Background: Suicides are more common in forensic patients than in the general population. Two reasons for this discrepancy are discussed: (1) Suicides are the consequence of maladaptation to the restrictive living conditions in forensic psychiatry, and (2) suicides are explained by the demographic, social, and psychosocial characteristics of the inmates themselves, i.e., suicides happen because the inmates belong to a particularly vulnerable group. Therefore, the present study aimed to analyze the relationship between quality of life, as an indicator of the restrictive living conditions, and hopelessness, depression, and suicide ideations in a sample of forensic patients. Methods: We assessed quality of life with a German version of the Measuring the Quality of Prison Life questionnaire that had been adapted to forensic hospitals (MQPL-forensic) and depressive symptoms with the Beck Depression Inventory, hopelessness with the Beck Hopelessness Scale, and suicide ideations with the Beck Scale for Suicide Ideation. The study included a total of 159 patients in 12 German forensic psychiatric hospitals who had been admitted in accordance with Section 64 of the German Criminal Code. We analyzed the relationships between quality of life and depression, hopelessness, and suicide ideations on the patient and hospital levels. Hospital characteristics were generated by aggregating the MQPL-forensic variables measured at the patient level. Results: In generalized estimating equation models, the MQPL-forensic total score and almost all the subscale scores were significant negative predictors of depressive symptoms, hopelessness, and suicide ideations at the patient and hospital levels. At the patient level, patients who experienced a supportive welcome at the hospital, good relationships with their therapists, respectful interactions, transparent decisions, and supportive therapeutic approaches were significantly less depressed, less hopeless, and less likely to consider suicide. At the hospital level, good relationships with therapists and respectful interactions were significant negative predictors of these variables.

The improvements in psychiatric treatment for inmates demanded by many stakeholders need to differentiate between long- and short-term prisoners. Because depression seems to cause the most psychological distress among inmates, suicide prevention seems to be an important issue in prisons.

No abstract

This study examined whether the associations between self‐aggression and different forms of externalized aggression (reactive and spontaneous aggression) are influenced by self‐esteem and current psychopathological symptoms. For this purpose, we asked 681 participants from the general population (GP) and 282 general psychiatric patients (PPs) to answer the German versions of the Short Questionnaire for Assessing Factors of Aggression (K‐FAF), the Multidimensional Self‐Esteem Scale (MSWS), and the Brief Symptom Inventory 25 Forensic (BSI‐25‐F). Statistically, we performed descriptive and mediation analyses. Our findings indicated that in both samples the association between self‐aggression and reactive aggression was mediated by self‐esteem but not by current psychological problems. The association between self‐aggression and spontaneous aggression was mediated by self‐esteem in the GP sample and by psychopathological symptoms in the PP sample. We conclude that when examining the association between self‐aggression and externalized aggression it is important to consider the various subtypes of externalized aggression and differences between populations.

Zusammenfassung Ziel der Studie Überprüfung des Zusammenhangs zwischen Depression, Selbstaggression und nach außen gerichteter Aggression. Methodik Mittels Mediatoranalyse wurde ein möglicher Mediatoreffekt der Selbstaggression auf den Zusammenhang von Depression und externalisierter Aggression an einer Stichprobe depressiver Patienten (n = 134) untersucht. Ergebnisse Selbstaggression mediiert den Zusammenhang von Depression und externalisierter Aggression. Schlussfolgerung Personen mit depressiver Erkrankung, die Aggression nach außen richten, richten diese auch auf sich selbst.