Inpatient fire-setting in a psychiatric ward: A retrospective case-control study of clinical and behavioral risk...

Fire-setting during psychiatric hospitalization is rare but potentially catastrophic. Most research has focused on forensic settings, leaving this behavior in general psychiatric wards underexplored.

We conducted a retrospective matched case-control study in a general psychiatric hospital in Israel, including all inpatients who engaged in fire-setting incident between 2011 and 2023 (n = 28). Each case was matched to five controls (n = 140) by age, sex, diagnosis, ward, and hospitalization period. Demographic, clinical, and behavioral data were extracted from electronic records. Group comparisons and conditional logistic regression, accounting for the matched case-control design, were used to examine factors associated with inpatient fire-setting.

Compared with controls, fire-setters showed significantly higher rates of violent behavior, self-harm, mechanical restraint, seclusion, and acute intramuscular medication administration during admission. In the reduced conditional logistic regression model, documented prior actual fire-setting, documented trauma history, and violent behavior during the index hospitalization were significantly associated with inpatient fire-setting. Most incidents occurred during acute psychotic or manic states, though a notable minority reflected antisocial or aggressive behavior without overt psychosis. Men comprised most fire-setters; however, men more often acted in distress or aggressive contexts, whereas women more frequently set fires in the context of suicidal intent or self-harm.

Inpatient fire-setting is linked to a pattern of severe behavioral dysregulation and elevated violence risk beyond diagnosis or demographics. It may serve as a clinical marker of heightened risk, underscoring the need for trauma-informed, behaviorally focused assessment and prevention strategies in psychiatric inpatient care.