Background/Objectives: Psychiatric inpatient care is characterised by power asymmetries between care providers and care receivers. Despite international guidelines and policies promoting autonomy, involvement, and empowerment, these ideals remain challenging to implement in clinical practice. Psychiatric self-admission has been developed to strengthen autonomy; however, its implementation may challenge established power structures, professional roles, and responsibilities within mental healthcare settings. This study aimed to explore stakeholder perspectives on power transfer during the implementation of psychiatric self-admission in Scandinavia. Methods: A qualitative multi-source study was conducted using semi-structured interviews, focus group interviews, and document collection. Interviews were conducted with 36 participants involved in the development and implementation of self-admission in Denmark, Norway, and Sweden. Additionally, approximately 250 documents were gathered. The documentary material was analysed alongside the interviews and focus groups to provide an understanding of the implementation of self-admission models and how power transfer was represented within these processes. The analyses were inspired by methods in qualitative content analysis and document analysis. Results: Findings on stakeholder perspectives on power transfer during implementation revealed a tension reflected in two subthemes: ‘Responsive and Responsible’, where self-admission was viewed as a necessary response to needs that the healthcare system was unable to address, and ‘Unsafe and Unsound’, where self-admission was associated with uncertainties and risks related to losing control. Conclusions: Implementing psychiatric self-admission, which involved challenging traditional power relations in healthcare, was permeated by trust, distrust, and fear. The findings highlight the need to address stakeholders’ concerns related to safety and professional responsibility.

INTRODUCTION:Mental health workers' attitudes toward individuals who self-harm impact accessibility and quality of care. Previous studies have established the role of training on professionals' attitudes, with mixed findings for gender and work experience. While self-report attitudinal scales are frequently used, latent response trends across such scales are seldom considered. The present study examines mental health workers' responses across the Self-Harm Antipathy Scale - Swedish Revised (SHAS-SR) and explores the predictive roles of various intrapersonal and contextual factors. METHODS:On a sample of 596 mental health workers in Sweden, we employed standard multiple regression to predict outcomes on the SHAS-SR. We performed latent profile analysis on SHAS-SR subscales to identify distinct attitude profiles and their predictors. RESULTS:We identified four distinct attitude profiles: Sympathetic, Reluctant, Judging, and Antipathic. Area of work and gender predicted both wholescale scores and certain profile memberships. Working in emergency settings was associated with more negative attitudes and nearly nine times higher odds of an Antipathic rather than Sympathetic scoring pattern, compared to non-emergency workers. CONCLUSION:Interventions to improve attitudes toward individuals who self-harm ought to be prioritized in emergency settings. The SHAS-SR scale might be used to identify target groups for health equity efforts in mental healthcare.

Brief Admission by self-referral (BA) is a crisis intervention for individuals with recurrent self-harm and suicidal ideation. While short-term effects are documented, long-term utilisation patterns remain unclear. This study examines BA usage over 4 years, identifies distinct utilisation profiles, and qualitatively explores participants' experiences with BA over time. Participants were 62 individuals from a prior randomised controlled trial who provided informed consent for follow-up. Using a mixed-methods convergent parallel design, quantitative and qualitative data were collected simultaneously, analysed separately, and integrated during the discussion. BA utilisation and profiles were examined quantitatively, while qualitative content analysis was applied to open-ended responses. When analysing mean levels across the entire sample, BA usage initially averaged 8 days per 6-month period but gradually declined over 4 years to 3-4 days. However, cluster analysis revealed distinct BA usage trajectories across three utilisation profiles: Cluster 1 (n = 40) exhibited consistently low BA usage, Cluster 2 (n = 14) showed a gradual decline following an initial phase of engagement, and Cluster 3 (n = 8) maintained high and sustained BA usage throughout the 4-year period, reporting greater impairments but strong satisfaction with BA. These individuals valued BA for its structured support, autonomy, and sense of security. BA appears to serve as both a form of self-care and a gateway to broader psychiatric support, particularly for those with greater functional impairments. To optimise its long-term effectiveness, structural barriers, access inconsistencies, and stigma must be addressed through better integration into psychiatric services.

