 0.006). Of all included patients, 23% had died at the end of follow-up (standardized mortality rate 10.4).


CONCLUSIONS
Since repetition of serious violent crimes was unusual, results indicate a positive development subsequent to treatment for those alive at follow-up.


CONCLUSIONS
The high mortality rate suggests that more attention should be paid in evaluation of the patients' somatic and psychiatric health during and after care in order to prevent premature death.
Psychiatric Research Centre, Örebro and Department of Clinical Neuroscience; Psychiatry, Karolinska Institutet, Stockholm, Sweden. tabita.bjork@orebroll.se
Björk
B
Tabita
Miguel G
MG
de Santi
Lars
L
Kjellin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003415:Crime / Q000523:psychology* / Q000706:statistics & numerical data*; D057237:Criminals; D005260:Female; D005500:Follow-Up Studies; D005555:Forensic Psychiatry; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000523:psychology; D008875:Middle Aged; D061213:Mortality, Premature; D010351:Patient Discharge; D010554:Personality Disorders / Q000523:psychology; D012008:Recurrence; D012559:Schizophrenia / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology; D014754:Violence / Q000523:psychology; D055815:Young Adult