Intervening factors between risk of violence and aggressive behaviours among forensic inpatients: a scoping review

BACKGROUND: Risk of violence is closely associated with aggression propensity. However, there is a lack of research to explain the mechanisms behind this association, especially among the patients of forensic secure facilities. This review aimed to identify and synthesize the available literature concerning the intervening factors (mediating or moderating factors) in the relationship between the risk of violence and aggressive behavior in forensic secure facilities.

METHODS: Two electronic academic databases were searched: Scopus and Web of Science (WoS) using specific keywords as search terms derived from the PCC framework with no specific time limit. The search strategy was developed based on the JBI Manual for Evidence Synthesis and utilised the PRISMA-ScR guidelines. Data on the risk of violence, intervening factors, and aggressive behavior were extracted from the included studies. Further analysis was performed whereby similar data were grouped and synthesised together.

RESULTS: The initial search produced 342 studies. However, only nine studies fulfilled the inclusion criteria. The nine studies included 1,068 adult forensic inpatients from various psychiatric hospitals. Only mediation studies reported significant mechanisms of influence between the risk of violence and aggressive behavior. It is postulated that the human agency factor may be the underlying factor that influences a person's functioning and the subsequent series of events between the risk of violence and aggression.

CONCLUSIONS: In light of the paucity of evidence in this area, a generalised conclusion cannot be established. More studies are warranted to address the gaps before conclusive recommendations can be proposed to the relevant stakeholders.