Brief Admission by Self-referral (BA), a standardized crisis intervention for individuals with repeated self-harm or suicidal behavior, was adapted for adolescents from 13 years in Region Skåne, Sweden, in 2018. BA aims to offer access to support based on autonomy and has been associated with reduced need of emergency care. Interviews with adolescents and legal guardians have pointed to BA as valuable and challenging, and professional support as key. This study aims to describe healthcare professionals’ (HCPs) experiences of BA for adolescents with self-harm at risk of suicide. Interviews six years after implementation with fourteen HCPs from outpatient and inpatient psychiatric care were analyzed with qualitative content analysis. BA was perceived as valuable caretaking without taking over, promoting mental growth and agency by being brief and granting access. It was described as offering relief to families and HCPs, although perceived to lack a sufficient level of legal guardian participation. Key work processes included being grounded in leadership and outpatient treatment. Challenges included system inflexibility and fitting BA into the physical care context. The results of this study may support future implementation of BA for adolescents with self-harm at risk of suicide and add guidance around potential pitfalls.

Brief User-Controlled Admission (BUCA) refers to a set of crisis interventions in which the traditional gatekeeping role of the physician is bypassed, allowing service users to independently decide when to access short-term inpatient care through a pre-negotiated agreement. Examples include Brief Admission by self-referral, Patient-Initiated Brief Admission, Patient-Controlled Admission, and Self-Referral to Inpatient Treatment. The structured agreement promotes predictability and collaboration, enabling the user to assume control over their care. BUCA has been studied in adults and adolescents with severe mental distress at risk for escalation of symptoms, self-harm or suicide. Users report high satisfaction, describing the agreement as a source of psychological safety, dignity, and proactive crisis management. Staff experience strengthened therapeutic alliances and role shifts from gatekeeping to collaboration. Families experience relief, though they may need information and support adapting to the user-led structure. BUCA has been associated with increased functioning in daily life, and lower healthcare costs, particularly among users with high service utilization. While earlier studies have suggested potential reductions in inpatient care, studies including controls have not proven significant effects. Representing a shift towards user-led care, BUCA offers a scalable and potentially cost-effective model aligned with current mental health reform priorities.

Brief Admission by self-referral (BA) was implemented in 2018 in Swedish child and adolescent psychiatric (CAP) inpatient care. This intervention empowers adolescents to self-admit at their own request for brief periods to prevent self-harm and suicidal crisis. As BA enhances healthcare user autonomy, it is a timely intervention to consider with the emerging human rights discourse and rising imperatives for person-centered care in psychiatry. The present study explores talk about adolescents access to BA specifically in terms of involvement and responsibilities of parents and other significant adults in CAP. In this qualitative study, we interviewed 26 significant adults (the majority being biological parents) of children with access to BA. Interviews were semi-structured, asking broadly about participants’ experiences with BA. We used reflexive thematic analysis from a social constructionist framework to explore how participants’ narratives drew on existing psychiatric discourses. We constructed four themes around narratives of involvement and responsibilities in BA specifically and CAP generally: there’s no need to be involved in BA, selflessly supporting child involvement, being insufficiently involved, and being left to shoulder everything. These themes illustrate a sliding scale from perceiving little responsibility nor need for involvement, to perceiving shared responsibility for children’s well-being but limited personal rights, to being under-involved and even perceptions of being left with sole responsibility as CAP refused to provide care. Participants’ narratives could generally be mapped onto rights-based discourse, emphasizing that adolescents should have access to BA as it helped them care for themselves. As participants took various positions regarding the responsibility of parents versus CAP to protect and help adolescents, the risk of perpetually downplaying the needs of parents and other significant adults became apparent, along with the pitfalls of neoliberal healthcare management and responsibilization of child mental health. CAP ought to systematically inform both adolescents and significant adults about BA, strengthening mental health literacy among the target population. It also ought to be emphasized that supporting significant others is considered part of the purpose with BA.

