Transgressive incidents targeted on staff in forensic psychiatric healthcare: a latent class analysis.

Transgressive incidents directed at staff by forensic patients occur frequently, leading to detrimental psychological and physical harm, underscoring urgency of preventive measures. These incidents, emerging within therapeutic relationships, involve complex interactions between patient and staff behavior. This study aims to identify clusters of transgressive incidents based on incident characteristics such as impact, severity, (presumed) cause, type of aggression, and consequences, using latent class analysis (LCA). Additionally, variations in incident clusters based on staff, patient, and context characteristics were investigated. A total of 1,184 transgressive incidents, reported by staff and targeted at staff by patients between 2018-2022, were extracted from a digital incident reporting system at Fivoor, a Dutch forensic psychiatric healthcare organisation. Latent Class Analysis revealed six incident classes: 1) verbal aggression with low impact; 2) verbal aggression with medium impact; 3) physical aggression with medium impact; 4) verbal menacing/aggression with medium impact; 5) physical aggression with high impact; and 6) verbal and physical menacing/aggression with high impact. Significant differences in age and gender of both staff and patients, staff function, and patient diagnoses were observed among these classes. Incidents with higher impact were more prevalent in high security clinics, while lower-impact incidents were more common in clinics for patients with intellectual disabilities. Despite limitations like missing information, tailored prevention approaches are needed due to varying types of transgressive incidents across patients, staff, and units.

Predictive validity on clinical item-level of the HKT-R divided into clinical patient classes.

BACKGROUND: Because of the heterogeneity of forensic groups, latent class analysis (LCA) can allow for the formation of stronger homogeneous patient classes, which can improve the predictive validity of forensic risk assessment tools, such as the Historical Clinical Future - Revised (HKT-R), which was used in this study. In particular, dynamic clinical risk and protective items are important in treatment and are obligatory assessed annually for every forensic patient with a TBS measure in the Netherlands. Therefore, this study investigated the predictive validity of the HKT-R at clinical item-level per patient class. METHOD: A cohort of 332 forensic patients, who were discharged from highly secured Forensic Psychiatric Centers/Clinics (FPCs) in the Netherlands between 2004 and 2008, was followed. LCA was performed to cluster this group of patients based on psychopathology and criminal offenses. The predictive validity of the HKT-R clinical items by class was assessed with official reconviction data two and five years after discharge as outcome measure. RESULTS: Four classes were identified. The predictive validity of the HKT-R clinical items showed differences between and within classes on admission or discharge, and for predicting violent reoffending after two or five years after discharge. DISCUSSION: Different risk/protective factors of the HKT-R may play a role for different subgroups of patients. Therefore, this heterogeneity should be considered for any measure or intervention.

Psychopathic traits in the interpersonal context: Is the effect of psychopathic traits on prosocial behavior mediated by peer problems?

Psychopathic traits are often investigated within the individual, while most traits come to expression within the interpersonal context. Low social communion might even be an important overlooked core feature of psychopathy. This raises the question how psychopathic (i.e., Grandiose-Manipulative, Callous-Unemotional, and Irresponsible-Impulsive) traits affect the tendency to show prosocial behavior, and whether peer problems explain this relationship. Besides, the effects of gender on these subrelations are explored. In total, 541 community adolescents and emerging adults (26.4 % men; 16-25 years old, Mage = 21.7, SDage = 2.50) completed questionnaires, measuring psychopathic traits, prosocial behavior, and peer problems. The relationship between psychopathic traits and prosocial behavior was investigated with three separate moderated mediation regression analyses (for Grandiose-Manipulative, Callous-Unemotional, and Impulsive-Irresponsible traits separately) including peer problems as mediator and gender as moderator. Significant direct negative effects of Grandiose-Manipulative and Callous-Unemotional traits on prosocial behavior were found, though not for Impulsive-Irresponsible traits. Peer problems did not mediate this relation and gender was no moderator. The significant moderation effect indicated that only for women a significant direct positive effect of Callous-Unemotional traits on peer problems was found, but not for men nor other psychopathic traits. More gender differences were found with men (vs. women) scoring significantly higher on all three psychopathic traits and lower on prosocial behavior. Implications of psychopathic traits within the interpersonal context are discussed and future research could further investigate how this relationship can be explained, for example by including different types of measures and other potential mediators (e.g., empathy).

We Don't Choose Whom We Love: Predictors for Romantic Attraction to Villains.

Introduction: Why are women (not) romantically attracted to dark personalities or villains, which might be a risk factor for intimate partner violence (IPV) victimization? In the current study, it is opted to investigate how adult attachment, maladaptive personality traits, and acceptance of couple violence in women predict romantic attraction to heroic/villainous characters using structural equation modeling (SEM). Method: First, a pilot study was conducted in 122 heterosexual women (aged 16-25) to select male TV characters. This resulted in the selection of six villains and 10 heroes for the main study, in which 194 other heterosexual women (aged 16-25) were asked to rate the pictures of TV characters through an online questionnaire. This was combined with self-report measures of maladaptive personality traits, acceptance of couple violence, and adult attachment. These variables were entered into a SEM model to assess model fit. Results: Overall, women rated heroes higher on physical appearance (pilot study) and romantic attraction (main study) compared to villains. We found different direct effects of avoidant (negative) and anxious (positive) attachment styles on romantic attraction to heroes. Moreover, maladaptive personality traits fully mediated the positive effect of avoidant attachment style on romantic attraction to villains. Discussion: Despite the limitations of the study design (e.g., low N, low notoriety of the TV characters), this study emphasizes that women are generally more romantically attracted to heroes (vs. villains). Besides, there are different predictors of romantic attraction to heroes and villains, which requires further investigation, especially in the context of IPV.

Associations Between Resilience, Psychological Well-Being, Work-Related Stress and Covid-19 Fear in Forensic Healthcare Workers Using a Network Analysis.

Forensic healthcare workers deal with patients with severe psychiatric and behavioral problems that put them at an increased risk of developing work-related stress and burnout. Working with this target group of patients during the Coronavirus disease 2019 (Covid-19) pandemic with far-reaching restrictive measures can negatively affect the psychological well-being of forensic workers. Research suggests that resilience can buffer workplace stress and contribute positively to psychological well-being. However, research on resilience, psychological well-being and work-related stress among forensic healthcare workers is still lacking. Therefore, in this study, we investigated the interrelations between psychological well-being and resilience on the one hand and work-related stress and Covid-19 fear-related symptoms on the other hand. Self-report data were obtained from 318 healthcare workers (73.9% women) working in three Forensic Psychiatric Centers (M age = 44.20, SD = 14.31) and are in direct contact with forensic patients. The data were analyzed using network analysis. Consistent with previous research, the results showed that workplace stress and fear associated with the Covid-19 pandemic can be detrimental to workers' psychological well-being, while resilience can serve as a protective factor against being personally attacked or threatened by patients at the workplace. Last but not least, we identified highly central symptoms, namely tremors due to the fear of the coronavirus and anxiety when other people coughing, which would be the best candidates for future treatment targets. This knowledge can help clinicians optimize interventions to reduce workplace stress and fear due to the pandemic. Future studies should aim to replicate our findings in a larger and more representative sample of forensic healthcare workers.