Purpose
The majority of patients treated at forensic psychiatric outpatient facilities suffer from personality disorders, especially Cluster B disorders. Life events have been shown to influence subjective well-being, severity of psychopathology and delinquent behaviour of patients with different personality disorders. However, the influence of life events on subjective well-being of patients suffering from Cluster B personality disorders has rarely been studied. Following General Strain Theory and the dynamic equilibrium model, we hypothesised that negative life events would negatively influence subjective well-being, and that subjective well-being would change when an instability of life events occurs.
Methods
Fifty-six adult male forensic psychiatric outpatients were interviewed on their subjective well-being and filled out a self-report life event questionnaire, at three time-points, with an interval of three months. Life events were categorized along two dimensions: positive / negative and controllable / uncontrollable.
Results
Patients had a stable pattern of positive, negative controllable and uncontrollable life events. Positive controllable events did not have a stable pattern. Results indicated that only negative controllable events correlated negatively with subjective well-being. Furthermore, positive and positive controllable events correlated with a positive change in subjective well-being and uncontrollable events correlated negatively with this change.
Conclusions
Forensic psychiatric outpatients seem to experience a relatively stable ‘load’ of stressful life events, that does not influence change in subjective well-being. We did not find unequivocal support for General Strain Theory. In line with the dynamic equilibrium model, forensic outpatients seemed less used to positive controllable life events, which influenced positive change in subjective well-being. In outpatient forensic treatment, attempts to limit negative life events together with enhancing behaviour which results in positive events should be targeted. This might result in better lives for patients and in reduced criminal behaviour.
Abbreviations
LE, life events; PD, personality disorder; SWB, subjective well-being; LQoLP, Lancashire Quality of Life Profile; QREE, Questionnaire of Recently Experienced Events; P/N, positive / negative (life events); C/U, controllable / uncontrollable (life events); LCU, Life Change Units
It is well known that stressful life events influence the subjective well-being of people in general (Lu, 1999, Lucas et al., 2004, Lucas et al., 2003, Suh et al., 1996 and Zautra and Majo, 1981), and of patients suffering from mental disorders such as schizophrenia (Chan, Ungvari, Shek, & Leung, 2003), bipolar disorder (Chand, Mattoo, & Sharan, 2004) and depression (Roy, 1996), in particular. Besides subjective well-being, life events (LE) also influence the severity of psychopathology. For instance, positive and negative LE correlated with depression in college students (Dixon & Reid, 2000) and in patients with personality disorders (PD; Perry, Lavori, Pagano, Hoke, & O'Connell, 1992), and negative LE are related to an increased symptom count in Cluster B PD patients (Taylor, 2005).
The majority of individuals treated at forensic outpatient facilities in The Netherlands suffer from a personality disorder, especially Cluster B PD, that is, antisocial, narcissistic, borderline and histrionic PD (American Psychiatric Association, 2000 and Hildebrand and de Ruiter, 2004). In this field of psychiatry, preventing criminal recidivism is the main treatment goal, and several studies have indicated that life events in general (Steadman and Ribner, 1982 and Vaux and Ruggiero, 1983) and specific life events in particular (such as witnessing violence, receiving traumatic news, marriage; Eitle and Turner, 2002 and Ouimet and Le Blanc, 1996) influence delinquent behaviour and criminal recidivism. In this study, we examined life events and subjective well-being in a group of 56 male forensic psychiatric outpatients.