Background: Brief Admission by self-referral (BA) is a crisis-management intervention standardized for individuals with self-harm at risk of suicide. We analyzed its health-economic consequences. Materials and methods: BA plus treatment as usual (TAU) was compared with TAU alone in a 12-month randomized controlled trial with 117 participants regarding costs for hospital admissions, coercive measures, emergency care and health outcomes (quality-adjusted life years; QALYs). Participants were followed from 12 months before baseline to up to five years after. Results: Over one year BA was associated with a mean annual cost reduction of 4800 or incremental cost of 4600 euros, depending on bed occupancy assumption. Cost-savings were greatest for individuals with >180 admission days in the year before baseline. In terms of health outcomes BA was associated with a QALY gain of 0.078. Uncertainty analyses indicated a significant QALY gain and ambiguity in costs, resulting in BA either dominating TAU or costing 59 000 euros per gained QALY. Conclusion: BA is likely to produce QALY gains for individuals living with self-harm and suicidality. Cost-effectiveness depends on targeting high-need individuals and comparable bed utilization between BA and other psychiatric admissions. Future research should elaborate the explanatory factors for individual variations in the usage and benefit of BA.

PURPOSE:Brief Admission by self-referral (BA) is a standardized crisis-management intervention for individuals with self-harm and risk for suicide. This study explored relatives' experiences of BA. Relatives' perspectives may contribute to an increased understanding of the effects of BA given the relatives' role as support and informal caregivers as well as being co-sufferers.METHODS:Fourteen relatives to adults with access to BA within one Swedish region participated in focus groups analysed with reflexive thematic analysis.RESULTS:We generated themes evolving around three meaning-based concepts: access (A low threshold to a safe back-up is crucial and obstacles may easily break faith), independence (Trust in their ability with care and respect), and recovery (The rest and relational recovery we all get are needed and invaluable).CONCLUSIONS:BA brings considerable value to users and relatives, by supporting them to take care of themselves and each other. Communication and involvement of relatives may enhance users' ability to overcome obstacles to accessing BA. Implementation and adherence may be strengthened by supervision of BA staff and education of emergency care staff. Resources are needed to improve access. Mapping hurdles to BA, support through peers and targeted psychoeducation may improve recovery for BA users and their relatives.

Abstract Background Exposure to adverse childhood experiences (ACE) have been found to have profound negative consequences on an individuals’ health. Non-suicidal self-injury (NSSI) is a clinically complex and serious global health issue and is closely related to suicide attempts. Previous research has found associations between ACE and NSSI and suicide attempts in clinical samples. However, this association has to our knowledge not been studied to this extent in a sample of forensic psychiatric patients. The aim of this study was therefore to describe the prevalence of adverse childhood experiences (ACE) and their associations with non-suicidal self-injury (NSSI) and/or suicide attempts in forensic psychiatric patients. Methods The current study is a cross-sectional study of a consecutive cohort of 98 forensic psychiatric patients (86.7% male) in Sweden. We invited 184 patients with a predicted stay of > 8 weeks who had been cleared for participation by their treating psychiatrist. Of these, 83 declined and 98 eligible patients provided informed consent. Information on ACE, NSSI, and suicide attempts derived from files, self-reports (Childhood Trauma Questionnaire-Short Form; CTQ-SF), and interviews were compared separately among participants with and without NSSI or suicide attempts using t-tests. The dose–response association between ACE and NSSI/suicide attempts was analysed using binary logistic regression. Results In file reviews, 57.2% of participants reported physical abuse, 20% sexual abuse, and 43% repeated bullying by peers during childhood. NSSI and suicide attempts were associated significantly with CTQ-SF total scores, with medium effect sizes (d = .60 to .63, p < .01), and strongly with several CTQ-SF subscales. Parental substance abuse was also associated with NSSI (p = .006, OR = 3.23; 95% confidence interval [CI] = 1.36 to 7.66) and suicide attempts (p = .018, OR = 2.75; 95% CI = 1.18 to 6.42). Each additional ACE factor predicted an increased probability of NSSI (p = .016, OR = 1.29; CI = 1.04 to 1.59) but not of suicide attempts. When anxiety and depressive disorders were included in the model, ACE remained a significant predictor of NSSI. Conclusions We report extensive ACE, from both files and self-reports. When comparing groups, correlations were found between ACE and NSSI, and ACE and suicide attempts among forensic psychiatric patients. ACE seem to predict NSSI but not suicide attempts in this group, even when controlling for affective and anxiety disorders. Early ACE among forensic psychiatric patients, especially physical and emotional abuse and parental substance abuse, have important impacts on self-harming behaviours that must be acknowledged both by the institutions that meet them as children and in their later assessment and treatment.

