Büsselmann Michael, Nigel Stefanie, Otte Stefanie, Lutz Maximilian, Franke Irina, Dudeck Manuela, Streb Judith
Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.
Department of Forensic Psychiatry, Psychiatric Services Graubuenden, Cazis, Switzerland.
Front Psychiatry. 2020 Jan 23;10:1014. doi: 10.3389/fpsyt.2019.01014. eCollection 2019.
Suicides are more common in forensic patients than in the general population. Two reasons for this discrepancy are discussed: (1) Suicides are the consequence of maladaptation to the restrictive living conditions in forensic psychiatry, and (2) suicides are explained by the demographic, social, and psychosocial characteristics of the inmates themselves, i.e., suicides happen because the inmates belong to a particularly vulnerable group. Therefore, the present study aimed to analyze the relationship between quality of life, as an indicator of the restrictive living conditions, and hopelessness, depression, and suicide ideations in a sample of forensic patients.
We assessed quality of life with a German version of the Measuring the Quality of Prison Life questionnaire that had been adapted to forensic hospitals (MQPL-forensic) and depressive symptoms with the Beck Depression Inventory, hopelessness with the Beck Hopelessness Scale, and suicide ideations with the Beck Scale for Suicide Ideation. The study included a total of 159 patients in 12 German forensic psychiatric hospitals who had been admitted in accordance with Section 64 of the German Criminal Code. We analyzed the relationships between quality of life and depression, hopelessness, and suicide ideations on the patient and hospital levels. Hospital characteristics were generated by aggregating the MQPL-forensic variables measured at the patient level.
In generalized estimating equation models, the MQPL-forensic total score and almost all the subscale scores were significant negative predictors of depressive symptoms, hopelessness, and suicide ideations at the patient and hospital levels. At the patient level, patients who experienced a supportive welcome at the hospital, good relationships with their therapists, respectful interactions, transparent decisions, and supportive therapeutic approaches were significantly less depressed, less hopeless, and less likely to consider suicide. At the hospital level, good relationships with therapists and respectful interactions were significant negative predictors of these variables.
The results indicate that the social framework within forensic psychiatric hospitals influences the frequency of suicide ideation and the severity of depressive symptoms and hopelessness among forensic patients. Forensic-psychiatric hospitals should be aware of these significant relationships and try to improve patients' quality of life.
法医鉴定患者中的自杀现象比普通人群更为常见。本文讨论了造成这种差异的两个原因：（1）自杀是法医精神病学中对限制性生活条件适应不良的结果；（2）自杀可以用患者自身的人口统计学、社会和心理社会特征来解释，即自杀发生是因为患者属于特别脆弱的群体。因此，本研究旨在分析作为限制性生活条件指标的生活质量与法医鉴定患者样本中的绝望感、抑郁和自杀意念之间的关系。
我们使用经过改编适用于法医医院的德文版《监狱生活质量测量问卷》（MQPL-法医版）评估生活质量，使用贝克抑郁量表评估抑郁症状，使用贝克绝望量表评估绝望感，使用贝克自杀意念量表评估自杀意念。该研究共纳入了德国12家法医精神病医院的159名根据德国刑法第64条收治的患者。我们在患者和医院层面分析了生活质量与抑郁、绝望和自杀意念之间的关系。医院特征是通过汇总在患者层面测量的MQPL-法医版变量生成的。
在广义估计方程模型中，MQPL-法医版总分以及几乎所有子量表得分在患者和医院层面都是抑郁症状、绝望感和自杀意念的显著负向预测因子。在患者层面，在医院受到支持性欢迎、与治疗师关系良好、互动尊重、决策透明以及治疗方法支持性强的患者，抑郁程度显著更低、绝望感更低，且考虑自杀的可能性更小。在医院层面，与治疗师的良好关系和尊重性互动是这些变量的显著负向预测因子。
结果表明，法医精神病医院的社会环境会影响法医鉴定患者中自杀意念的频率以及抑郁症状和绝望感的严重程度。法医精神病医院应意识到这些重要关系，并努力改善患者的生活质量。
