Mats Dernevik | University of Lincoln (original) (raw)

Papers by Mats Dernevik

Research paper thumbnail of Risk and offenders with intellectual disabilities: reappraising Hodgins (1992) classic study

Criminal Behaviour and Mental Health, Apr 10, 2013

Hodgins' (1992) study on mentally disordered offenders has been a classic in the field since its ... more Hodgins' (1992) study on mentally disordered offenders has been a classic in the field since its publication. At the time of writing it has 537 citations in Google scholar. Webster et al. (1995), in their manual to their widely used structured professional judgement tool, the HCR-20, cited her study as asserting that major mental disorder, including intellectual disability, is a factor contributing to risk for violence. They wrote Hodgins (1992) has amassed convincing data from population-based research that major mental illness elevates the probability of lifetime violence (p 38). One of us (WL) has had a handful of communications over the years contesting our view that research is inconclusive on whether or not intellectual disability is over or under represented in the criminal population. In summary, these communications say "surely the Hodgins (1992) study is the last word on the issue and people with ID are over represented". On this specific issue, our doubts have not yet been resolved. Hodgins (1992) used a census cohort of 15,117 people born in Stockholm in 1953 and still living there in 1963. Only those living in Sweden at the 30 year follow-up period in 1983, were included in the analysis. Available information on the sample (when the subjects were 30 years of age) included: admissions to psychiatric wards and most serious diagnosis on discharge from psychiatric services, including schizophrenia, affective disorders, paranoid states, alcohol and/or drug abuse and other mental disorders. Intellectual disability was defined "as those who were placed in special classes for intellectually deficient children in high school and were never admitted to a psychiatric ward" (p 478). The actual age of those entering and leaving high school was not defined. Given that these children were born in 1953, they would have attended high school from around 1964 to no later than 1971.

Research paper thumbnail of A response to Dr. Gudjonsson's commentary

Journal of Forensic Psychiatry & Psychology, Aug 1, 2009

We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial ... more We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial issue. He places our paper in the context of the Home Office commissioning independent 'experts' to conduct risk assessments. It was indeed such an assessment that ...

Research paper thumbnail of Deaf People in Forensic Contexts

Routledge eBooks, Oct 4, 2022

Research paper thumbnail of Violent behaviour in forensic psychiatric patients: Risk assessment and different risk-management levels using the HCR-20

Psychology Crime & Law, Mar 1, 2002

... Heilbrun Page 3. RISK ASSESSMENT AND MANAGEMENT 95 (1997; Heilbrun et al., 2000) has argued t... more ... Heilbrun Page 3. RISK ASSESSMENT AND MANAGEMENT 95 (1997; Heilbrun et al., 2000) has argued that two models of risk assess-ment are called for. ... Page 5. RISK ASSESSMENT AND MANAGEMENT 91 management within the context of the care episodes. ...

Research paper thumbnail of Individual Bias in Forensic Practice

Routledge eBooks, Oct 4, 2022

Research paper thumbnail of The use of psychiatric and psychological evidence in the assessment of terrorist offenders

Journal of Forensic Psychiatry & Psychology, Aug 1, 2009

The present paper focuses on the prediction of violent recidivism among individuals convicted of ... more The present paper focuses on the prediction of violent recidivism among individuals convicted of politically motivated violence–terrorism. We argue that the assumptions of general violence prediction models, used in risk assessment procedures with other ...

Research paper thumbnail of Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders

Background: The assessment of risk of violence among mentally disordered offenders has been a con... more Background: The assessment of risk of violence among mentally disordered offenders has been a controversial and well-researched area in forensic psychology and psychiatry in the last decades. The main focus of this research has been on the predictive validity of various risk factors and methods of combining risk factors to gain the highest possible predictive accuracy. In the present thesis, risk assessment is defined more broadly than predictive accuracy, and also includes process factors, riskmanagement and the communication and decision-making associated with risk of violence. The overall aim of this thesis was to study was to explore the process of structured risk assessment in its naturalistic clinical setting. Method: Four different samples were included in the 5 studies. A guideline for structured clinical risk assessment, Historical-Clinical-Risk assessment (HCR-20), was used in the first 4 studies. The first study used a 6 raters x 6 patients design to establish inter-rater reliability and validity of the HCR-20. 54 forensic patients were followed over time and monitored for inpatient violence and violence after discharge during three risk-management conditions in study 2. A sample of 40 nurses, assessing the same 8 patients, was included in studies 3 and 4. Finally study 5 included a sample of 88 decision-makers, divided into 3 groups; Clinicians, Criminal law professionals and Controls. Results: The HCR-20 was found to have reasonable reliability and validity in study 1. The main finding in study 2 was that the predictive accuracy of the HCR-20 was influenced by the intensity of risk management (AUC .64 compared to .82). In study 3 we found that structured clinical risk assessment was not "immune" to emotional bias in the assessment process. 43% of the variance in risk-scores could be attributed to the assessors' emotions towards the patient. The information utilised to make the assessment and how the assessor values it, also influenced the assessments in study 4. Placing value on personal interaction was more associated with inpatient violence than with recidivism. In study 5 we found that the inclination of making release decisions was greatly influenced (η= .58) by the prospect of making false negative error of judgement. Conclusions: Structured clinical risk assessments can be undertaken in a reliable and valid way in forensic clinical settings. Attention needs to be paid to factors that might influence the outcome of the assessments and the risk-management decisions that are the consequence of risk assessment. These factors can be emotional biases, evaluation of different kinds of information that form the basis for the process. There also needs to be an awareness of other factors than probabilities that influence decisions about risk. It is suggested that future descriptive, as opposed to prescriptive, research is needed on the processes and influences on risk assessments as they are actually done by clinicians in forensic, psychiatric and correctional settings.

Research paper thumbnail of Clinicians' Perceptions of Which Factors Increase or Decrease the Risk of Violence Among Forensic Out-patients

International Journal of Forensic Mental Health, Apr 1, 2004

... Decrease the Risk of Violence Among Forensic Out-patients Knut Sturidsson, Ulrika Haggård-Gra... more ... Decrease the Risk of Violence Among Forensic Out-patients Knut Sturidsson, Ulrika Haggård-Grann, Malin Lotterberg, Mats Dernevik, and Martin Grann There is a debate in the academic community about which approach to the assessment of risk for violence is preferable. ...

Research paper thumbnail of Deaf People in Forensic Contexts

Challenging Bias in Forensic Psychological Assessment and Testing, Oct 4, 2022

Research paper thumbnail of Individual Bias in Forensic Practice

Challenging Bias in Forensic Psychological Assessment and Testing, Oct 4, 2022

Research paper thumbnail of Running head : COGNITIVE DISTORTIONS AND ANTISOCIAL BEHAVIOR Self-Serving Cognitive Distortions and Antisocial Behavior among Adults and Adolescents

The reliability and validity of the self-report questionnaire How I Think (HIT), designed to asse... more The reliability and validity of the self-report questionnaire How I Think (HIT), designed to assess self-serving cognitive distortions related to antisocial behavior, was tested among Swedish incarcerated and non-incarcerated adults and adolescents (N = 364). The results showed that self-serving distortions were more common among incarcerated individuals and that they predicted self-reported antisocial behavior among adults. Confirmatory factor analysis revealed, in contrast to earlier findings, that the underlying structure of the HIT was best explained by a 3-factor-solution with 1 major cognitive factor, referred to as “criminal mind”. It was concluded that the HIT, after further examination of its structural and divergent validity, could be used as a measure of criminal thinking in adults as well as in adolescents.

Research paper thumbnail of Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders

5 List of Publications 7 List of Abbreviations 9 BACKGROUND 11 Violence and mental disorder 13 Vi... more 5 List of Publications 7 List of Abbreviations 9 BACKGROUND 11 Violence and mental disorder 13 Violence Prediction and Risk Assessment 15 Defining Risk Assessment 20 Ethical considerations in risk prediction 22 Methods of Risk Assessment 23 Implementation into Clinical Practice 29 Risk communication 31 Risk Decision-making 32 AIMS 35 METHODS 37 Designs and Procedures 40 Statistics 43 Research Ethical considerations 44 RESULTS 47 DISCUSSION 51 Limitations 51 Comments to Results 52 Discussion Proper 54 Conclusions 56 ACKNOWLEDGEMENTS 61 REFERENCES 63

Research paper thumbnail of Preliminary findings on reliability and validity of the historical-clinical-risk assessment in a forensic psychiatric setting