Introduction: Decreased dopaminergic activity – as reflected by lower levels of the major metabolite homovanillic acid (HVA) in cerebrospinal fluid (CSF) – may be involved in the pathophysiology of attempted suicide. An inverse association has also been found between dopaminergic activity and clinical symptoms of depression and anxiety in non-suicidal individuals. The aim of this study was to assess the relationship between CSF-HVA and clinical symptoms associated with an increased risk of suicide in individuals who attempted suicide. Methods: Ninety-five people (52 women; 43 men) who had recently attempted suicide received lumbar punctures to analyse levels of HVA in the CSF. They were also evaluated with the Comprehensive Psychopathological Rating Scale, from which scores on the Montgomery-Åsberg Depression Rating Scale (MADRS), the Brief Scale of Anxiety (BSA), and an item on suicidal thoughts were analysed. Results: Among female participants, CSF-HVA was significantly and negatively correlated with BSA total scores, after adjusting for covariates (beta = −0.442, p = 0.002), but not with scores on the MADRS or suicidal thought item. No significant correlations were observed between CSF-HVA and symptoms among male participants. Conclusion: Our findings suggest that lower dopaminergic activity may be associated with clinical symptoms of anxiety among women who have recently attempted suicide.

Background: Dialectical behavior therapy (DBT) is an evidence-based treatment for self-harm and emotion regulation difficulties. A modified version, DBT-Skills System (DBT-SS), has been developed in the USA for individuals with cognitive difficulties. The present study is a pilot study, testing the DBT-SS in a Swedish context. Methods: Six participants were treated with individual therapy and group skills training for 48 sessions each. A case series design was used to follow individual development over time. The primary outcome measure was reduction in challenging behaviors. Secondary outcomes were level of functioning in daily life, hospital admissions, and resilience and vulnerabilities in different risk domains. Data was analyzed using time-series diagrams. Effect sizes of changes were calculated using Cohen's d. Results: Challenging behaviors decreased over time and participants' global level of functioning increased. There was a reduction in number of hospital admissions over time. As for resilience and vulnerabilities, participants' overall level of risk in various areas remained unchanged or decreased after treatment. Conclusions: The results indicate that DBT-SS might be a promising treatment for cognitively challenged individuals with emotion regulation difficulties and challenging behaviors in a Swedish context. The study provides suggestions for a future randomized controlled trial. Supplemental data for this article is available online at here.

Background Brief Admission by self-referral is a preventive intervention here intended for individuals who recurrently self-harm and have a history of contact with emergency psychiatric services. Individuals with access to Brief Admission are empowered to self-admit to inpatient care for up to three days per stay and are encouraged to do so before experiencing crisis. Brief Admission was implemented relatively recently in child and adolescent psychiatric settings in Sweden. The purpose of this study was to phenomenologically explore the lived experience of parents whose teenagers, who recurrently self-harm and experience suicidal thoughts, use Brief Admissions. Methods This is a qualitative study using phenomenological psychological analysis. We interviewed 17 parents who had experienced their teenagers using Brief Admissions. The interviews were recorded and transcribed verbatim and analyzed to arrive at the essential meaning structure of the phenomenon of Brief Admissions for the parent. Results We identified two essential meaning structures of the parent’s experience of their teenager’s use of Brief Admissions: being gifted relief and hope or being robbed of everything you believed in. The experience of Brief Admissions as a gift was structured by the following constituents: ‘a sense of safety and containment’, ‘liberation from a hostage situation’, ‘a return to wellbeing’, and ‘catalysts for relational shifts’. In contrast, the constituents of the experience of being robbed included ‘a tug of war for control’, ‘an unworthy wasteland’, ‘abandonment and collapse of authority’, and ‘no sense of purpose and plan’. Conclusions Brief Admissions may come across as challenging, futile and painful in the life of the parent, yet they may also support a process of recovery and healthy development for the entire family. To realize the full potential of the intervention, mental health professionals providing Brief Admission must be mindful of the challenges the parent may face as their teenager starts self-admitting, tactfully and sensitively preparing the parent for a new parental role.

