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Risk factors for inpatient violence and self-harm in forensic psychiatry: The role of head injury, schizophrenia and substance misuse

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    Rights statement: This is an Accepted Manuscript of an article published by Taylor & Francis in Brain Injury on 3 December 2019, available online: https://www.tandfonline.com/doi/full/10.1080/02699052.2018.1553064

    Accepted author manuscript, 694 KB, PDF document

Original languageEnglish
JournalBrain Injury
Early online date3 Dec 2018
Publication statusE-pub ahead of print - 3 Dec 2018


Objective: To investigate factors relevant to violence and self-harm in forensic psychiatric inpatients the cross-sectional association between four potential contributory factors; head injury, schizophrenia, drug and alcohol misuse, and self-harm or violence-related outcomes was examined.

Methodology: Data were extracted from an existing dataset of routinely collected data on all patients under the care of Scotland’s Forensic Mental Health Managed Care Network, of whom (n = 432) met inclusion criteria. A Factorial MANOVA and Pearson’s chi-square tests were conducted to assess the relationship between potential contributory factors and self-harm and violence.

Results: Forty-seven individuals had a documented head injury (10.9%). The presence of head injury was significantly associated with inpatient violence and assessed violence risk. Number of historic violent offences was significantly associated with a history of drug misuse and co-morbid alcohol misuse and schizophrenia. Self-harm was significantly associated with drug misuse and a diagnosis of schizophrenia.

Conclusion: These findings highlight a significant association between head injury and actual/assessed risk in forensic psychiatry, over and above that of substance misuse and a diagnosis of schizophrenia, emphasising the need for routine assessment of head injury in clinical practice. Further examination of the impact of head injury in forensic psychiatric populations is needed.

    Research areas

  • violence, risk assessment, self-harm, forensic psychiatry, head injury

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