Http Dx Doi Org 10 1080 10683169808401753, Jan 4, 2008

ABSTRACT The purpose of this study was to establish inter-rater reliability and retrospective val... more ABSTRACT The purpose of this study was to establish inter-rater reliability and retrospective validity of the Historical-Clinical-Risk assessment (HCR-20). HCR-20 is an instrument for assessing risk, incorporating three different approaches to the area.Six patients sentenced to Forensic psychiatric care for violent crimes were individually rated on the HCR-20 by 6 raters, trained in the assessment manual. The correlation's between raters were in the range of 0.76 to 0.96 for the full scale. The range for the Clinical evaluation was found to be somewhat weaker (0.52–0.95). Overall the results indicates that the HCR-20 has a satisfactory level of reliability provided that raters are properly trained. The HCR-20 was also compared to independent ratings of past violent crimes.The independent ratings were done by two professionals using the criminal records of the clients. These were rated in a 6 point crime-index scale, considering criminal versatility and seriousness of violent crimes. The correlate of the crime-index Scale and “HCR-19” was 0.67.The results were discussed with respect to the usefulness of HCR-20 as a risk assessment instrument with good levels of reliability and validity.

Research paper thumbnail of Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders

Research paper thumbnail of A response to Dr. Gudjonsson's commentary

Journal of Forensic Psychiatry and Psychology, Aug 1, 2009

We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial ... more We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial issue. He places our paper in the context of the Home Office commissioning independent 'experts' to conduct risk assessments. It was indeed such an assessment that ...

Research paper thumbnail of The assessment of terrorist offenders: a commentary on the Dernevik et al. article and suggestions for future directions

Journal of Forensic Psychiatry & Psychology, 2009

Research paper thumbnail of Methodological development: Structured outcome assessment and community risk monitoring (SORM)

International Journal of Law and Psychiatry, 2005

Background: Violence is one of the leading causes of unnatural deaths, and the consequences of vi... more Background: Violence is one of the leading causes of unnatural deaths, and the consequences of violence for victims, victims' families, offenders, and society at large involve extensive suffering and monetary costs. Improving strategies to prevent and reduce violence is of great importance, and refining techniques for risk assessments in forensic and correctional settings is assumed to be one way of doing so. The procedures currently used for risk assessment mainly focus unchangeable, static risk factors, and provide few directions as to what clinicians can do in order to decrease a client's risk by treatment and management. The aim of this thesis was to improve understanding of the violence relapse process, to identify triggers and protective factors for violence among mentally disordered offenders, and to develop a structured model for the management of violence risk in forensic mental health after-care. Methods: This thesis used both qualitative and quantitative research designs. To identify protective factors of violent behaviour we interviewed individuals, selected from a cohort of 401 violent offenders who had unexpectedly ended their criminal career (n=4; Paper I). Semistructured interviews were likewise conducted to explore the violence relapse process and communication of risk among offenders who had relapsed into criminal violence (n=14; Paper II). Content analysis was used for the exploration of data. In the quantitative studies, which aimed to identify triggers of violence among offenders, we used the case-crossover design, by which each subject serves as his or her own control. Structured interviews were performed with 133 violent offenders with respect to hypothesised triggers (Papers III and IV). Standard Mantel-Haenszel methods were used for the statistical analyses. To develop a structured model for the management of mentally disordered offenders, we gathered law, criminology, and mental health professionals with different educational backgrounds to elicit clinically relevant contextual and individual factors related to the individual outcome following forensic psychiatric hospitalisation (Paper V). Results: Qualitative studies suggested that the desistance process among individuals with long criminal and violent "careers" was triggered by a shocking experience related to their criminal lifestyle and insight about the negative consequences to that lifestyle. Suggested protective factors were a strong relationship with family, social and geographical isolation, and the identification and avoidance of potential risk situations. Important risk factors in the relapse process were separations, drug problems, homelessness, and acute risk factors were lack of sleep, substance intoxication and conflicts. Some of these acute risk factors of violence were tested and confirmed in the quantitative case-crossover study. Acute suicidal ideation/ parasuicide and alcohol intoxication were among the most important triggering factors. Acute conflicts and being denied psychiatric care also increased the risk of criminal violence. In contrast, potential inhibitors of violence were regular doses of benzodiazepines and antidepressants. All but one of the mentally disordered offenders interviewed in the relapse study had, by their own account, communicated that there was a risk of acting violently. The communication patterns were directed towards professionals and acquaintances and were verbal and non-verbal. Finally, a structured model for management of violence risk in forensic psychiatric after-care called the SORM (Structured Outcome Assessment and Community Risk Monitoring) was developed. Conclusions: This thesis points to several potentially fruitful research areas for the violence prevention field. Previously, communication of risk has only been addressed in clinical work with suicidal patients, even though this may be of substantial interest also in the field of violence prevention. Some triggering and protective factors of violence among mentally disordered offenders were identified in this thesis, but needs to be replicated in future studies. The case-crossover design, for the first time applied to study triggers of aggressive acts, may substantially advance research on acute risk factors of violence.

