166 Chapter 6 Cauwer, Leenders, Vloemans, Mondelaers, & Viaene, 2020; Sheridan Rains et al., 2021). More knowledge regarding the psychosocial impact of social distancing on forensic psychiatric populations is necessary to effectively address potential future pandemics. Therefore, this mixed methods prospective cohort study aimed to explore the impact of the COVID-19 restrictions on social relationships of forensic psychiatric outpatients with pre-existing social network-related problems. In this study, the following research questions and hypotheses for this forensic outpatient population were addressed: (1) What is the self-perceived quality of social relationships before the COVID-19 restrictions? We expected high levels of dissatisfaction on social relationships. (2a) What are the self-perceived changes in quality of social relationships due to the COVID-19 restrictions? Deteriorated social relationships were expected. (2b) What are the self-perceived changes in quality of social relationships due to the COVID-19 restrictions over time? We expected more deteriorated social relationships over time(3) (3) What is the effect of loneliness and social support on self-perceived changes in quality of social relationships due to the COVID-19 restrictions? We expected that pre-existing social network-related problems, such as loneliness and lower levels of social support, would predict adverse changes in social relationships. METHODS Data from an ongoing randomized controlled trial (RCT) among forensic psychiatric outpatients at Inforsa Forensic Outpatient Care, a department of Arkin Mental Health Institute in Amsterdam, the Netherlands, was used in this mixed methods prospective cohort study (Swinkels et al., 2020). Inforsa provides outpatient mental healthcare for youth and (young) adults with complex addiction, psychiatric and personality disorders, and a risk of delinquent behavior. Treatment consists of ambulatory psychotherapies (e.g., cognitive behavioral therapy, eye movement desensitization, and reprocessing) and/or forensic flexible assertive community treatment (FACT) (van Veldhuizen, 2007). Our study sample contains 70 ethnically diverse, predominantly male patients (89%), in the age between 17 and 67 years (M = 40.89, SD = 12.69). Participants were included in the RCT before as well as during the COVID-19 pandemic (between April 2018 and April 2021), and still participated after the start of the restrictions announced by the Dutch government on the 12th of March 2020. They received either treatment as usual (TAU) or TAU with the
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