The Intricate Link Between Violence and Mental Disorder Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Forensic Psychiatry Program and Clinic, Department of Psychiatry, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA.
Archives of general psychiatry (Impact Factor: 14.48). 03/2009; 66(2):152-61. DOI: 10.1001/archgenpsychiatry.2008.537
Source: PubMed


The relationship between mental illness and violence has a significant effect on mental health policy, clinical practice, and public opinion about the dangerousness of people with psychiatric disorders.
To use a longitudinal data set representative of the US population to clarify whether or how severe mental illnesses such as schizophrenia, bipolar disorder, and major depression lead to violent behavior.
Data on mental disorder and violence were collected as part of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a 2-wave face-to-face survey conducted by the National Institute on Alcohol Abuse and Alcoholism.
A total of 34 653 subjects completed NESARC waves 1 (2001-2003) and 2 (2004-2005) interviews. Wave 1 data on severe mental illness and risk factors were analyzed to predict wave 2 data on violent behavior.
Reported violent acts committed between waves 1 and 2.
Bivariate analyses showed that the incidence of violence was higher for people with severe mental illness, but only significantly so for those with co-occurring substance abuse and/or dependence. Multivariate analyses revealed that severe mental illness alone did not predict future violence; it was associated instead with historical (past violence, juvenile detention, physical abuse, parental arrest record), clinical (substance abuse, perceived threats), dispositional (age, sex, income), and contextual (recent divorce, unemployment, victimization) factors. Most of these factors were endorsed more often by subjects with severe mental illness.
Because severe mental illness did not independently predict future violent behavior, these findings challenge perceptions that mental illness is a leading cause of violence in the general population. Still, people with mental illness did report violence more often, largely because they showed other factors associated with violence. Consequently, understanding the link between violent acts and mental disorder requires consideration of its association with other variables such as substance abuse, environmental stressors, and history of violence.

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    • "Importantly, however, much of the research linking mental health symptoms to IPV perpetration has been derived from non treatment-seeking samples and has tended not to include those with severe mental illness (SMI), such as psychotic or major mood disorders. Given the interest in the relationship between severe mental illness (SMI) and general violence perpetration over the past two decades (Bonta et al. 1998; Doyle and Dolan 2006; Douglas, Guy, and Hart 2009; Elbogen and Johnson 2009; Friedman 2006; Pulay et al. 2008; Steadman et al. 1998; Swanson et al. 2006), the relative lack of research on the association between SMI and IPV specifically is notable. Of the relatively modest number of studies that have examined IPV perpetration among individuals with SMI, most have relied primarily on psychiatric inpatients' self-reported IPV. "
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    ABSTRACT: Minimal research has examined partner violence committed by individuals with severe mental illness. This study examined rates of IPV in the first year post-discharge from psychiatric hospitalization, trends over time, gender differences, and the impact of follow-up mental health services. One in five (20.3 %) patients committed at least one act of IPV in the first year. Whereas women were more than twice as likely to perpetrate IPV, men were nearly twice as likely to be violent toward non-family members. Risk of IPV was highest immediately post-discharge and decreased over time, with the sharpest decline after 20 weeks in the community. Mental health treatment was associated with a 40% decrease and medication non-adherence a 50% increase in risk for IPV. Partner violence is a prevalent concern among discharged psychiatric patients, and these findings suggest that coordinated risk management efforts should focus on the time immediately following hospital discharge.
    Journal of Family Violence 09/2015; Advance online first. DOI:10.1007/s10896-015-9780-0 · 1.17 Impact Factor
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    • "Variables that have been found to predict future aggressive or criminal behavior may also exist in people who do not suffer from mental disorders or never commit criminal offenses (Harris and y Lurigio, 2008). However, there are certain variables that act negatively upon the presence of mental illness such as substance abuse in combination with personality disorders that dynamitize and lead to explosive and uncontrollable behaviors that characterize criminal offending and particularly homicide (Elbogen and Johnson, 2009). "
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    DESCRIPTION: This dissertation is submitted in partial fulfillment for the requirements of the MSc in Criminology and Criminal Psychology
    • "Risk assessment research suggests a contrasting approach . Many key indicators of risk are thought to be the same irrespective of clinical diagnosis (Bonta, Law, & Hanson, 1998; Elbogen & Johnson, 2009; Fazel, Gulati, Linsell, Geddes, & Grann, 2009) with diagnostic categories having little or no predictive ability (Phillips et al., 2005). Clinical risk predictors show smallest effect sizes in metaanalysis of mentally disordered patients (Bonta et al., 1998). "
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    ABSTRACT: Psychiatric diagnosis is not considered a risk factor for offending following discharge. However, treatment interventions and aftercare are strongly influenced by clinical primary diagnosis. We compared differential risks of reoffending of patients falling into six primary diagnostic categories following discharge from Medium Secure Units in the UK: schizophrenia/schizoaffective disorder; delusional disorder; mania/hypomania; depressive disorder; organic brain syndrome; personality disorder. We followed up 1344 patients, on average 6.2years (SD=2.1) at risk, discharged from 7 of 14 Regional Medium Secure services in England and Wales. Outcomes were period prevalence, incidence, and cumulative probability of criminal conviction. Established demographic and criminal history predictors of reoffending were observed across different diagnostic categories. Risks of all offending were increased for personality disorder, violence/acquisitive offending for delusional disorder, sexual offending for mania/hypomania and violence/acquisitive offending for organic brain syndrome. Patterns of risk over time differed markedly between categories of mental disorder. Most patients with personality disorder who offended violently did so within 4years of discharge. A subgroup with delusional disorder demonstrated increased risk of violent offending 5years after discharge. Differential risks of reoffending are observed between different diagnostic groups. Clinical diagnosis should be included together with established risk measures in risk management following discharge. Close supervision of patients with personality disorder should begin immediately after discharge when risks of reoffending are greatest. For delusional disorder further investigation is needed into the marked increase in risk of violence after 5years. Copyright © 2015. Published by Elsevier Ltd.
    International Journal of Law and Psychiatry 02/2015; 38. DOI:10.1016/j.ijlp.2015.01.009 · 1.19 Impact Factor
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