Patients' perceptions of violence risk in forensic and general psychiatry: A convergent mixed-methods study

Purpose Violence risk assessment in psychiatry has traditionally relied on clinician-centered approaches, while comparatively little is known about how patients themselves understand violence and their own potential for violent behavior. This study examined how forensic and general psychiatric inpatients conceptualize violence and violence risk, including contributing factors, appraisal of personal risk, warning signs, and strategies for preventing escalation. We additionally examined how these accounts related to standardized measures of clinically relevant psychological and psychiatric factors. Methods One hundred hospitalized adults (50 forensic and 50 general psychiatry patients) completed semi-structured interviews exploring their understanding of violence, perceived triggers and personal risk factors, and strategies for preventing escalation. Participants also completed standardized measures of emotional dysregulation, psychiatric symptom severity, quality of life, and perceived stigma, which were used to provide complementary clinical context. Qualitative and quantitative data were analyzed independently and integrated during interpretation. Results Thematic analysis showed that participants in both groups conceptualized violence primarily as a dynamic and conditional process arising from interactions among psychiatric symptoms, emotional dysregulation, interpersonal conflict, substance use, and contextual stressors. Forensic participants more frequently identified individualized warning signs and structured strategies for preventing escalation, whereas general psychiatry participants more often described emotional crises as difficult to anticipate. Quantitative findings provided complementary context: forensic participants had lower emotional dysregulation and psychiatric symptom severity and higher physical and psychological quality of life, while perceived stigma did not differ significantly between groups. Conclusion Patients articulated clinically relevant knowledge regarding the circumstances, warning signs, and protective strategies associated with their own risk of behavioural escalation. Although forensic and general psychiatry participants shared broadly similar conceptualizations of violence, forensic participants more frequently described individualized warning signs and structured self-management strategies. Incorporating patients’ experiential knowledge may complement clinician-led violence risk assessment and support collaborative, recovery-oriented approaches to violence prevention.