CrimeTibecNCT07162909
The Time Before the Crime - Risk Patterns in Offenders Undergoing a Forensic Psychiatric Evaluation
An observational study of Crime, run by Karolinska Institutet at 1 site in Sweden.
Trial summary
The overarching aim of the research project is to identify risk patterns preceding criminal acts among individuals later subject to forensic psychiatric evaluation (FPE) in Sweden, including factors within psychiatric care as well as broader individual or contextual factors. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Crime
- How many people
- 500 participants
- Where
- 1 siteSweden
- Study dates
- 1 Jun 2026to 31 Dec 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Case group: individuals ≥ 18 years who had contact with at least one psychiatric care provider within Region Stockholm, Sweden. This included both clinics operated by a Swedish healthcare region and private clinics operating under regional agreements. Individuals eligible for the case group were those whose psychiatric medical records were requested by the Swedish National Board of Forensic Medicine (NBFM) in 2023 for the purpose of conducting a forensic psychiatric evaluation, either a preliminary assessment (§7 examination) or a full forensic psychiatric evaluation (FPE). Control group: Similar individuals, but whose psychiatric medical records were not requested by the NBFM in 2023 for the purpose of conducting a forensic psychiatric evaluation.
Who may be able to join
- Age ≥ 18 years
- Contact with a psychiatric care provider within Region Stockholm
- Medical records requested by the NBFM in 2023 for forensic psychiatric evaluation
- Age ≥ 18 years
- Contact with a psychiatric care provider within Region Stockholm
- Medical records NOT requested by the NBFM in 2023 for forensic psychiatric evaluation
Show all 10Show fewer
- Matching criteria:
- Gender (male/female)
- Age group (18-24, 24-39 and >39 years)
- Psychiatric care unit
Who cannot join
- No registered psychiatric care contact in Region Stockholm's shared electronic medical record system, three months prior to the date of the index offense.
- The index offense before 2018.
- Individual previously underwent an FPE at some point.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Sweden1 site, 1 recruiting
- Recruiting
Karolinska Institutet
Stockholm
Katarina Howner, MD, PhD, ass prof, +46725989418, katarina.howner@ki.se
Tim Tengberg, MD, PhD-student
About this study
Official title: The Time Before the Crime: Risk Patterns in Individuals Who Commit Criminal Acts and Undergo a Forensic Psychiatric Evaluation
The overarching aim of the research project is to identify risk patterns preceding criminal acts among individuals later subject to forensic psychiatric evaluation (FPE) in Sweden, including factors within psychiatric care as well as broader individual or contextual factors.
Although individuals who undergo an FPE represent a small subset of all individuals who commit criminal acts, the implications of being sentenced to forensic psychiatric care are profound. In Sweden, approximately 300 individuals are transferred to forensic psychiatric care each year, with a median duration of 7.5 years. Notably, the number of admissions exceeds the number of discharges annually, resulting in a growing forensic psychiatric population. This increasing trend underscores the need for increased knowledge and preventive efforts. All forensic psychiatric patients undergo an FPE before the sentencing, and previous studies show that most of these individuals were already known to the psychiatric system prior to the offenses, which means that individuals in these groups are overlapping. However, the mean length of stay in psychiatric inpatient compulsory care is much shorter than that in forensic psychiatric care. Clinical expertise from FPEs suggests that identifiable risk patterns may exist before the criminal offence. The question of whether such potential risk patterns exist within this patient group has not been systematically studied before, which is why the current study aims to investigate this issue. Can risk patterns be identified within psychiatric care prior to the offense? If risk patterns can be identified, knowledge of such risk patterns could hopefully increase risk awareness within psychiatric services and lead to more frequent and accurate violence risk assessments. Knowledge of such risk patterns could also serve as a foundation for preventive measures. The long-term goal is to reduce the likelihood that individuals receiving psychiatric care progress to becoming forensic psychiatric patients.
Read the detailed description
Case-control study
Design and methodology:
The study is designed as a case-control study. The study population consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were requested by the NBFM in 2023 for forensic psychiatric evaluation (§ 7-evaluation or FPE), estimated to be n=250.
The control group consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were not requested by the NBFM in 2023. The control group is matched to the study population based on gender, age and psychiatric care unit (psychiatric intensive care units, psychosis ward, general psychiatric ward, psychiatric outpatient clinic, psychiatric emergency unit). Thereby we hope that the control group will consist of individuals with similar psychiatric conditions and care burden as the study population.
An exclusion criterion for the study population is if the offense underlying the NBFM request for the medical records (the index offense) occurred before 2018. This is because the study aims to investigate psychiatric care as it is currently structured and provided. An exclusion criterion for the control group is if the individual previously underwent an FPE at some point. Additional exclusion criteria for both groups are if there is no registered psychiatric care contact in Region Stockholm's shared electronic medical record system, TakeCare, three months prior to the date of the index offense.
