Seasonal variation of seclusion incidents from violent and suicidal acts in forensic psychiatric patients |
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| Authors: | Paula Paavola Jari Tiihonen |
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| Affiliation: | 1. The Department of Psychiatry, Trinity College Dublin, Ireland;2. The National Forensic Mental Health Service, The Central Mental Hospital, Dundrum, Dublin 14, Ireland;1. Violence Prevention Research Unit, Queen Mary University of London, Garrod Building, Turner Street, London E1 2AD, England, UK;2. West China School of Public Health, Sichuan University, 29 Wangjiang Rd, Wuhou, Chengdu, Sichuan, China;3. Department of Medicine, Imperial College London, London SW7 2AZ, UK;4. Three Bridges Unit, Ealing Hospital, Uxbridge Road, Southall UB1 3HW, UK;1. Knowledge Center Forensic Psychiatric Care (KeFor) OPZC Rekem, Daalbroekstraat 106, 3621 Rekem, Belgium;2. Ghent University, De Pintelaan 185 K12, 9000 Ghent, Belgium;3. Ghent University, Universiteitstraat 4, 9000 Ghent, Belgium;4. Commission for the Protection of Society at the prison of Ghent, Belgium;5. Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands;6. KARID, FIVOOR, Forensic Psychiatric Center The Kijvelanden, Kijvelandsekade 1, 3172 AB Poortugaal, The Netherlands |
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| Abstract: | BackgroundA seasonal variation in violence and suicidal behaviour has been reported in several studies with partially congruent results. Most of forensic psychiatric patients have a history of severe violent behaviour that often continues in spite of regular treatment. In the forensic psychiatric hospital environment aggressive and suicidal acts are often sudden and unpredictable. For reasons of safety, rapid and intensive coercive measures, such as seclusion and restraint, are necessary in the treatment of such patients.ObjectiveTo examine whether these involuntary seclusions have a seasonal pattern, possibly similar than the reported seasonal variation in violence and suicidal behaviour. By investigating the possibility of a seasonal variation of seclusion incidents from violent and suicidal acts, it may become possible to improve the management of forensic psychiatric patients.MethodsThe hospital files of all secluded patients at Niuvanniemi Hospital from 1 January 1996 to 31 December 2002 were examined. In total, 385 patients (324 male and 61 female) were identified as being secluded at least once in 1930 different incidents (1476 from male and 454 from female patients). Seasonal decomposition and linear regression with dummy month variables were used to examine the possibility of annual variations for seclusions.ResultsThe seasonal variation of involuntary seclusion incidents was statistically significant. According to the linear regression model, most of the seclusion incidents, affecting many different patients, began in July and August, and were concentrated throughout the fall until November. The sum of all seclusion days was lowest in January and highest between July and November (difference + 31% to + 37%).ConclusionsThese findings are mainly in agreement with results from other studies on seasonal variation and violent behaviour. The allocation of staff for late summer and fall might enhance the management of forensic psychiatric patients, thus leading to possible decreases in seclusion incidents. The factors affecting violent, aggressive and suicidal behaviours are complex and more investigation is needed to understand, identify, intervene and effectively reduce such behaviours. |
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