Research paper thumbnail of A response to Dr. Gudjonsson's commentary

Journal of Forensic Psychiatry & Psychology, 2009

We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial ... more We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial issue. He places our paper in the context of the Home Office commissioning independent 'experts' to conduct risk assessments. It was indeed such an assessment that ...

Research paper thumbnail of Self-Serving Cognitive Distortions and Antisocial Behavior Among Adults and Adolescents

Criminal Justice and Behavior, 2011

The reliability and validity of the self-report questionnaire How I Think (HIT), designed to asse... more The reliability and validity of the self-report questionnaire How I Think (HIT), designed to assess self-serving cognitive distortions related to antisocial behavior, was tested among Swedish incarcerated and non-incarcerated adults and adolescents (N = 364). The results showed that self-serving distortions were more common among incarcerated individuals and that they predicted self-reported antisocial behavior among adults. Confirmatory factor analysis revealed, in contrast to earlier findings, that the underlying structure of the HIT was best explained by a 3-factor-solution with 1 major cognitive factor, referred to as "criminal mind". It was concluded that the HIT, after further examination of its structural and divergent validity, could be used as a measure of criminal thinking in adults as well as in adolescents.

Research paper thumbnail of Publications & Presentations

Research paper thumbnail of Risk and offenders with intellectual disabilities: reappraising Hodgins (1992) classic study

Criminal Behaviour and Mental Health, Apr 10, 2013

Hodgins' (1992) study on mentally disordered offenders has been a classic in the field since its ... more Hodgins' (1992) study on mentally disordered offenders has been a classic in the field since its publication. At the time of writing it has 537 citations in Google scholar. Webster et al. (1995), in their manual to their widely used structured professional judgement tool, the HCR-20, cited her study as asserting that major mental disorder, including intellectual disability, is a factor contributing to risk for violence. They wrote Hodgins (1992) has amassed convincing data from population-based research that major mental illness elevates the probability of lifetime violence (p 38). One of us (WL) has had a handful of communications over the years contesting our view that research is inconclusive on whether or not intellectual disability is over or under represented in the criminal population. In summary, these communications say "surely the Hodgins (1992) study is the last word on the issue and people with ID are over represented". On this specific issue, our doubts have not yet been resolved. Hodgins (1992) used a census cohort of 15,117 people born in Stockholm in 1953 and still living there in 1963. Only those living in Sweden at the 30 year follow-up period in 1983, were included in the analysis. Available information on the sample (when the subjects were 30 years of age) included: admissions to psychiatric wards and most serious diagnosis on discharge from psychiatric services, including schizophrenia, affective disorders, paranoid states, alcohol and/or drug abuse and other mental disorders. Intellectual disability was defined "as those who were placed in special classes for intellectually deficient children in high school and were never admitted to a psychiatric ward" (p 478). The actual age of those entering and leaving high school was not defined. Given that these children were born in 1953, they would have attended high school from around 1964 to no later than 1971.

Research paper thumbnail of A response to Dr. Gudjonsson's commentary

Journal of Forensic Psychiatry & Psychology, Aug 1, 2009

We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial ... more We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial issue. He places our paper in the context of the Home Office commissioning independent 'experts' to conduct risk assessments. It was indeed such an assessment that ...