The individuals whose medical records were requested by the NBFM in 2023 for forensic psychiatric evaluations (§ 7 evaluation or FPE) are identified by retrieving data from TakeCare. The NBFM's requests for medical records are documented routinely with a specific search term in TakeCare, minimizing the risk of missing data. Once the individuals in the study population are identified, their personal identification numbers (PINs) are sent to the NBFM. Based on the PINs, the NBFM retrieves the relevant dates of criminal offenses for each individua in the study population. Additional variables are also identified in the NBFM case management system, including criminal charges, prior convictions, information about substance use at the time of the offense, and court rulings. If an individual has committed multiple offenses, the most serious offense is selected, i.e., the one with the highest penal value. In cases of repeated offenses with similar penal value or multiple offenses within the same criminal charge category, the date of the first offense is chosen as the index crime.
The retrospective record review is conducted systematically based on a predefined review template containing 26 markers. Each marker has a specific definition. During the planning phase of the project, the project team received input from a reference group consisting of professionals from various areas within healthcare. The reference group participated in meetings during the project's planning phase. The development of the 26 markers in the review template was carried out in collaboration with the reference group to ensure that the markers are as relevant and specific as possible. The review period is set to three months prior to the date of the alleged offense, as this is considered the period in which there would be the greatest opportunity to design specific interventions. In the control group, the medical record review is based on the same month as the dates of the matched offenses.
- Conditions
- Crime
- Keywords
- severe mental disorder, forensic psychiatric evaluation, risk patterns, violence
- Medical subject headings
- Mental Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| Cases | The study population consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were requested by the National Board of Forensic Medicine (NBFM) in 2023 for forensic psychiatric evaluation (§ 7-evaluation or FPE), estimated to be n=250. | |
| Controls | The control group consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were not requested by the NBFM in 2023. The control group is matched to the study population based on gender, age and psychiatric care unit (psychiatric intensive care units, psychosis ward, general psychiatric ward, psychiatric outpatient clinic, psychiatric emergency unit). Thereby we hope that the control group will consist of individuals with similar psychiatric conditions and care burden as the study population. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Risk markers
26 predefined risk markers that will be searched for in the retrospective record review. All risk markers have their own specific definition. For detailed description, see attached document.
Measured: All risk makers will be searched for in the three-month period before the date of the criminal act (case croup) and also in a three-month period for the control group.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Sep 2025
- Study start1 Jun 2026
- Primary completion1 Jun 2027 (estimated)
- Study completion31 Dec 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for CrimeStudies of the same condition, open and under way.
- More trials run by Karolinska InstitutetThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Case-control
- Time perspective
- Retrospective
- Enrolment
- 500 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Karolinska Institutet
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Katarina Howner, Karolinska Institutet
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07162909
- Sponsor's protocol ID
- 2024-07566-01
- Acronym
- Tibec
- Status last verified
- Aug 2026
- First submitted
- 23 Jun 2025
- Last updated
- 19 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 19 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Time Before the Crime: Risk Patterns in Individuals Who Commit Criminal Acts and Undergo a Forensic Psychiatric Evaluation
- ClinicalTrials.gov ID
- NCT07162909
- Acronym / sponsor ID
- Tibec / 2024-07566-01
- Conditions
- Crime
- Keywords
- severe mental disorder, forensic psychiatric evaluation, risk patterns, violence
- Study type
- Observational
- Recruitment status
- Recruiting
- Enrolment
- 500 participants (estimated)
- Lead sponsor
- Karolinska InstitutetUniversity, hospital or other
- Study start
- 1 Jun 2026 (actual)
- Primary completion
- 1 Jun 2027 (estimated)
- Study completion
- 31 Dec 2027 (estimated)
- First posted
- 9 Sep 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The overarching aim of the research project is to identify risk patterns preceding criminal acts among individuals later subject to forensic psychiatric evaluation (FPE) in Sweden, including factors within psychiatric care as well as broader individual or contextual factors.
Although individuals who undergo an FPE represent a small subset of all individuals who commit criminal acts, the implications of being sentenced to forensic psychiatric care are profound. In Sweden, approximately 300 individuals are transferred to forensic psychiatric care each year, with a median duration of 7.5 years. Notably, the number of admissions exceeds the number of discharges annually, resulting in a growing forensic psychiatric population. This increasing trend underscores the need for increased knowledge and preventive efforts. All forensic psychiatric patients undergo an FPE before the sentencing, and previous studies show that most of these individuals were already known to the psychiatric system prior to the offenses, which means that individuals in these groups are overlapping. However, the mean length of stay in psychiatric inpatient compulsory care is much shorter than that in forensic psychiatric care. Clinical expertise from FPEs suggests that identifiable risk patterns may exist before the criminal offence. The question of whether such potential risk patterns exist within this patient group has not been systematically studied before, which is why the current study aims to investigate this issue. Can risk patterns be identified within psychiatric care prior to the offense? If risk patterns can be identified, knowledge of such risk patterns could hopefully increase risk awareness within psychiatric services and lead to more frequent and accurate violence risk assessments. Knowledge of such risk patterns could also serve as a foundation for preventive measures. The long-term goal is to reduce the likelihood that individuals receiving psychiatric care progress to becoming forensic psychiatric patients.
