Kaggwa Mark Mohan, Erb Bailea, Prat Sébastien, Davids Arianna, Bradford John, Chaimowitz Gary Andrew, Olagunju Andrew Toyin
Department of Psychiatry and Behavioral Sciences, McMaster University/St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
PLoS One. 2024 Dec 30;19(12):e0316364. doi: 10.1371/journal.pone.0316364. eCollection 2024.
Dual harm involves the unfortunate experience of harm to self and others/objects. Safeguarding individuals in forensic psychiatric settings against all forms of harm to self and others is sacrosanct. While understanding dual harm is crucial in the care and rehabilitation of patients in forensic psychiatric settings, only a few studies have explored this phenomenon. This study examined dual harm and its associated clinical and sociodemographic factors among forensic patients in Ontario, Canada.
In this retrospective study, we used data from the Ontario Review Board (ORB) (n = 1240; mean age 42.54±3.32 years, and 85.73% male). We defined dual harm as the co-occurrence of self-harming behaviour in the last 12 months and violent behaviour towards others or objects (such as verbal, physical, or sexual aggression). We analysed the data in relation to clinical and sociodemographic factors.
Of 1240 patients, 43 (3.55%) had engaged in dual harm. Most of them had engaged in dual harm related to verbal aggression (3.15%), followed by dual harm related to aggression towards objects (2.97%), dual harm related to aggression towards others (2.73%), and dual harm related to sexual aggression was the rarest (1.32%). Only 12 patients had engaged in all types of dual harm. Having a previous history of dual harm and a diagnosis of a neurodevelopmental disorder increased the chance of perpetrating/engaging in dual harm. However, increasing age and a higher education decreased the chance of dual harm. These factors were similar for different types of dual harm, except for dual harm related to sexual aggression, which was the only subtype associated with having a personality disorder diagnosis. Again, the experience of violence increased the chance of self-harm.
Dual harm is present among forensic patients in Ontario, and self-harm is prevalent among individuals with various forms of aggression, especially when the violence was perpetrated towards objects. Strategies to manage the risk of self-harm among aggressive patients should be put in place to mitigate dual harm and the associated complications, especially among individuals with neurodevelopmental disorders.
双重伤害涉及对自己以及他人/物体造成伤害的不幸经历。在法医精神病学环境中保护个人免受对自己和他人的一切形式伤害是神圣不可侵犯的。虽然理解双重伤害对于法医精神病学环境中患者的护理和康复至关重要，但只有少数研究探讨了这一现象。本研究调查了加拿大安大略省法医患者中的双重伤害及其相关的临床和社会人口学因素。
在这项回顾性研究中，我们使用了安大略审查委员会（ORB）的数据（n = 1240；平均年龄42.54±3.32岁，男性占85.73%）。我们将双重伤害定义为在过去12个月内同时出现自我伤害行为以及对他人或物体的暴力行为（如言语、身体或性侵犯）。我们分析了与临床和社会人口学因素相关的数据。
在1240名患者中，43名（3.55%）有双重伤害行为。其中大多数人的双重伤害行为与言语攻击有关（3.15%），其次是与对物体的攻击有关的双重伤害（2.97%）、与对他人的攻击有关的双重伤害（2.73%），与性侵犯有关的双重伤害最为罕见（1.32%）。只有12名患者实施了所有类型的双重伤害。有双重伤害既往史和神经发育障碍诊断会增加实施/参与双重伤害的可能性。然而，年龄增长和受教育程度提高会降低双重伤害的可能性。除了与性侵犯有关的双重伤害外，这些因素在不同类型的双重伤害中相似，与性侵犯有关的双重伤害是唯一与人格障碍诊断相关的亚型。同样，暴力经历会增加自我伤害的可能性。
安大略省的法医患者中存在双重伤害，自我伤害在各种形式攻击行为的个体中普遍存在，尤其是当暴力行为针对物体时。应制定策略来管理攻击性行为患者的自我伤害风险，以减轻双重伤害及其相关并发症，特别是在患有神经发育障碍的个体中。
