Self-harm behaviour and externally-directed aggression In psychiatric outpatients: a multicentre, prospective study...

Area of Science:

• Psychiatry
• Clinical Psychology
• Forensic Psychology

Background:

• Severe mental disorders (SMDs) are often associated with challenging behaviors.
• Understanding the distinct trajectories of self-harm behavior (SHb) and violent behavior (Vb) in SMDs is crucial for effective treatment.
• Previous research has not fully elucidated the differences and predictors associated with these behaviors in an outpatient setting.

Purpose of the Study:

• To investigate differences in socio-demographic, clinical characteristics, and violent behavior between outpatients with SMDs with and without a history of SHb and/or Vb.
• To identify predictors of SHb and Vb during a 1-year follow-up (FU).
• To compare outcomes across four groups: lifetime Vb (V), Vb and SHb (V-SH), only SHb (SH), and controls (CONT).

Main Methods:

• A cohort of 246 outpatients with SMDs was enrolled and divided into four groups based on lifetime history of Vb and SHb.
• The frequency and severity of SHb and Vb were assessed bi-weekly using the Modified Overt Aggression Scale (MOAS).
• Correlations were examined using measures including the Brief Psychiatric Rating Scale-Expanded (BPRS-E), Self-Rating of Functional Abilities (SLOF), Buss-Durkee Hostility Inventory (BDHI), Buss Impulsivity Scale (BIS), and State-Trait Anger Expression Inventory-2 (STAXI-2).

Main Results:

• Significant correlations were found between group status and BPRS-E Depression, SLOF Social acceptability, BDHI Indirect Aggression, BIS Motor Impulsiveness, and STAXI-2 Control-Out (p < 0.030).
• Patients in the V and V-SH groups reported higher scores on all MOAS sub-scales, indicating greater aggression.
• Age predicted aggression in the SH group, while the BPRS-E affect-anxiety subscale predicted aggression in the V group.

Conclusions:

• A history of SHb or Vb in individuals with SMDs is linked to differing medium-term outcomes.
• Specific clinical factors, such as depression, social functioning, impulsivity, and anger control, differentiate these patient groups.
• Predictors of aggression vary depending on the specific behavioral history (SHb vs. Vb) within the SMD population.