IntroductionThe Five Self-Harm Behavior Groupings Measure (5S-HM) is a novel assessment that evaluates behaviours which may go undetected by existing measures. Self-harm is formulated across directness and lethality spectra, including under-studied behaviors such as indirect self-harm, harmful self-neglect and sexual self-harm. Aims of the study were to: (1) empirically evaluate the 5S-HM; (2) to determine whether the 5S-HM generates relevant new information with respect to the forms and functions given by participants for self-harm within a clinical sample; (3) to test the utility and novel contributions of the Unified Model of Self-Harm and the 5S-HM by extension. MethodsData were collected from N = 199 individuals (M-age = 29.98, SD = 8.41, 86.4% female), receiving specialized evidence-based treatments for self-harm, borderline personality disorder or eating disorders. Construct validity was determined via Spearman correlations, and internal consistency was established from Cronbach's alpha. Inductive thematic analysis was used to analyze and interpret qualitative data on reasons, forms and functions participants reported in relation to self-harm following Braun and Clarke's analytic guidelines. Thematic mapping was used to summarize qualitative data. ResultsTest-retest reliability on a subsample of n = 24, tested 14 days after Time 1 was supported by a good intraclass correlation (0.68). Internal consistency (Cronbach's alpha = 0.75) was acceptable to good, as was construct validity comparing the 5S-HM total score to two validated self-harm measures (rho = 0.40, p < 0.01; rho = 0.26, p < 0.01). A thematic map depicting antecedents and consequences of self-harm over time suggests that self-harm is initiated by negative emotional states and self-intolerance. Novel findings in relation to sexual self-harm indicated that reasons for these behaviors were either to improve or worsen one's situation through being hurt by someone else. DiscussionThe empirical analyses of the 5S-HM demonstrate that it is a robust measure for use in clinical and research settings. Thematic analyses proposed explanations for why self-harm behaviors are initiated and how they are reinforced over time. Sexual self-harm in particular requires further careful study.

Introduction Whether melancholia is a distinct syndrome has long been debated. One aspect of a valid syndrome is whether it allows for determination of a prognosis. The aim of this study is to investigate the course of melancholic depression versus non-melancholic depression with a focus on: (i) time to and probability of recovery from the first depressive episode, (ii) time to and risk of the first recurrence, (iii) rate of recurrence, (iv) time with depression or antidepressant medication, and (v) suicide risk. Methods The Lundby Study is a longitudinal community study on mental health that followed a geographically defined population (N = 3,563) for up to 50 years, 1947–1997. Subjects with first onset depression were assessed as melancholic (N = 46) or non-melancholic (N = 381) using the DSM-IV melancholic specifier. These diagnoses were made in retrospect using all available information from semi-structured interviews by psychiatrists, key informants, registers, and patient records. Results We found no significant difference between melancholic- and non-melancholic depression in time to and probability of recovery from the first depressive episode. The time to first recurrence was shorter in melancholic than in non-melancholic depression and the risk of first recurrence for the melancholic group was 2.77 (95% confidence interval [CI] 1.83–4.20) times the risk in the non-melancholic group. The median rate of recurrence was higher in the melancholic group, at 0.19 recurrences per year at risk (interquartile range [IQR] 0.08–0.47), compared to the non-melancholic group, at 0.10 recurrences per year at risk (IQR 0.05–0.21) (p < 0.03). The median percentage of time being depressed or on antidepressant medication was higher in the melancholic group, 17% (IQR 3–20%), compared to the non-melancholic group, 8% (IQR 7–33%) (p < 0.001). The risk of suicide was higher in the melancholic group, hazard ratio 4.13 (95% CI 1.49–11.48, p < 0.01). Discussion To conclude, melancholic depression had a more recurrent, chronic, and severe course with a higher suicide risk than did non-melancholic depression in the Lundby population. Although our use of retrospective diagnosis might limit interpretation of results, the findings indicate that melancholia may be useful in determining prognosis and may be a valid psychopathological syndrome.

