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Background Forensic psychiatry is often associated with long admissions and has a high cost of care. There is little known about factors influencing length of stay (LOS), and no previous systematic review has synthesised the available data. This paper aims to identify factors influencing the LOS in forensic psychiatry hospitals to inform care and interventions that may reduce the length of admissions. Methodology A systematic review was conducted by searching major databases, including PubMed, EMBASE and PsycInfo, from inception until May 2022. Observational studies conducted in forensic hospitals that examined associations between variables of interest and LOS were included. Following data extraction, the Newcastle‒Ottawa Scale was used for quality appraisal. No meta-analysis was conducted due to heterogeneity of information; a quantitative measure to assess the strength of evidence was developed and reported. Results A total of 28 studies met the inclusion criteria out of 1606 citations. A detailed quantitative synthesis was performed using robust criteria. Having committed homicide/attempted homicide, a criminal legal status with restrictions, and a diagnosis of schizophrenia-spectrum disorders were all associated with longer LOS. Higher Global Assessment of Functioning (GAF) scores were associated with a shorter LOS. Conclusion High-quality research examining factors associated with LOS in forensic psychiatry is lacking, and studies are heterogeneous. No modifiable characteristics were identified, and thus, practice recommendations were not made. There is an increasing necessity to understand the factors associated with longer admissions to inform care and increase success in reintegration and rehabilitation. This paper provides recommendations for future research.

The public health community needs to better understand the complex factors that contribute to mass shootings in the United States (US). We explored how firearm dealership density related to geographic distance from mass shooting sites in the US in 2010-2020, and compared it with the corresponding density of Starbucks (Starbucks Corporation, Seattle, Washington, United States) and McDonald’s (McDonald's Corporation, Chicago, Illinois, United States) outlets. We obtained locations of firearm dealerships, Starbucks, and McDonald's retailers, as well as mass shootings across the contiguous US from 2010 to 2020. We mapped buffer rings, at 1, 5, 10, 30, and 50 miles around the locations of each mass shooting. We compared the per area and per population density of the dealerships and the two types of retailers around mass shooting sites within each buffer ring. We identified 67 mass shootings from 2010-2020. We mapped 54,722 firearm dealerships, with 28.1% located within 50 miles of mass shootings. Within a 50-mile radius of shooting events, there were an average of 0.30 dealerships, while there were only 0.14 Starbucks and 0.12 McDonald’s outlets per 10 square miles. There was an incremental reduction in the density of firearm dealerships, Starbucks, and McDonald’s as the distance from the mass shooting site increased. Density per population did not show a similar relationship. Our findings suggest that the availability of firearms deserves more study as a contributing factor to mass shootings in the US. The high number, area, and population density of firearm dealerships compared to the other two retailers illuminate how numerous firearm dealerships are compared to common retailers in the US.