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Background:  Long-term violent re-offending in forensic psychiatric (FP) patients  vs . non-FP offenders is largely unknown.    Methods:  We studied rates and facets of long-term violent reoffending among 1,062 violent forensic psychiatric examinees (FPE) consecutively undergoing pre-trial, forensic psychiatric examination (FPE) in Denmark during 1980–1992. Altogether, 392 were sentenced to  FP treatment  (FPE+T); the remaining 670 examinees received ordinary non-FP sanctions (FPE-T). FPE+T were compared to 392 contemporary  matched violent general offenders  (GEN) without FPE or other psychiatric contacts and sentenced to ordinary non-FP sanctions. FPE data were linked to population-based registers with sociodemographic, psychiatric, and crime information, and we estimated relative risks controlling for birth year, sex, educational and marital status, and previous violent crime.    Results:  During follow-up (mean = 18.0–19.5 years), FPE+T and GEN had  any violent recidivism  rates of 43%  vs . 29% [adjusted hazard ratio (aHR) = 1.5; 95% CI, 1.1–1.9], respectively. Corresponding findings for  severe violence  (21%  vs . 14%; aHR = 1.3; 95% CI, 0.9–1.9) and  recurrent violence  (3+ violent convictions; 16%  vs . 6%; adjusted odds ratio [aOR] = 2.5; 95% CI, 1.5–4.4) also suggested weakly to moderately increased risks in FPE+T, albeit non-significantly for the former. Comparing FPE+T to FPE-T suggested  decreased  risk of  any violence  (43%  vs . 51%; aHR = 0.8; 95% CI, 0.6–1.1),  severe  (21%  vs . 34%; aHR = 0.6; 95% CI, 0.4–0.8), and  recurrent violence  [16%  vs . 22%; adjusted odds ratio (aOR) = 0.7; 95% CI, 0.5–1.0] in FP patients, though non-significantly for any violence and recurrent violence. Among all FPE examinees, violent reoffending was independently predicted by male sex, younger age, pre-index violent crime, personality disorder ( vs . schizophrenia spectrum and other psychiatric disorder), substance use disorder, and 5+ hospital admissions.    Conclusion:  FPE examinees, untreated followed by treated, reoffend violently more often than GENs. Similar trends are suggested also for severe and recurrent violence suggesting a need for continua of services for FPE examinees, independently of medico-legal status (i.e., sentencing to treatment or not).

Long-Term Violent Reoffending Following Forensic Psychiatric Treatment: Comparing Forensic Psychiatric Examinees and General Offender Controls