Brief admission by self-referral, which allows patients to briefly admit themselves to a psychiatric ward, is a crisis intervention designed to reduce suicide and self-harm. This method was introduced in Sweden for adult patients in 2015, achieving high patient satisfaction and good acceptance among staff. In 2018, the method was adapted and implemented in pediatric psychiatry. The present study comprehensively describes the multifaceted strategies for implementing brief admissions, including planning, education, financing, restructuring, quality management, and policy implementation and reform. It also includes staff’s opinions of the practice of brief admissions for young people. Neither of these topics has been addressed in the existing literature. During the study period (April 2018–April 2021), 63 brief admission contracts were established. The number of new contracts increased exponentially (12.7%) per quarter (p < 0.05), and staff satisfaction with both the implementation and its benefits for unstable patients was high. Brief admission by self-referral can be successfully implemented in pediatric psychiatry and appears to be a functional crisis management method for adolescents.

Personer med upprepat självskadebeteende är inte sällan föremål för psykiatrisk tvångsvård. Tvångsvården motiveras vanligen med att personen löper risk att allvarligt skada sig själv, och därför har ett oundgängligt behov av psykiatrisk heldygnsvård. Det finns emellertid inget tydligt vetenskapligt stöd för att sådan vård effektivt förhindrar självskadehandlingar i dessa fall. Medicinska studier pekar tvärtom på att heldygnsvård kan bidra till att självskadebeteenden eskalerar, vilket också bekräftas av den kliniska erfarenheten. I artikeln konstaterar vi att psykiatrisk tvångsvård av personer med självskadebeteende förutsätter en noggrann och kunskapsbaserad avvägning mellan de risker och den nytta som heldygnsvården innebär. Detta följer av proportionalitetsprincipen och av kravet på att hälso- och sjukvård ska stå i överensstämmelse med vetenskap och beprövad erfarenhet. Vi analyserar därför om kravet på ett oundgängligt behov av psykiatrisk heldygnsvård i 3 § 1 p. lagen om psykiatrisk tvångsvård (1991:1128, LPT) kan anses uppfyllt mot bakgrund av kunskapsläget kring självskadebeteende. Vår slutsats är att så ofta inte är fallet.

Evidence is lacking on how to manage imminent suicidality in adolescents with self-harm. Brief Admission by Self-referral (BA) is a crisis-management intervention, developed for adults with self-harm at risk for suicide. Structured, individualized and based on responsible autonomy, BA aims to provide a respite while minimizing negative effects of hospitalization. This qualitative interview study illuminates adolescents’ experiences of BA, adapted for this target group. Nineteen adolescents aged 14 to 19 years, described BA as helpful for timely rest and recovery to save themselves from impulses to self-harm. The individual contract, which is a prerequisite for access to BA, was perceived to give access to professional support in a safe environment, also among adolescents not using their contract. Being trusted with responsibility to self-admit was also hard work with struggles of self-doubt. Challenges included experiencing distrust from staff and fear of not being able to abstain from self-harm, which BA is conditioned upon. However, this condition was also perceived to induce self-motivation and growth. BA appeared well-adapted to the target group, fulfilling needs of predictability, autonomy, and opportunity for recovery to prevent self-harm. Suggestions for improvement included continually informing staff about important features of BA. To further evaluate benefits and challenges of BA, future research may evaluate clinical and health-economic outcomes and perspectives from parents and caregivers.