Research paper thumbnail of Deaf People in Forensic Contexts

Routledge eBooks, Oct 4, 2022

Research paper thumbnail of Violent behaviour in forensic psychiatric patients: Risk assessment and different risk-management levels using the HCR-20

Psychology Crime & Law, Mar 1, 2002

... Heilbrun Page 3. RISK ASSESSMENT AND MANAGEMENT 95 (1997; Heilbrun et al., 2000) has argued t... more ... Heilbrun Page 3. RISK ASSESSMENT AND MANAGEMENT 95 (1997; Heilbrun et al., 2000) has argued that two models of risk assess-ment are called for. ... Page 5. RISK ASSESSMENT AND MANAGEMENT 91 management within the context of the care episodes. ...

Research paper thumbnail of Individual Bias in Forensic Practice

Routledge eBooks, Oct 4, 2022

Research paper thumbnail of The use of psychiatric and psychological evidence in the assessment of terrorist offenders

Journal of Forensic Psychiatry & Psychology, Aug 1, 2009

The present paper focuses on the prediction of violent recidivism among individuals convicted of ... more The present paper focuses on the prediction of violent recidivism among individuals convicted of politically motivated violence–terrorism. We argue that the assumptions of general violence prediction models, used in risk assessment procedures with other ...

Research paper thumbnail of Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders

Background: The assessment of risk of violence among mentally disordered offenders has been a con... more Background: The assessment of risk of violence among mentally disordered offenders has been a controversial and well-researched area in forensic psychology and psychiatry in the last decades. The main focus of this research has been on the predictive validity of various risk factors and methods of combining risk factors to gain the highest possible predictive accuracy. In the present thesis, risk assessment is defined more broadly than predictive accuracy, and also includes process factors, riskmanagement and the communication and decision-making associated with risk of violence. The overall aim of this thesis was to study was to explore the process of structured risk assessment in its naturalistic clinical setting. Method: Four different samples were included in the 5 studies. A guideline for structured clinical risk assessment, Historical-Clinical-Risk assessment (HCR-20), was used in the first 4 studies. The first study used a 6 raters x 6 patients design to establish inter-rater reliability and validity of the HCR-20. 54 forensic patients were followed over time and monitored for inpatient violence and violence after discharge during three risk-management conditions in study 2. A sample of 40 nurses, assessing the same 8 patients, was included in studies 3 and 4. Finally study 5 included a sample of 88 decision-makers, divided into 3 groups; Clinicians, Criminal law professionals and Controls. Results: The HCR-20 was found to have reasonable reliability and validity in study 1. The main finding in study 2 was that the predictive accuracy of the HCR-20 was influenced by the intensity of risk management (AUC .64 compared to .82). In study 3 we found that structured clinical risk assessment was not "immune" to emotional bias in the assessment process. 43% of the variance in risk-scores could be attributed to the assessors' emotions towards the patient. The information utilised to make the assessment and how the assessor values it, also influenced the assessments in study 4. Placing value on personal interaction was more associated with inpatient violence than with recidivism. In study 5 we found that the inclination of making release decisions was greatly influenced (η= .58) by the prospect of making false negative error of judgement. Conclusions: Structured clinical risk assessments can be undertaken in a reliable and valid way in forensic clinical settings. Attention needs to be paid to factors that might influence the outcome of the assessments and the risk-management decisions that are the consequence of risk assessment. These factors can be emotional biases, evaluation of different kinds of information that form the basis for the process. There also needs to be an awareness of other factors than probabilities that influence decisions about risk. It is suggested that future descriptive, as opposed to prescriptive, research is needed on the processes and influences on risk assessments as they are actually done by clinicians in forensic, psychiatric and correctional settings.

Research paper thumbnail of Clinicians' Perceptions of Which Factors Increase or Decrease the Risk of Violence Among Forensic Out-patients

International Journal of Forensic Mental Health, Apr 1, 2004

... Decrease the Risk of Violence Among Forensic Out-patients Knut Sturidsson, Ulrika Haggård-Gra... more ... Decrease the Risk of Violence Among Forensic Out-patients Knut Sturidsson, Ulrika Haggård-Grann, Malin Lotterberg, Mats Dernevik, and Martin Grann There is a debate in the academic community about which approach to the assessment of risk for violence is preferable. ...

