Self-harming behaviors among forensic psychiatric patients who committed violent offences: an exploratory study on the role of circumstances during the index offence and victim characteristics.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968559 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-244X (Electronic) Linking ISSN: 1471244X NLM ISO Abbreviation: BMC Psychiatry Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Self-Injurious Behavior*/epidemiology ; Self-Injurious Behavior*/psychology ; Crime Victims*/psychology ; Crime Victims*/statistics & numerical data ; Violence*/psychology ; Violence*/statistics & numerical data ; Criminals*/psychology ; Criminals*/statistics & numerical data; Humans ; Male ; Adult ; Female ; Middle Aged ; Forensic Psychiatry ; Ontario/epidemiology ; Prevalence ; Young Adult

Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted under the Declaration of Helsinki. The Hamilton Integrated Research Ethics Board (HiREB) approved the present study, reference number #15564. The need for informed consent was waived by the ethics committee/institutional review board of Hamilton, Ontario institutions, i.e., the Hamilton Integrated Research Ethics Board (HiREB), since the study involved de-identified retrospective data, and individual consents could not practically be fully obtained. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
(© 2025. The Author(s).)

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Keywords: Forensic; Guilt; Negative emotions; Self-harming behaviors; Shame; Suicidal behaviors; Victims; Violence offences; Weapons

Date Created: 20250428 Date Completed: 20250429 Latest Revision: 20250501

20250501

PMC12039141

10.1186/s12888-025-06877-2

40295960