The Time Before the Crime - Risk Patterns in Offenders Undergoing a Forensic Psychiatric Evaluation

NCT07162909 | Recruiting

• 1 other identifier: 2024-07566-01
• Study Type: observational
• Target: 500
• Locations: 1 country
• Sites: 1

Brief Summary

The overarching aim of the research project is to identify risk patterns preceding criminal acts among individuals later subject to forensic psychiatric evaluation (FPE) in Sweden, including factors within psychiatric care as well as broader individual or contextual factors. Although individuals who undergo an FPE represent a small subset of all individuals who commit criminal acts, the implications of being sentenced to forensic psychiatric care are profound. In Sweden, approximately 300 individuals are transferred to forensic psychiatric care each year, with a median duration of 7.5 years. Notably, the number of admissions exceeds the number of discharges annually, resulting in a growing forensic psychiatric population. This increasing trend underscores the need for increased knowledge and preventive efforts. All forensic psychiatric patients undergo an FPE before the sentencing, and previous studies show that most of these individuals were already known to the psychiatric system prior to the offenses, which means that individuals in these groups are overlapping. However, the mean length of stay in psychiatric inpatient compulsory care is much shorter than that in forensic psychiatric care. Clinical expertise from FPEs suggests that identifiable risk patterns may exist before the criminal offence. The question of whether such potential risk patterns exist within this patient group has not been systematically studied before, which is why the current study aims to investigate this issue. Can risk patterns be identified within psychiatric care prior to the offense? If risk patterns can be identified, knowledge of such risk patterns could hopefully increase risk awareness within psychiatric services and lead to more frequent and accurate violence risk assessments. Knowledge of such risk patterns could also serve as a foundation for preventive measures. The long-term goal is to reduce the likelihood that individuals receiving psychiatric care progress to becoming forensic psychiatric patients.

Conditions

Crime

Keywords

severe mental disorder; forensic psychiatric evaluation; risk patterns; violence

Outcome Measures

Primary Outcomes (1)

• Risk markers

  26 predefined risk markers that will be searched for in the retrospective record review. All risk markers have their own specific definition. For detailed description, see attached document.

  All risk makers will be searched for in the three-month period before the date of the criminal act (case croup) and also in a three-month period for the control group.

Study Arms (2)

Cases

The study population consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were requested by the National Board of Forensic Medicine (NBFM) in 2023 for forensic psychiatric evaluation (§ 7-evaluation or FPE), estimated to be n=250.

Controls

The control group consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were not requested by the NBFM in 2023. The control group is matched to the study population based on gender, age and psychiatric care unit (psychiatric intensive care units, psychosis ward, general psychiatric ward, psychiatric outpatient clinic, psychiatric emergency unit). Thereby we hope that the control group will consist of individuals with similar psychiatric conditions and care burden as the study population.

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Case group: individuals ≥ 18 years who had contact with at least one psychiatric care provider within Region Stockholm, Sweden. This included both clinics operated by a Swedish healthcare region and private clinics operating under regional agreements. Individuals eligible for the case group were those whose psychiatric medical records were requested by the Swedish National Board of Forensic Medicine (NBFM) in 2023 for the purpose of conducting a forensic psychiatric evaluation, either a preliminary assessment (§7 examination) or a full forensic psychiatric evaluation (FPE). Control group: Similar individuals, but whose psychiatric medical records were not requested by the NBFM in 2023 for the purpose of conducting a forensic psychiatric evaluation.

You may qualify if:

• Age ≥ 18 years
• Contact with a psychiatric care provider within Region Stockholm
• Medical records requested by the NBFM in 2023 for forensic psychiatric evaluation
• Age ≥ 18 years
• Contact with a psychiatric care provider within Region Stockholm
• Medical records NOT requested by the NBFM in 2023 for forensic psychiatric evaluation
• Matching criteria:
• Gender (male/female)
• Age group (18-24, 24-39 and \>39 years)
• Psychiatric care unit

You may not qualify if:

• No registered psychiatric care contact in Region Stockholm's shared electronic medical record system, three months prior to the date of the index offense.
• The index offense before 2018.
• Individual previously underwent an FPE at some point.

Sponsors & Collaborators

• Karolinska Institutet: lead

Study Sites (1)

Karolinska Institutet

Stockholm, Sweden

RECRUITING

MeSH Terms

Conditions

Mental Disorders

Central Study Contacts

Katarina Howner, MD, PhD, ass prof

CONTACT

+46725989418; katarina.howner@ki.se

Study Design

• Study Type: observational
• Observational Model: CASE CONTROL
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate professor

Study Record Dates

• First Submitted: June 23, 2025
• First Posted: September 9, 2025
• Study Start: June 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): December 31, 2027
• Last Updated: August 19, 2026

Record last verified: 2026-08

Data Sharing

• IPD Sharing: Will not share

Locations

SE (1)