The Long-Term Changes in Dynamic Risk and Protective Factors Over Time in a Nationwide Sample of Dutch Forensic Psychiatric Patients

Abstract

The long-term changes of dynamic risk and protective factors have rarely been studied in forensic psychiatric patients. We utilized a latent growth curve analysis to investigate trajectories of risk and protective factors over time in all 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from any of 12 Dutch forensic psychiatric centers (FPCs). The study covered the period from juridical observation until unconditional release. Moreover, we investigated whether these trajectories differ between patients depending on their psychiatric diagnosis namely substance use disorders (SUD), psychotic disorders, and cluster B personality disorders (PDs). In addition, we also investigated whether SUD may influence changes in risk and protective factors in a group of psychotic and cluster B PDs patients, respectively. Overall, findings suggest that all changes in dynamic risk and protective factors could be depicted by two phases of patients' stay in the FPCs. Specifically, most changes on dynamic risk and protective factors occurred at the beginning of treatment, that is, from the time of juridical assessment up to the time of unguided leave. Moreover, the moment of unguided leave could be considered the ‘turning point’ in the treatment of offenders. We also found that SUD and psychotic patients changed the most in the first phase of their stay, while cluster B PDs patients changed the most in the second phase. However, SUD did not modify changes in risk and protective factors in psychotic and cluster B PDs patients. These findings may help improve offender treatment and crime prevention strategies.

Longitudinal Change of Risk Factors During Treatment in High-Security Forensic Psychiatry in Flanders

“…The aim of this study was to empirically measure longitudinal change of the risk scales and risk factors of the HKT-R in 341 male patients after 2 years of treatment in the two FPCs in Flanders. Based on group-level analyses, the clinical scale did not change significantly, contrary to findings of previous literature that reported a significant small decline (Belfrage & Douglas, 2002; De Jonge et al, 2009; Hogan & Olver, 2016, 2019; Janković et al, 2021; Jeandarme et al, 2017; Mastromanno et al, 2018; Morrissey et al, 2014; O’Shea & Dickens, 2015; Olsson et al, 2013; Richter et al, 2018; Van der Linde et al, 2020). Furthermore, a decline was observed in only one clinical factor.…”

“…Furthermore, it should be noted that some factors that did not change significantly, such as psychotic symptoms and self-reliance, as well as hostility and impulsivity may be specific to psychotic patients. However, since not all patients in our study were diagnosed with psychotic disorders, it is possible that changes may become apparent when the analyses are performed only on patients with psychotic symptoms (Janković et al, 2021). The same conclusion can be drawn for patients who exhibit antisocial behavior.…”

“…For example, treatment duration seems relevant, as Van der Veeken et al (2018) reported better resocialization skills in patients with a longer treatment history at the forensic psychiatric center (FPC) at first IFTE assessment. Janković et al (2021) found a significant decrease in the clinical scale of the HKT-R during the first phase of treatment (period from juridical assessment until the first unguided leave), but a slower decrease during the second phase (period from the first unguided leave until unconditional release). This is in line with the finding of Richter et al (2018), who found that only patients admitted for less than 2,112 days at baseline significantly decreased on the clinical scale.…”

“…Furthermore, psychopathology has been found to be associated with change (Janković et al, 2021). Patients diagnosed with substance use disorder or psychotic disorder showed a greater reduction in risk factors in the first phase of treatment, while patients with a cluster B personality disorder showed a greater decline in the second phase.…”

Childhood trauma as a mediator between attachment and recidivism risk: A study of Canadian offenders with mental disorders

“…Thus, the clinical override of risk tools allows clinicians to moderate risk levels based on the benefit of treatment, advancement of age and improvement in dynamic risk factor. As a result protective factors are becoming widespread as risk assessment tools, something we hope to incorporate in our understanding of attachment, strength based assessment and recidivism in future studies (Janković et al., 2021).…”