INTRODUCTION:Deliberate self-harm (DSH) is common in clinical populations. Childhood maltreatment (CM) and attitudes both towards oneself and towards DSH may be of importance for the development of DSH. This study aimed to test whether patients with DSH report more CM, more negative attitudes towards oneself and more positive attitudes towards DSH than a clinical and a healthy comparison group, and whether the effects of CM are mediated by negative attitudes towards oneself. METHOD:Females with DSH and psychiatric disorders (n = 34), females without DSH but with psychiatric disorders (n = 31) and healthy female individuals (n = 29) were compared regarding DSH, CM, attitudes towards the self and attitudes towards self-harm. RESULTS:Females with DSH reported more emotional abuse and more self-hatred as compared to both comparison groups. The effect of emotional abuse was mediated by self-hatred. The DSH-group had significantly more positive attitudes towards DSH than the healthy comparison group. CONCLUSION:Self-hatred and CM in the form of emotional abuse may be distinguishing characteristics of female patients with DSH in psychiatric settings. The present results are compatible with the hypothesis that emotional abuse leads to DSH via self-hatred, but the cross-sectional nature of the study precludes any causal conclusions. The clinical utility of the results is discussed.

Background: Deliberate self-harm (DSH) is a common behavior in psychiatric populations. However, little is known regarding how DSH impacts daily life. The concept of functional disability, adopted by the World Health Organization (WHO), refers to the impact of disorders on six domains of daily functioning. The aim of the current study was to explore the functional disability of psychiatric patients with DSH as compared to a psychiatric control group. Methods: 32 psychiatric patients with DSH and 31 psychiatric patients without DSH were assessed with regards to demographic information, functional disability, psychiatric illness, DSH, general cognitive functioning, and measures of psychopathology. Group comparisons were made by means of t-tests, Mann-Whitney-tests, and Chi-square tests. Correlation analyses were done to assess the association between measures of psychopathology and functional disability. Results: The results indicated that patients with DSH had a lower ability to self-care as compared to the patients without DSH (p = 0.001, d = 0.90). Also, the patients with DSH reported a significantly higher number of days when they were totally unable to carry out usual activities in the past month (p = 0.008, d = 0.70) and that they were admitted in an inpatient setting significantly more days over the past year compared to the patients without DSH (p < 0.001, d = 0.58). The group with DSH was significantly younger (t = 3.00, p = 0.004) and reported significantly more BPD-symptoms (p = 0.013, d = 0.64) as well as higher current suicidality (p < 0.001, d = 1.32) compared to the group without DSH. The group with DSH also included a significantly higher number of patients diagnosed with borderline personality disorder (χ2 = 13.72, p < 0.001). There were no differences between the groups regarding general cognitive functioning or severity of depression. More research is needed to understand the underlying factors involved.

Self-harm, comprising non-suicidal self-injury, and suicide attempts, is a serious and potentially life-threatening behavior that has been associated with poor life quality and an increased risk of suicide. In forensic populations, increased rates of self-harm have been reported, and suicide is one of the leading causes of death. Aside from associations between self-harm and mental disorders, knowledge on self-harm in forensic psychiatric populations is limited. The purpose of this study was to characterize the clinical needs of a cohort of forensic psychiatric patients, including self-harm and possible risk factors thereof. Participants ( N = 98) were consecutively recruited from a cohort of forensic psychiatric patients in Sweden from 2016 to 2020. Data were collected through file information, self-reports, and complemented with semi-structured interviews. Results showed that self-harm was common among the participants, more than half (68.4%) of whom had at some point engaged in self-harm. The most common methods of non-suicidal self-injury were banging one's head or fist against a wall or other solid surface and cutting, and the most common method of suicide attempt was hanging. The most prominent functions of non-suicidal self-injury among the participants were intrapersonal functions such as affect regulation, self-punishment, and marking distress. Self-harm in general was associated to neurodevelopmental disorders ( p = 0.014, CI = 1.23–8.02, OR = 3.14) and disruptive impulse-control and conduct disorders ( p = 0.012, CI = 1.19–74.6, OR = 9.41), with reservation to very wide confidence intervals. Conclusions drawn from this study are that self-harm was highly prevalent in this sample and seems to have similar function in this group of individuals as in other studied clinical and non-clinical groups.