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Background  Suicides are more common in forensic patients than in the general population. Two reasons for this discrepancy are discussed: (1) Suicides are the consequence of maladaptation to the restrictive living conditions in forensic psychiatry, and (2) suicides are explained by the demographic, social, and psychosocial characteristics of the inmates themselves, i.e., suicides happen because the inmates belong to a particularly vulnerable group. Therefore, the present study aimed to analyze the relationship between quality of life, as an indicator of the restrictive living conditions, and hopelessness, depression, and suicide ideations in a sample of forensic patients.    Methods  We assessed quality of life with a German version of the Measuring the Quality of Prison Life questionnaire that had been adapted to forensic hospitals (MQPL-forensic) and depressive symptoms with the Beck Depression Inventory, hopelessness with the Beck Hopelessness Scale, and suicide ideations with the Beck Scale for Suicide Ideation. The study included a total of 159 patients in 12 German forensic psychiatric hospitals who had been admitted in accordance with Section 64 of the German Criminal Code. We analyzed the relationships between quality of life and depression, hopelessness, and suicide ideations on the patient and hospital levels. Hospital characteristics were generated by aggregating the MQPL-forensic variables measured at the patient level.    Results  In generalized estimating equation models, the MQPL-forensic total score and almost all the subscale scores were significant negative predictors of depressive symptoms, hopelessness, and suicide ideations at the patient and hospital levels. At the patient level, patients who experienced a supportive welcome at the hospital, good relationships with their therapists, respectful interactions, transparent decisions, and supportive therapeutic approaches were significantly less depressed, less hopeless, and less likely to consider suicide. At the hospital level, good relationships with therapists and respectful interactions were significant negative predictors of these variables.    Discussion  The results indicate that the social framework within forensic psychiatric hospitals influences the frequency of suicide ideation and the severity of depressive symptoms and hopelessness among forensic patients. Forensic-psychiatric hospitals should be aware of these significant relationships and try to improve patients’ quality of life.

High Quality of Life Reduces Depression, Hopelessness, and Suicide Ideations in Patients in Forensic Psychiatry