Association of Self-Rated Attribution of Blame for Criminal Acts and of Psychiatric Symptoms Among Patients Undergoing Specialist Forensic Psychiatric Treatment in Japan.

Background: Treatment goals for offenders with mental disorders include restoring and maintaining health, establishing social participation and preventing negative outcomes, including further offending. The development of patient insight into their prior offences may facilitate their reintegration into society and prevent further harms.

Aims: To find out whether, among offenders with mental disorder, their own causal attribution of their criminal acts, based on the Japanese version of the Gudjonsson blame attribution inventory-revised (GBAI-R-J), is associated with psychiatric symptoms according to the positive and negative syndrome scale (PANSS) ratings.

Methods: A cross-sectional study was conducted by collecting data from 45 patients in forensic psychiatric services, both in- and out-patients. All participants had a psychosis and a history of serious crimes. Attribution of blame was self-rated in the same session during which a clinician rated their symptoms using the PANSS. GBAI-R-J scores were converted into a categorical variable by allocating each participant into one of two groups-those scoring up to the half point or those scoring at or above it on each subscale. The three PANSS scale scores were treated as continuous variables.

Results: There was a significant positive relationship between the GBAI-R-J externalising blame scores and PANSS scores for positive symptoms and general psychopathology but not for negative symptoms. Neither the acceptance of personal the guilt factor nor the mental element factor, which imply attribution of the offence to mental disorder, was significantly related to any aspect of symptoms.

Conclusions: This is the first study to compare blame attribution for a serious index offence and mental state simultaneously, albeit at various stages of treatment and time after the offence. The association of persistent positive symptoms with externalising blame is understandable in terms of the nature of the symptoms, almost invariable including paranoid delusions. The absence of a relationship with acceptance of guilt or understanding the role of mental disorder in the offending suggests that many of these patients require further treatment to accept personal agency. A longitudinal study is indicated to test these possibilities further.