Aggressive and self-harming behaviour among psychiatric inpatients in a specialised prison hospital: a retrospective cohort study.

BACKGROUND: Aggressive behaviour and self-harming behaviour are common psychiatric emergencies in correctional settings, yet little is known about the factors distinguishing these behavioural presentations in psychiatric inpatients. This study compared the sociodemographic and clinical characteristics of psychiatric inpatients presenting with aggressive or self-harming behaviour in a specialised prison hospital. METHODS: In this retrospective cohort study, routinely collected data from 643 psychiatric inpatients admitted to the Berlin Prison Hospital (2010-2016) were analysed. Patients presenting with aggressive behaviour (n = 73) or self-harming behaviour (n = 60) were each compared with the remaining psychiatric inpatients using multivariable logistic regression. RESULTS: Schizophrenia spectrum disorders were independently associated with lower odds of self-harming behaviour after multivariable adjustment. Parenthood was independently associated with lower odds of aggressive behaviour and higher odds of self-harming behaviour. In contrast, stress-related disorders and personality disorders were not independently associated with either behavioural presentation after adjustment. CONCLUSIONS: Aggressive and self-harming behavioural emergencies were associated with different clinical and sociodemographic characteristics among psychiatric inpatients in a specialised prison hospital. Parenthood emerged as the most consistent independent correlate of aggressive and self-harming behaviour presentation, whereas schizophrenia spectrum disorders were independently associated with lower odds of self-harming behaviour. These findings may contribute to behaviour-specific risk assessment and prevention strategies in correctional psychiatry.