Franke Irina, Büsselmann Michael, Streb Judith, Dudeck Manuela
Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.
Psychiatric Services Graubuenden, Department of Forensic Psychiatry, Cazis, Switzerland.
Front Psychiatry. 2019 Jun 11;10:410. doi: 10.3389/fpsyt.2019.00410. eCollection 2019.
Patients in forensic mental health care experience internal and external coercion; the latter comprises different levels of institutional restraint. These restrictions of individual freedom are mainly justified by the safety interests of third parties and are not necessarily in the patients' best interests. The effects of such a setting on mentally disordered offenders' psychological state and treatment course are not fully understood. Assessing both patients' perception of restraint and psychopathological symptoms would allow us to better understand how restraint and psychopathology interact and how they might influence treatment. In 184 forensic psychiatric inpatients, we assessed perception of institutional restraint with an adapted version of the Measuring the Quality of Prison Life (aMQPL) questionnaire and current psychological state with the Brief Symptom Checklist (BSCL) and Beck Hopelessness Scale (BHS). Perceived institutional restraint (as expressed in the aMPQL subscales , , and ) was associated with a higher general level of psychological symptoms. Furthermore, patients who perceived a lack of institutional transparency and respect were more likely to have higher scores for hostility, depression, and suicidal ideation. We also found age and sex differences, with higher levels of psychological symptoms in younger and female patients. The diagnosis and duration of detention did not relate to perceived restraint. Our results indicate that certain aspects of institutional restraint in long-term forensic inpatient settings correlate with certain psychological symptoms. The observed association might be explained by different kinds of factors: institutional (custodial focus), individual (self-efficacy, diagnosis, and personality), and situational (duration of detention). Although not all of these explanatory factors were addressed by the present study design, forensic mental health professionals should be aware of the relationship between perceived institutional restriction and psychopathology because it might influence treatment course and outcome.
法医精神卫生保健中的患者经历着内部和外部的强制约束；后者包括不同程度的机构性限制。这些对个人自由的限制主要是基于第三方的安全利益，并不一定符合患者的最大利益。这种环境对精神错乱罪犯心理状态和治疗过程的影响尚未完全明了。评估患者对限制的感知以及心理病理症状，将有助于我们更好地理解限制与心理病理学之间的相互作用，以及它们如何可能影响治疗。在184名法医精神病住院患者中，我们使用改编版的《监狱生活质量测量问卷》（aMQPL）评估了对机构性限制的感知，并使用《简明症状清单》（BSCL）和《贝克绝望量表》（BHS）评估了当前的心理状态。感知到的机构性限制（如在aMPQL子量表、和中所表达的）与更高水平的心理症状相关。此外，那些认为机构缺乏透明度和尊重的患者，更有可能在敌意、抑郁和自杀意念方面得分更高。我们还发现了年龄和性别差异，年轻患者和女性患者的心理症状水平更高。诊断和拘留时间与感知到的限制无关。我们的结果表明，长期法医住院环境中机构性限制的某些方面与某些心理症状相关。观察到的这种关联可能由不同类型的因素来解释：机构因素（监管重点）、个体因素（自我效能、诊断和个性）和情境因素（拘留时间）。尽管本研究设计并未涉及所有这些解释因素，但法医精神卫生专业人员应意识到感知到的机构限制与心理病理学之间的关系，因为它可能会影响治疗过程和结果。
