title: Predictors of length of stay in forensic psychiatry: the influence of perceived risk of violence.
abstract: This study describes the prevalence of adverse events and length of stay in forensic psychiatric patients with and without a restriction order. Detailed clinical and administrative information from medical records and written court decisions was gathered retrospectively from admission until discharge for a Swedish population-based, consecutive cohort of forensic psychiatric patients (n=125). The median length of stay for the whole cohort was 951 days, but patients with a restriction order stayed in hospital almost five times as long as patients without. Restriction orders were related to convictions for violent crime, but not for any other differences in demographic or clinical variables. The majority of the patients (60%) were involved in adverse events (violence, threats, substance abuse, or absconding) at some time during their treatment. Patients with restriction orders were overrepresented in violent and threat events. Previous contact with child and adolescence psychiatric services, current violent index crime, psychotic disorders, a history of substance, and absconding during treatment predicted longer length of stay. Being a parent, high current Global Assessment of Functioning scores, and mood disorders were all significantly related to earlier discharge. In a stepwise Cox regression analysis current violent index crime and absconding remained risk factors for a longer hospital stay, while a diagnosis of mood disorder was significantly related to a shorter length of stay.
authors.affiliation: Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden. Electronic address: bjorn.hofvander@med.lu.se.
authors.forename: Helena
authors.initials: H
authors.lastname: Andreasson
authors.affiliation: Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden.
authors.forename: Marielle
authors.initials: M
authors.lastname: Nyman
authors.affiliation: Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden.
authors.forename: Hedvig
authors.initials: H
authors.lastname: Krona
authors.affiliation: Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Meyer
authors.affiliation: Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden; Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Anckarsäter
authors.affiliation: Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nilsson
authors.affiliation: Forensic Psychiatry, Department of Clinical Sciences, Malmö, Lund University, Sweden; Institute of Neuroscience and Physiology, Centre of Ethics, Law and Mental Health (CELAM), University of Gothenburg, Sweden; Department of Psychiatry, Autism Research Centre, Cambridge University, UK.
authors.forename: Björn
authors.initials: B
authors.lastname: Hofvander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D003415:Crime; D057237:Criminals / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005555:Forensic Psychiatry; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D008875:Middle Aged; D010351:Patient Discharge; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D019966:Substance-Related Disorders; D013548:Sweden / Q000453:epidemiology; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Adverse events; Forensic psychiatry; Length of stay; Restriction orders; Risk assessment