Kaggwa Mark Mohan, Davids Arianna, Moulden Heather, Chaimowitz Gary Andrew, Mohibi Parwiz, Erb Bailea, Olagunju Andrew Toyin
Forensic Psychiatry Program, St Joseph's Healthcare Hamilton, 100 West 5th, Hamilton, ON, L89 3K7, Canada.
Department of Psychiatry and Behavioral Sciences, McMaster University, St Joseph's Healthcare Hamilton, 100 West 5th Hamilton, Hamilton, ON, L89 3K7, Canada.
BMC Psychiatry. 2025 Apr 28;25(1):427. doi: 10.1186/s12888-025-06877-2.
Self-harming behaviors are common among forensic patients with violent index offenses. While various factors, including feelings of shame and guilt, may influence self-harming behaviors, little is known about how the circumstances surrounding the index offense and the victims' characteristics affect self-harming tendencies among forensic patients. In this study, we examined the association of the circumstances surrounding the index offence and victim characteristics with self-harming behaviors among forensic patients who have committed violent offences.
The present study consisted of 845 forensic psychiatric patients under the Ontario Review Board who had violent offences (Mean age = 42.13 ± 13.29; 85.68% male) in the reporting year 2014/15. The study examined the association between self-harming incidents with the circumstances during the index offense and victims' characteristics while controlling for clinical and demographic factors based on multiple hierarchical negative binominal regression.
The prevalence of self-harm was 4.14%, and more than half (61.29%) of the patients with self-harming behaviors had multiple incidents. The total number of self-harming incidences recorded in the reporting year was 113. The results showed that of the overall 24.05% explained by the models, the victim's characteristics contributed approximately 5% points, and circumstances during the index offence contributed an additional 2% points in explaining self-harming behaviors among forensic psychiatric patients during the reporting year. In the final model, the risk of self-harm increased with having a victim who was a healthcare/support staff or a co-patient/cohabitant.
Self-harm among forensic patients who committed violent offences is associated with various factors, including previous history of self-harm and the victim's characteristics, especially when the victim was a healthcare/support worker or co-patient. These findings suggest that self-harm might be a maladaptive way of coping with negative emotions, such as feelings of guilt and shame triggered by harming others. Mitigating measures for self-harm among patients with violent offences need to be robust and individualized, taking into consideration vulnerability issues and the best available evidence.
自残行为在有暴力犯罪前科的法医精神病患者中很常见。虽然包括羞耻感和内疚感在内的各种因素可能会影响自残行为，但对于导致犯罪的具体情况以及受害者特征如何影响法医精神病患者的自残倾向，我们却知之甚少。在本研究中，我们调查了导致犯罪的具体情况以及受害者特征与实施暴力犯罪的法医精神病患者自残行为之间的关联。
本研究纳入了安大略审查委员会管辖下的845名法医精神病患者，这些患者在2014/15报告年度有暴力犯罪行为（平均年龄 = 42.13 ± 13.29；85.68%为男性）。该研究在控制临床和人口统计学因素的基础上，通过多重分层负二项回归分析，研究了自残事件与导致犯罪的具体情况以及受害者特征之间的关联。
自残的发生率为4.14%，超过一半（61.29%）有自残行为的患者发生过多次自残事件。报告年度记录的自残事件总数为113起。结果显示，在模型解释的总体24.05%中，受害者特征约占5个百分点，导致犯罪的具体情况在解释报告年度法医精神病患者的自残行为方面又额外占2个百分点。在最终模型中，若受害者是医护人员/支持人员或同病房患者/同居者，自残风险会增加。
实施暴力犯罪的法医精神病患者的自残行为与多种因素有关，包括既往自残史和受害者特征，尤其是当受害者是医护人员/支持人员或同病房患者时。这些发现表明，自残可能是应对负面情绪（如伤害他人引发的内疚和羞耻感）的一种适应不良的方式。针对有暴力犯罪行为患者的自残缓解措施需要强有力且个性化，要考虑到脆弱性问题和现有最佳证据。
