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Objective predictors of outcome in forensic mental health services—a systematic review

  • Ottilie Sedgwick (a1) (a2) (a3), Susan Young (a2) (a4), Mrigendra Das (a2) and Veena Kumari (a1) (a3)


This systematic review aimed to examine whether neurobiological methods, or other methods independent of clinical judgment, have been investigated to assist decision making in forensic mental health services and, if so, whether this may be a useful strategy for predicting outcomes. OVID-Medline, Embase, and PsychInfo (inception–January 2015) were searched, limiting to English and human studies, using terms relating to “predict,” “outcome,” “psychiatry,” and “forensic” to identify primary research articles reporting on predictors of outcome in forensic mental health services not reliant on clinical judgment/self-report. Fifty studies investigating demographic, neuropsychological/neurophysiological, and biological predictors were identified, reporting on 3 broad outcomes: (i) inpatient violence, (ii) length of stay, (iii) reoffending. Factors associated positively, negatively, and showing no relationship with each outcome were extracted and compiled across studies. Of various demographic predictors examined, the most consistent associations were between previous psychiatric admissions and inpatient violence; a more “severe” offense and a longer length of stay; and young age and reoffending. Poor performance on tests of cognitive control and social cognition predicted inpatient violence while a neurophysiological measure of impulsivity showed utility predicting reoffending. Serum cholesterol and creatine kinase emerged as biological factors with potential to predict future inpatient violence. Research in this field is in its infancy, but investigations conducted to date indicate that using objective markers is a promising strategy to predict clinically significant outcomes.

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Corresponding author

*Address for correspondence: Ottilie Sedgwick, Department of Psychology (PO78), Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, UK. (Email:


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Ottilie Sedgwick receives funding support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley National Health Service (NHS) Foundation Trust and King’s College London. Veena Kumari is part funded by the Biomedical Research Centre for Mental Health at the Institute of Psychiatry, Psychology and Neuroscience King’s College London, and the South London and Maudsley NHS Foundation Trust, UK. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. The authors wish to thank Hannah Mullens for reading and providing constructive comments on an early draft of the manuscript.



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