Detailed description
Case-control study
Design and methodology:
The study is designed as a case-control study. The study population consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were requested by the NBFM in 2023 for forensic psychiatric evaluation (§ 7-evaluation or FPE), estimated to be n=250.
The control group consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were not requested by the NBFM in 2023. The control group is matched to the study population based on gender, age and psychiatric care unit (psychiatric intensive care units, psychosis ward, general psychiatric ward, psychiatric outpatient clinic, psychiatric emergency unit). Thereby we hope that the control group will consist of individuals with similar psychiatric conditions and care burden as the study population.
An exclusion criterion for the study population is if the offense underlying the NBFM request for the medical records (the index offense) occurred before 2018. This is because the study aims to investigate psychiatric care as it is currently structured and provided. An exclusion criterion for the control group is if the individual previously underwent an FPE at some point. Additional exclusion criteria for both groups are if there is no registered psychiatric care contact in Region Stockholm's shared electronic medical record system, TakeCare, three months prior to the date of the index offense.
The individuals whose medical records were requested by the NBFM in 2023 for forensic psychiatric evaluations (§ 7 evaluation or FPE) are identified by retrieving data from TakeCare. The NBFM's requests for medical records are documented routinely with a specific search term in TakeCare, minimizing the risk of missing data. Once the individuals in the study population are identified, their personal identification numbers (PINs) are sent to the NBFM. Based on the PINs, the NBFM retrieves the relevant dates of criminal offenses for each individua in the study population. Additional variables are also identified in the NBFM case management system, including criminal charges, prior convictions, information about substance use at the time of the offense, and court rulings. If an individual has committed multiple offenses, the most serious offense is selected, i.e., the one with the highest penal value. In cases of repeated offenses with similar penal value or multiple offenses within the same criminal charge category, the date of the first offense is chosen as the index crime.
The retrospective record review is conducted systematically based on a predefined review template containing 26 markers. Each marker has a specific definition. During the planning phase of the project, the project team received input from a reference group consisting of professionals from various areas within healthcare. The reference group participated in meetings during the project's planning phase. The development of the 26 markers in the review template was carried out in collaboration with the reference group to ensure that the markers are as relevant and specific as possible. The review period is set to three months prior to the date of the alleged offense, as this is considered the period in which there would be the greatest opportunity to design specific interventions. In the control group, the medical record review is based on the same month as the dates of the matched offenses.
Study design
- Observational model
- Case-control
- Time perspective
- Retrospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Cases | – | –The study population consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were requested by the National Board of Forensic Medicine (NBFM) in 2023 for forensic psychiatric evaluation (§ 7-evaluation or FPE), estimated to be n=250. |
| Controls | – | –The control group consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were not requested by the NBFM in 2023. The control group is matched to the study population based on gender, age and psychiatric care unit (psychiatric intensive care units, psychosis ward, general psychiatric ward, psychiatric outpatient clinic, psychiatric emergency unit). Thereby we hope that the control group will consist of individuals with similar psychiatric conditions and care burden as the study population. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Case group: individuals ≥ 18 years who had contact with at least one psychiatric care provider within Region Stockholm, Sweden. This included both clinics operated by a Swedish healthcare region and private clinics operating under regional agreements. Individuals eligible for the case group were those whose psychiatric medical records were requested by the Swedish National Board of Forensic Medicine (NBFM) in 2023 for the purpose of conducting a forensic psychiatric evaluation, either a preliminary assessment (§7 examination) or a full forensic psychiatric evaluation (FPE). Control group: Similar individuals, but whose psychiatric medical records were not requested by the NBFM in 2023 for the purpose of conducting a forensic psychiatric evaluation.
Key inclusion criteria (10 listed)
- Age ≥ 18 years
- Contact with a psychiatric care provider within Region Stockholm
- Medical records requested by the NBFM in 2023 for forensic psychiatric evaluation
- Age ≥ 18 years
- Contact with a psychiatric care provider within Region Stockholm
Key exclusion criteria (3 listed)
- No registered psychiatric care contact in Region Stockholm's shared electronic medical record system, three months prior to the date of the index offense.
- The index offense before 2018.
- Individual previously underwent an FPE at some point.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Risk markers
Time frame: All risk makers will be searched for in the three-month period before the date of the criminal act (case croup) and also in a three-month period for the control group.
26 predefined risk markers that will be searched for in the retrospective record review. All risk markers have their own specific definition. For detailed description, see attached document.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 19 Aug 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Crime, run by Karolinska Institutet at 1 site in Sweden.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 10 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 19 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Katarina Howner, MD, PhD, ass prof (+46725989418, katarina.howner@ki.se), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Risk markers (time frame: All risk makers will be searched for in the three-month period before the date of the criminal act (case croup) and also in a three-month period for the control group.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 19 Aug 2026; AzTrials last refreshed its copy on 31 Oct 2026.