Research paper thumbnail of Deaf People in Forensic Contexts

Challenging Bias in Forensic Psychological Assessment and Testing, Oct 4, 2022

Research paper thumbnail of Individual Bias in Forensic Practice

Challenging Bias in Forensic Psychological Assessment and Testing, Oct 4, 2022

Research paper thumbnail of Running head : COGNITIVE DISTORTIONS AND ANTISOCIAL BEHAVIOR Self-Serving Cognitive Distortions and Antisocial Behavior among Adults and Adolescents

The reliability and validity of the self-report questionnaire How I Think (HIT), designed to asse... more The reliability and validity of the self-report questionnaire How I Think (HIT), designed to assess self-serving cognitive distortions related to antisocial behavior, was tested among Swedish incarcerated and non-incarcerated adults and adolescents (N = 364). The results showed that self-serving distortions were more common among incarcerated individuals and that they predicted self-reported antisocial behavior among adults. Confirmatory factor analysis revealed, in contrast to earlier findings, that the underlying structure of the HIT was best explained by a 3-factor-solution with 1 major cognitive factor, referred to as “criminal mind”. It was concluded that the HIT, after further examination of its structural and divergent validity, could be used as a measure of criminal thinking in adults as well as in adolescents.

Research paper thumbnail of Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders

5 List of Publications 7 List of Abbreviations 9 BACKGROUND 11 Violence and mental disorder 13 Vi... more 5 List of Publications 7 List of Abbreviations 9 BACKGROUND 11 Violence and mental disorder 13 Violence Prediction and Risk Assessment 15 Defining Risk Assessment 20 Ethical considerations in risk prediction 22 Methods of Risk Assessment 23 Implementation into Clinical Practice 29 Risk communication 31 Risk Decision-making 32 AIMS 35 METHODS 37 Designs and Procedures 40 Statistics 43 Research Ethical considerations 44 RESULTS 47 DISCUSSION 51 Limitations 51 Comments to Results 52 Discussion Proper 54 Conclusions 56 ACKNOWLEDGEMENTS 61 REFERENCES 63

Research paper thumbnail of Preliminary findings on reliability and validity of the historical-clinical-risk assessment in a forensic psychiatric setting

Http Dx Doi Org 10 1080 10683169808401753, Jan 4, 2008

ABSTRACT The purpose of this study was to establish inter-rater reliability and retrospective val... more ABSTRACT The purpose of this study was to establish inter-rater reliability and retrospective validity of the Historical-Clinical-Risk assessment (HCR-20). HCR-20 is an instrument for assessing risk, incorporating three different approaches to the area.Six patients sentenced to Forensic psychiatric care for violent crimes were individually rated on the HCR-20 by 6 raters, trained in the assessment manual. The correlation's between raters were in the range of 0.76 to 0.96 for the full scale. The range for the Clinical evaluation was found to be somewhat weaker (0.52–0.95). Overall the results indicates that the HCR-20 has a satisfactory level of reliability provided that raters are properly trained. The HCR-20 was also compared to independent ratings of past violent crimes.The independent ratings were done by two professionals using the criminal records of the clients. These were rated in a 6 point crime-index scale, considering criminal versatility and seriousness of violent crimes. The correlate of the crime-index Scale and “HCR-19” was 0.67.The results were discussed with respect to the usefulness of HCR-20 as a risk assessment instrument with good levels of reliability and validity.

Research paper thumbnail of Structured clinical assessment and management of risk of violent recidivism in mentally disordered offenders

Research paper thumbnail of A response to Dr. Gudjonsson's commentary

Journal of Forensic Psychiatry and Psychology, Aug 1, 2009

We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial ... more We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial issue. He places our paper in the context of the Home Office commissioning independent 'experts' to conduct risk assessments. It was indeed such an assessment that ...

