PTSD outcomes in forensic settings
Research type
Research Study
Full title
Posttraumatic Stress Disorder and Psychosis in Forensic Mental Health Settings: Prevalence, Risk and Clinical Outcomes
IRAS ID
324977
Contact name
Filipa Alves-Costa
Contact email
Sponsor organisation
Noclor on behalf of Barnet Enfield and Haringey NHS Trus
Duration of Study in the UK
0 years, 7 months, 31 days
Research summary
Exceedingly high rates of victimisation and exposure to trauma have been identified in forensic populations (Bohle & de Vogel, 2017; Bruce & Laporte, 2015; Green et al., 2017; McKenna et al., 2019). To date, studies have predominantly examined past exposure to trauma, including adverse childhood experiences, and its association with other factors (e.g. psychological distress, psychiatric comorbidity, violence risk, and attachment), leaving posttraumatic stress disorder (PTSD) out of the equation. Only a few studies have explored PTSD in a UK forensic mental health or prison samples (Brackenridge & Morissey, 2010; McCallum, 2019; Papanastassiou et al., 2004; Sarkar et al., 2005). Studies have yet to examine the prevalence and clinically relevant outcomes of those who have developed PTSD within secure forensic mental health settings. The proposed study aims to examine the prevalence of PTSD in forensic psychiatric settings and explore associated clinically relevant outcomes, including engagement with treatment, risk of violence, and psychological distress, which have previously been explored only in association with past traumatic experiences rather than in the context of meeting clinical diagnostic criteria for PTSD. The study will utilise a cross-sectional design. The sample will consist of 100 male and female forensic psychiatric patients with a diagnosis of a psychotic disorder who have the capacity to provide consent and have the ability to complete the two outcome measures (PDS-5 and CORE-OM). Their risk and engagement in treatment will be assessed by their psychologist using the HCR-20v3 and the SES respectively. The study intends to add to the growing body of literature on PTSD and trauma-informed care in forensic mental health settings as well as to inform policy and practice at North London Forensic Service and other secure services in the UK.
Lay summary of study results: The research was a cross-sectional study based in a UK forensic psychiatric unit examining the rates and impacts of PTSD symptoms on clinical outcomes, service engagement, and risk in patients with psychosis. The study analysed a sample of 48 patients (46 men and 2 women) who provided an informed consent to participate. Results revealed high rates of trauma exposure, with 65% of participants reporting multiple traumatic events across lifetime. PTSD symptoms were highly prevalent, with 39.6% meeting the threshold for a probable PTSD diagnosis. Only one patient had an existing PTSD diagnosis recognised on the hospital record-keeping system and nine (18.8%) patients accessed trauma-focused therapy during their admission. Significant correlations were found between PTSD symptoms and all four domains of psychological distress, as measured by the CORE-OM (wellbeing, symptomatology, life functioning, and subjective risk). No significant relationships were observed for PTSD with treatment engagement or risk of violence.
REC name
London - Camberwell St Giles Research Ethics Committee
REC reference
23/LO/0395
Date of REC Opinion
19 Jul 2023
REC opinion
Further Information Favourable Opinion