Mentally disordered offenders in Sweden: differentiating recidivists from non-recidivists in a 10-year follow-up study

Abstract

Background: Forensic psychiatric patients present a challenge as they manifest severe mental disorders together with criminal behaviour. There are well-known risk factors for criminal behaviour in the general population, yet knowledge of what predicts reconviction in the Swedish forensic population in the long-term perspective is still insufficient.

Aims: The study aims to (1) describe background and clinical characteristics of forensic psychiatric patients in a 10-year follow-up, (2) analyse risk factors associated with recidivism, and (3) test the predictive validity of risk factors for general and violent criminality.

Methods: Detailed information on all offenders from the Malmö University Hospital catchment area sentenced to forensic psychiatric in-patient treatment from 1999–2005 (n = 125) was collected. Court decisions were collected up until the end of 2008 (median follow-up time = 6.2 years, range = 0.6–9.7 years).

Results: Relapse in general crime (n = 30) was predicted by low educational attainment, mental disorder in a first degree relative, and low age at first sentenced crime. Relapse in violent crime (n = 16) was predicted by low educational attainment and low GAF scores. Patients with a restriction order were less likely to relapse in both crime categories.

Conclusions: Signs of childhood adversities together with early debut in criminality appeared as important risk factors for general and violent recidivism. Forensic psychiatric treatment combined with a restriction order was demonstrated as a protective factor against recidivism, suggesting that the risk of recidivism is strongly related to the level of supervision. Although the low number of recidivism cases is highly desirable, it unfortunately reduces the power of the analyses in this paper.

Keywords:

• Forensic psychiatry
• risk assessment
• violent recidivism
• prediction

Acknowledgements

The authors thank Åse Holl, Anders Yngvesson Rastenberger, Kjell Tidäng, Anna-Kari Sjödin, and Anita Larsson at the research group for Forensic Psychiatry in Lund and Gothenburg for their help with the preparation of this manuscript and administrative assistance. We also thank Rebecca Rylance at the R&D Center Skåne, Medical Statistics and Epidemiology, Skåne University Hospital, Lund.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.