Fosse Roar, Eidhammer Gunnar, Selmer Lars Erik, Knutzen Maria, Bjørkly Stål
Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.
Center for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.
Front Psychiatry. 2021 Feb 1;11:628734. doi: 10.3389/fpsyt.2020.628734. eCollection 2020.
Childhood abuse and neglect increase the risk of both mental disorders and violent behavior. Associations between child relational adversities and violent behavior have not been extensively investigated in forensic mental health settings. We asked whether the extent of child adversities predicts the extent of violence in the community in forensic mental health patients. We included 52 male patients at a medium security forensic mental health ward, with diagnoses of predominantly paranoid schizophrenia and other schizophrenia and psychotic disorders. Seventy-five percent had comorbid substance abuse. We extracted information on six types of child adversities based on clinicians' administrations of the Historical Clinical Risk Management 20 version 3 (HCR 20) scale and summary notes in electronic patient journals. These same sources were used to extract information on war trauma and interpersonal violence in the community. We established cumulative scales for exposure to number of types of child adversities and number of incidents of community violence. Physical and emotional abuse, emotional and physical neglect, and bullying were associated with higher levels of community violence. We observed a linear, significant increase in the frequency of community violence with cumulative numbers of child adversity types. Cumulative exposure to child adversities may be associated with higher degrees of violence in forensic mental health patients, with the most violent patients having the most extensive exposures to adversities. An enhanced focus on child adversities in risk assessment and management of violence may be considered in forensic inpatient settings.
童年期受虐待和被忽视会增加患精神障碍和暴力行为的风险。在法医精神卫生环境中，儿童关系逆境与暴力行为之间的关联尚未得到广泛研究。我们询问儿童逆境的程度是否能预测法医精神卫生患者在社区中的暴力程度。我们纳入了52名男性患者，他们来自一个中等安全级别的法医精神卫生病房，主要诊断为偏执型精神分裂症、其他精神分裂症和精神障碍。75%的患者伴有物质滥用。我们根据临床医生对《历史临床风险管理20版》第3版（HCR 20）量表的管理以及电子患者日志中的总结记录，提取了六种儿童逆境类型的信息。同样的来源被用于提取关于战争创伤和社区人际暴力的信息。我们建立了接触儿童逆境类型数量和社区暴力事件数量的累积量表。身体和情感虐待、情感和身体忽视以及欺凌与更高水平的社区暴力相关。我们观察到社区暴力频率随着儿童逆境类型的累积数量呈线性显著增加。累积接触儿童逆境可能与法医精神卫生患者更高程度的暴力有关，暴力程度最高的患者接触逆境的情况最为广泛。在法医住院环境中，可能需要在暴力风险评估和管理中更加关注儿童逆境。
