title: Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: a School of Law, Psychology and Social Work, Örebro University , Sweden ;
authors.forename: Heidi
authors.initials: H
authors.lastname: Selenius
authors.affiliation: b Department of Social Sciences , Mid Sweden University , Sweden ;
authors.forename: Sari
authors.initials: S
authors.lastname: Leppänen Östman
authors.affiliation: a School of Law, Psychology and Social Work, Örebro University , Sweden ;|c Centre for Forensic Behavioural Science at Swinburne University of Technology , Melbourne , Australia.
authors.forename: Susanne
authors.initials: S
authors.lastname: Strand
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology*; D003134:Commitment of Persons with Psychiatric Disorders; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000523:psychology*; D055815:Young Adult
keywords: Forensic psychiatry; inpatient aggression; risk factor; self-harm; women