Wilkie Treena, Penney Stephanie R, Fernane Stephanie, Simpson Alexander I F
Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, Canada M6J 1H4.
BMC Psychiatry. 2014 Mar 27;14:91. doi: 10.1186/1471-244X-14-91.
Absconding from hospital is a significant health and security issue within psychiatric facilities that can have considerable adverse effects on patients, their family members and care providers, as well as the wider community. Several studies have documented correlates associated with absconding events among general psychiatric samples; however, few studies have examined this phenomenon within samples of forensic patients where the perception of threat to public safety in the event of an unauthorized absence from hospital is often higher.
We investigate the frequency, timing, and determinants of absconding events among a sample of forensic psychiatric patients over a 24-month period, and compare patients who abscond to a control group matched along several sociodemographic and clinical dimensions. We explore, in a qualitative manner, patients' motives for absconding.
Fifty-seven patients were responsible for 102 incidents of absconding during the two year study window. Forensic patients who absconded from hospital were more likely to have a history of absconding attempts, a diagnosed substance use disorder, as well as score higher on a structured professional violence risk assessment measure. Only one of the absconding events identified included an incident of minor violence, and very few included the commission of other illegal behaviors (with the exception of substance use). The most common reported motive for absconding was a sense of boredom or frustration.
Using an inclusive definition of absconding, we found that absconding events were generally of brief duration, and that no member of the public was harmed by patients who absconded. Findings surrounding the motivations of absconders suggest that improvements in therapeutic communication between patients and clinical teams could help to reduce the occurrence of absconding events.
逃离医院是精神科机构中一个重大的健康与安全问题，会对患者、其家庭成员及护理人员以及更广泛的社区产生相当大的不利影响。多项研究记录了普通精神科样本中与逃跑事件相关的因素；然而，很少有研究在法医患者样本中考察这一现象，这类患者若未经授权离开医院，对公共安全构成威胁的可能性往往更高。
我们调查了一个法医精神科患者样本在24个月期间逃跑事件的发生频率、时间及决定因素，并将逃跑患者与在社会人口统计学和临床多个维度匹配的对照组进行比较。我们以定性方式探究患者逃跑的动机。
在为期两年的研究期间，57名患者引发了102起逃跑事件。逃离医院的法医患者更有可能有逃跑未遂史、被诊断为物质使用障碍，并且在结构化专业暴力风险评估量表上得分更高。所确定的逃跑事件中只有一起涉及轻微暴力事件，极少有涉及实施其他非法行为的情况（物质使用除外）。报告的最常见逃跑动机是无聊或沮丧感。
采用对逃跑的包容性定义，我们发现逃跑事件通常持续时间较短，且逃跑患者未对公众造成伤害。关于逃跑者动机的研究结果表明，改善患者与临床团队之间的治疗性沟通有助于减少逃跑事件的发生。