Research paper thumbnail of The assessment of terrorist offenders: a commentary on the Dernevik et al. article and suggestions for future directions

Journal of Forensic Psychiatry & Psychology, 2009

Research paper thumbnail of Methodological development: Structured outcome assessment and community risk monitoring (SORM)

International Journal of Law and Psychiatry, 2005

Background: Violence is one of the leading causes of unnatural deaths, and the consequences of vi... more Background: Violence is one of the leading causes of unnatural deaths, and the consequences of violence for victims, victims' families, offenders, and society at large involve extensive suffering and monetary costs. Improving strategies to prevent and reduce violence is of great importance, and refining techniques for risk assessments in forensic and correctional settings is assumed to be one way of doing so. The procedures currently used for risk assessment mainly focus unchangeable, static risk factors, and provide few directions as to what clinicians can do in order to decrease a client's risk by treatment and management. The aim of this thesis was to improve understanding of the violence relapse process, to identify triggers and protective factors for violence among mentally disordered offenders, and to develop a structured model for the management of violence risk in forensic mental health after-care. Methods: This thesis used both qualitative and quantitative research designs. To identify protective factors of violent behaviour we interviewed individuals, selected from a cohort of 401 violent offenders who had unexpectedly ended their criminal career (n=4; Paper I). Semistructured interviews were likewise conducted to explore the violence relapse process and communication of risk among offenders who had relapsed into criminal violence (n=14; Paper II). Content analysis was used for the exploration of data. In the quantitative studies, which aimed to identify triggers of violence among offenders, we used the case-crossover design, by which each subject serves as his or her own control. Structured interviews were performed with 133 violent offenders with respect to hypothesised triggers (Papers III and IV). Standard Mantel-Haenszel methods were used for the statistical analyses. To develop a structured model for the management of mentally disordered offenders, we gathered law, criminology, and mental health professionals with different educational backgrounds to elicit clinically relevant contextual and individual factors related to the individual outcome following forensic psychiatric hospitalisation (Paper V). Results: Qualitative studies suggested that the desistance process among individuals with long criminal and violent "careers" was triggered by a shocking experience related to their criminal lifestyle and insight about the negative consequences to that lifestyle. Suggested protective factors were a strong relationship with family, social and geographical isolation, and the identification and avoidance of potential risk situations. Important risk factors in the relapse process were separations, drug problems, homelessness, and acute risk factors were lack of sleep, substance intoxication and conflicts. Some of these acute risk factors of violence were tested and confirmed in the quantitative case-crossover study. Acute suicidal ideation/ parasuicide and alcohol intoxication were among the most important triggering factors. Acute conflicts and being denied psychiatric care also increased the risk of criminal violence. In contrast, potential inhibitors of violence were regular doses of benzodiazepines and antidepressants. All but one of the mentally disordered offenders interviewed in the relapse study had, by their own account, communicated that there was a risk of acting violently. The communication patterns were directed towards professionals and acquaintances and were verbal and non-verbal. Finally, a structured model for management of violence risk in forensic psychiatric after-care called the SORM (Structured Outcome Assessment and Community Risk Monitoring) was developed. Conclusions: This thesis points to several potentially fruitful research areas for the violence prevention field. Previously, communication of risk has only been addressed in clinical work with suicidal patients, even though this may be of substantial interest also in the field of violence prevention. Some triggering and protective factors of violence among mentally disordered offenders were identified in this thesis, but needs to be replicated in future studies. The case-crossover design, for the first time applied to study triggers of aggressive acts, may substantially advance research on acute risk factors of violence.

Research paper thumbnail of A response to Dr. Gudjonsson's commentary

Journal of Forensic Psychiatry & Psychology, 2009

We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial ... more We thank Dr Gudjonsson for his thoughtful response to our article on a complex and controversial issue. He places our paper in the context of the Home Office commissioning independent 'experts' to conduct risk assessments. It was indeed such an assessment that ...

Research paper thumbnail of Self-Serving Cognitive Distortions and Antisocial Behavior Among Adults and Adolescents

Criminal Justice and Behavior, 2011

The reliability and validity of the self-report questionnaire How I Think (HIT), designed to asse... more The reliability and validity of the self-report questionnaire How I Think (HIT), designed to assess self-serving cognitive distortions related to antisocial behavior, was tested among Swedish incarcerated and non-incarcerated adults and adolescents (N = 364). The results showed that self-serving distortions were more common among incarcerated individuals and that they predicted self-reported antisocial behavior among adults. Confirmatory factor analysis revealed, in contrast to earlier findings, that the underlying structure of the HIT was best explained by a 3-factor-solution with 1 major cognitive factor, referred to as "criminal mind". It was concluded that the HIT, after further examination of its structural and divergent validity, could be used as a measure of criminal thinking in adults as well as in adolescents.

Research paper thumbnail of Publications & Presentations