This study examines whether clinical need subgroups in forensic care have evolved over 20 years and explores differences in adverse childhood experiences (ACEs) and assaultive behaviors across groups. This retrospective observational study used data from a hospital for men; Sample 1 (S1, N = 97) collected in 1990, and Sample 2 (S2, N = 176) in 2009–2012. A data-driven multiple correspondence analysis and a cluster analysis was conducted on S1 based on clinical needs, then applied to S2. ACEs and assault proportions within each cluster were compared using chi-square tests. Clusters identified: minimal needs (S1 = 23%, S2 = 20%); psychotic disorders (S1 = 19%, S2 = 17%); personality disorders (S1 = 21%, S2 = 22%); complex needs (S1 = 37%, S2 = 41%). Participants reporting ACEs (p = .004) and assault (p < .001) differed between clusters. The third cluster reported the highest ACEs (84.6%) and assault (61.5%).
Plain Language Summary
Clinical subgroups of hospitalized forensic service users: Changes over a 20-year period and implications for care
This study examined whether subgroups of men hospitalized in a forensic psychiatric facility could be identified based on their clinical needs. It also explored whether the proportion of men reporting adverse childhood experiences (ACEs) and exhibiting assaultive behavior during hospitalization differed significantly across these subgroups. Data were drawn from two samples: Sample 1 from 1990 (97 individuals) and Sample 2 from 2009–2012 (176 individuals). Using a data-driven approach, subgroups were identified in the 1990 sample based on clinical characteristics. The same grouping structure was then applied to the second sample to assess whether subgroup proportions changed over time. Finally, the prevalence of ACEs and assaultive behavior was compared across the different subgroups. Four clinical needs subgroups were identified: Minimal needs (Sample 1: 23%; Sample 2: 20%), Psychotic disorders (Sample 1: 19%; Sample 2: 17%), Personality disorders (Sample 1: 21%; Sample 2: 22%), and Complex needs (Sample 1: 37%; Sample 2: 41%) Statistical comparisons revealed significant differences across groups in both childhood adversity and assaultive behavior. The personality disorders group stood out: 84.6% reported ACEs, and 61.5% had engaged in assaultive behavior. These findings suggest a growing proportion of service users with complex clinical needs over time. The results highlight the importance for forensic psychiatric services to adopt trauma-responsive and individualized care approaches that address specific treatment needs.
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