This article reports a study of the possible impact of immigration on interactional aspects of intimate partner violence (IPV) among help-seeking women. Are there differences concerning (a) IPV categories, (b) IPV severity, frequency, duration, regularity, and predictability, (c) guilt and shame, (d) partners' ethnicity, and (e) children being exposed to interparental IPV, adjusted for sociodemographic variables? A representative sample of IPV help-seeking women (N = 157) recruited from family counseling, police, and shelters in Norway were interviewed. Multivariate analyses showed that immigrant women had lower income, were less likely to use alcohol and had increased likelihood of having an immigrant partner. No differences were found concerning IPV severity, frequency, guilt, shame, or victimization pertaining to different IPV categories. Immigrant women were better at predicting physical IPV but had an increased risk of physical injury related to sexual IPV. Children's risk of being exposed to interparental IPV increased if parents were immigrants. Psychosocial consequences of being an immigrant such as having a lower sociodemographic rank rather than IPV aspects constituted the main difference between ethnic Norwegian and immigrant help-seeking women.
Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway; Division of Mental Health and Addiction, Department of Research and Education, Oslo University Hospital, Ullevål, P.O.Box 4956, Nydalen, N-0424 Oslo, Norway. Electronic address: email@example.com.
This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18-29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0-4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients.
The main scope of this small-scale investigation was to compare clinical application of the HCR-20V3 with its predecessor, the HCR-20. To explore concurrent validity, two experienced nurses assessed 20 forensic mental health service patients with the tools. Estimates of internal consistency for the HCR-20 and the HCR-20V3 were calculated by Cronbach's alpha for two levels of measurement: the H-, C-, and R-scales and the total sum scores. We found moderate (C-scale) to good (H- and R- scales and aggregate scores) estimates of internal consistency and significant differences for the two versions of the HCR. This finding indicates that the two versions reflect common underlying dimensions and that there still appears to be differences between V2 and V3 ratings for the same patients. A case from forensic mental health was used to illustrate similarities and differences in assessment results between the two HCR-20 versions. The case illustration depicts clinical use of the HCR-20V3 and application of two structured nursing interventions pertaining to the risk management part of the tool. According to our experience, Version 3 is superior to Version 2 concerning: (a) item clarity; (b) the distinction between presence and relevance of risk factors; (c) the integration of risk formulation and risk scenario; and (d) the explicit demand to construct a risk management plan as part of the standard assessment procedure.
The authors report on the impact of motherhood and pregnancy on interactional aspects of intimate partner violence (IPV) among help-seeking women. Is having children a protective or a risk factor for IPV severity, injury, duration, frequency, and mortal danger, controlling for sociodemographics? Regarding interactional aspects of IPV, do survivors who experience IPV during pregnancy differ from those who do not? Is IPV during pregnancy characterized by different severity, injury, frequency, and mortal danger? A representative sample of women was interviewed. Motherhood increased the risk for longer duration of physical, psychological, and sexual IPV, even controlling for duration of partnership. Combinations of main categories of IPV during pregnancy were different from when not pregnant. Duration of physical and psychological IPV was the only variable increasing the likelihood of experiencing IPV during pregnancy. All physical IPV variables were significantly lower during pregnancy. For psychological IPV, all variables but frequency were lower. Only mortal danger was significantly lower in the sexual IPV main category.
Intimate partner homicide (IPH) is the only lethal violence in which women are the principal victims. This research reports on an investigation of possible differences between dynamics of lethal and nonlethal intimate partner violence (IPV). A representative sample of 157 help-seeking female victims of IPV in Norway was interviewed. Results from multivariate logistic regression analysis indicated that women who perceived they had been subjected to lethal IPV were different from those who had not perceived the IPV as lethal concerning interactional dimensions of IPV and in their help-seeking responses. There was no difference related to sociodemographic factors. Because some IPV help-seeking women may be at a heightened risk for lethal violence, it is imperative that their efforts to seek assistance are responded to with care and structured risk assessment.
Restraint use has been reported to be common in acute psychiatry, but empirical research is scarce concerning why and how restraints are used. This study analysed data from patients' first episodes of restraint in three acute psychiatric wards during a 2-year study period. Logistic regression analyses were used to identify predictors for type and duration of restraint. The distribution of restraint categories for the 371 restrained patients was as follows: mechanical restraint, 47.2%; mechanical and pharmacological restraint together, 35.3%; and pharmacological restraint, 17.5%. The most commonly reported reason for restraint was assault (occurred or imminent). It increased the likelihood of resulting in concomitant pharmacological restraint. Female patients had shorter duration of mechanical restraint than men. Age above 49 and female gender increased the likelihood of pharmacological versus mechanical restraint, whereas being restrained due to assault weakened this association. Episodes with mechanical restraint and coinciding pharmacological restraint lasted longer than mechanical restraint used separately, and were less common among patients with a personality disorder. Diagnoses, age and reason for restraint independently increased the likelihood for being subjected to specific types of restraint. Female gender predicted type of restraint and duration of episodes.
