The impacts of therapeutic interventions on reducing aggression among individuals in forensic psychiatric settings: A scoping review

Aggression is prevalent in forensic psychiatric settings and poses significant risks to both patients and staff. However, the existing evidence on interventions against aggression has not been comprehensively synthesized. In this scoping review, we map the therapeutic interventions against aggression in forensic psychiatric settings and summarize their reported effects. This review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines ( https://osf.io/bkfs9 ). A comprehensive search was performed in MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, EMCARE, and Evidence-Based Medicine Reviews, without restrictions on date or language to identify eligible reports. Study selection, data extraction and quality assessment were performed independently by at least two reviewers. Of the 1,375 records identified, 53 studies met inclusion criteria. Studies were set in different countries, including United Kingdom ( n = 18) and United States ( n = 12) among others. Psychological and behavioral interventions were described in nearly two-thirds of the included studies and generally associated consistently with positive outcomes, albeit multi-modal interventions that combined several strategies such as behavioural, psychological, pharmacological, environmental, technological and others were frequently used. Interventions that were both staff- and patient-centered demonstrated the most favorable effects. However, substantial methodological heterogeneity and differences in reporting limit comparability. The available evidence suggests that structured, multi-component therapeutic interventions are effective against aggression. Future research should use standardized outcome measures, rigorous designs and globally representative samples to enhance the strength and clinical applicability of the findings.