title: Violent victimization and health service utilization in a forensic psychiatric context: a comparison between offenders with mental disorders and matched controls.
abstract: Offenders with mental disorders constitute a particularly exposed group in society, with high rates of morbidity, mortality, and social deprivation. Often thought of primarily as perpetrators, these individuals may also be subjected to violence. Previous research indicates that violent victimization during lifespan is a risk factor for violent perpetration among psychiatric patients, but victimization studies on the group of offenders with mental disorders are scarce. Health services are pivotal to this group, but although most individuals do utilize these services, their vulnerability seems to remain. This study aimed at exploring the rates of victimization and health service utilization, including perceptions of unmet health care needs, among offenders with mental disorders.
  
  
  
  Two hundred detainees undergoing a forensic psychiatric evaluation in Stockholm were asked about violent victimization and health service utilization. Each detainee was compared with three controls from the general population, matched regarding age, sex, and occupation.
  
  
  
  Victimization during the past year was reported by 52.3% of the detainees and 11.1% of the controls, with a corresponding risk ratio of 8.2. Health service utilization during the past three months was reported by 47.7 and 23.7%, respectively (risk ratio 2.0); and unmet health care needs by 42.2 and 16.7%, respectively (risk ratio 3.4). There was no distinct association between victimization and health service utilization among detainees.
  
  
  
  Offenders with mental disorders are at great risk of being victimized, and they experience impediments to receiving requisite health care. A possible way to reduce victimization and improve health service utilization may be to establish interdisciplinary yet specialized health centers with outreach teams but without complicated referral procedures.
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. mats.persson.1@ki.se.
authors.forename: Mats
authors.identifier: 0000-0002-8614-2047
authors.initials: M
authors.lastname: Persson
authors.affiliation: Vadstena Forensic Psychiatric Hospital, Vadstena, Sweden.|Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Belfrage
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.|Department of Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden.
authors.forename: Marianne
authors.initials: M
authors.lastname: Kristiansson
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D058445:Bullying; D016022:Case-Control Studies; D019548:Crime Victims / Q000523:psychology*; D057237:Criminals / Q000523:psychology*; D005260:Female; D005555:Forensic Psychiatry / Q000379:methods; D006296:Health Services; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D012307:Risk Factors; D013548:Sweden; D014754:Violence / Q000523:psychology; D055815:Young Adult
keywords: Forensic psychiatry; Mental disorder; Victimization; Violence