Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
Forensic Psychiatry Program, St. Joseph's Healthcare, Hamilton, ON, Canada.
BMC Psychiatry. 2024 May 1;24(1):332. doi: 10.1186/s12888-024-05771-7.
Adverse childhood events (ACEs), psychopathy, and self-harming behaviours are prevalent among individuals in the forensic psychiatry system. While existing literature suggests that ACEs, self-harm, and psychopathy are interrelated, little is known about the interplay of psychopathic traits in this relationship. The present study aimed to determine the mediating role of psychopathy in the relationship between ACEs and self-harming behaviours in forensic patients.
This was a retrospective study of patients under the Ontario Review Board (ORB) between 2014 and 2015. In the analysis, we included patients with complete data on ACEs, self-harming behaviours, and a Psychopathy Checklist-Revised (PCL-R) score - a measure of psychopathic traits and their severity conducted during the reporting period. Mediation analysis was based on the Baron and Kenny approach, and sensitivity analysis was performed based on the types of ACEs.
The sample population (n = 593) was made up of adults, with a mean age of 41.21 (± 12.35) years and were predominantly males (92.37%). While there was a partial mediating effect of psychopathy on the relationship between ACEs and incidents of self-harming behaviours in the past year, the mediation was complete in the relationship between ACEs and a lifetime history of self-harming behaviours. Following sensitivity analysis based on the types of ACE, the mediating effects were more attributed to specific ACEs, especially having experienced child abuse or having an incarcerated household member before 18 years.
Among forensic patients in Ontario, psychopathy mediates the relationship between experiencing ACEs and engaging in self-harming behaviours. Effective intervention to mitigate self-harming behaviours in this population should consider the potential role of psychopathy, especially among individuals who have experienced ACEs involving a history of child abuse and a family who was incarcerated.
不良童年经历（ACEs）、精神病态和自残行为在法医精神病学系统中的个体中很常见。虽然现有文献表明 ACEs、自残和精神病态相互关联，但对于精神病态特征在这种关系中的相互作用知之甚少。本研究旨在确定精神病态在法医患者 ACEs 与自残行为之间的关系中的中介作用。
这是一项针对 2014 年至 2015 年期间安大略审查委员会（ORB）患者的回顾性研究。在分析中，我们纳入了 ACEs、自残行为和精神病态检查表修订版（PCL-R）评分的完整数据的患者-报告期内进行的一种衡量精神病态特征及其严重程度的措施。中介分析基于 Baron 和 Kenny 方法进行，敏感性分析基于 ACE 类型进行。
样本人群（n=593）由成年人组成，平均年龄为 41.21（±12.35）岁，主要为男性（92.37%）。虽然精神病态对 ACEs 与过去一年自残事件之间的关系存在部分中介作用，但在 ACEs 与终生自残史之间的关系中，中介作用是完全的。根据 ACE 的类型进行敏感性分析后，中介效应更多归因于特定的 ACE，尤其是在 18 岁之前经历过儿童虐待或家中有被监禁的成员。
在安大略省的法医患者中，精神病态中介了经历 ACEs 与自残行为之间的关系。为减轻该人群的自残行为而进行的有效干预应考虑精神病态的潜在作用，尤其是在经历过涉及儿童虐待和家庭监禁史的 ACE 的个体中。