Cross-sectional studies have reported an association between lipids and serotonin levels and aggression, but a literature search revealed a paucity of prospective studies. Subjects of the present naturalistic study were 254 of all (489) involuntary and voluntary acutely admitted patients to a psychiatric hospital during 1year. Serum lipids and platelet serotonin at admission were prospectively compared with recorded intra-institutional and 1-year post-discharge violence and self-harm. Total cholesterol had a significant negative relationship to inpatient suicidal behaviour and inpatient violent behaviour and to 3-month post-discharge violent behaviour. Triglycerides were a significant marker of inpatient self-mutilation and of self-mutilation in combination with suicidal behaviour at 3 and 12 months of follow-up. High-density lipoprotein (HDL) had a significant negative relationship to violence at 12-months, and to repeated violence in seven patients with two or more admissions. The post-discharge relationships between total cholesterol and violence and between triglycerides and self-harm remained significant even when controlling for other possible explanatory variables in a multivariate model. Results did not change after controlling for current medication at admission. There was no association between platelet serotonin and violence or self-harm. Future research may examine if lipid measurements add incremental validity to established clinical risk assessment procedures of violent and self-harm behaviour.
Ålesund Hospital, Psychiatric Department, Box 1600, 6026 Ålesund, Norway; Oslo University Hospital, Centre of Research and Education in Forensic Psychiatry, Box 4956, Nydalen, 0424, Oslo, Norway; Department of Mental Health, The Norwegian University of Science and Technology (NTNU), Box 8905, 7491 Trondheim, Norway. Electronic address: firstname.lastname@example.org.
The Violence Risk Screening - Police Version (V-RISK-POL) is a seven-item screening tool for use at police stations by police officers and law enforcement officials to assist in the process of decision making regarding release, restrictive measures or arrest for apprehended individuals where the risk of future violence must be considered. The screen is based on the V-RISK-10, originally developed for emergency psychiatry. We examined psychometric properties and the prospective predictive validity of future violent convictions for the V-RISK-POL in a sample of 111 persons arrested for suspicion of violent crimes. Seventeen persons were convicted for a new violent crime committed during the 24-40months follow-up. The V-RISK-POL demonstrated good internal consistency; Cronbach's alpha=0.81 (95% CI=0.75-0.86) and moderate predictive validity; the area under the curve of the receiving operator characteristics (AUC)=0.753 (95% CI=0.644-0.843). Further research on larger and more heterogeneous samples is necessary to examine whether the screen may be useful in the police context.
First episode psychosis (FEP) patients have an increased risk for violence and criminal activity prior to initial treatment. However, little is known about the prevalence of criminality and acts of violence many years after implementation of treatment for a first episode psychosis.
To assess the prevalence of criminal and violent behaviors during a 10-year follow-up period after the debut of a first psychosis episode, and to identify early predictors and concomitant risk factors of violent behavior.
A prospective design was used with comprehensive assessments of criminal behavior, drug abuse, clinical, social and treatment variables at baseline, five, and 10-year follow-up. Additionally, threatening and violent behavior was assessed at 10-year follow-up. A clinical epidemiological sample of first-episode psychosis patients (n=178) was studied.
During the 10-year follow-up period, 20% of subjects had been apprehended or incarcerated. At 10-year follow-up, 15% of subjects had exposed others to threats or violence during the year before assessment. Illegal drug use at baseline and five-year follow-up, and a longer duration of psychotic symptoms were found to be predictive of violent behavior during the year preceding the 10-year follow-up.
After treatment initiation, the overall prevalence of violence in psychotic patients drops gradually to rates close to those of the general population. However, persistent illicit drug abuse is a serious risk factor for violent behavior, even long after the start of treatment. Achieving remission early and reducing substance abuse may contribute to a lower long-term risk for violent behavior in FEP patients.
This article reports a study of how mothers perceive the effects of intimate partner violence (IPV) during pregnancy and children's exposure to IPV: (a) Do interactional aspects of IPV have a negative impact on the fetus during pregnancy or on the newborn baby? and (b) Is there a relationship between interactional aspects of IPV and (a) children's risk of being exposed to IPV and (b) the age of the child when at risk for exposure to IPV? A representative sample of 137 IPV help-seeking mothers in Norway was interviewed. Severity of physical IPV and injury from sexual IPV increased the risk of consequences to the fetus. Frequency of physical and psychological IPV increased the likelihood of children's exposure. Duration of the partnership increased the risk of children's exposure to physical and sexual IPV. Finally, there was a negative linear association between children's age when exposed for the first time and frequency of physical and psychological IPV.