Psychosis as a Risk Factor for Violence to Others: A Meta-Analysis

Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada, V5A 1S6.
Psychological Bulletin (Impact Factor: 14.76). 10/2009; 135(5):679-706. DOI: 10.1037/a0016311
Source: PubMed


The potential association between psychosis and violence to others has long been debated. Past research findings are mixed and appear to depend on numerous potential moderators. As such, the authors conducted a quantitative review (meta-analysis) of research on the association between psychosis and violence. A total of 885 effect sizes (odds ratios) were calculated or estimated from 204 studies on the basis of 166 independent data sets. The central tendency (median) of the effect sizes indicated that psychosis was significantly associated with a 49%-68% increase in the odds of violence. However, there was substantial dispersion among effect sizes. Moderation analyses indicated that the dispersion was attributable in part to methodological factors, such as study design (e.g., community vs. institutional samples), definition and measurement of psychosis (e.g., diagnostic vs. symptom-level measurement, type of symptom), and comparison group (e.g., psychosis compared with externalizing vs. internalizing vs. no mental disorder). The authors discuss these findings in light of potential causal models of the association between psychosis and violence, the role of psychosis in violence risk assessment and management, and recommendations for future research.

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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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    • "Evidence suggests that individuals with serious mental illness (SMI) are at elevated risk of violence (Brennan et al., 2000; Douglas et al., 2009), including homicide (Richard- Devantoy et al., 2009; Simpson et al., 2004; Taylor and Gunn, 1999; Wallace et al., 1998). However, people with SMI may behave violently for a variety of motivations (Nestor, 2002), including as a direct result of positive symptoms of psychosis or when symptoms result in heightened stress or exposure to provocation (Hiday, 1997). "
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    ABSTRACT: Objective: To identify subgroups of forensic psychiatric patients based on the age onset of serious mental illness and offending and assess the external validity of the subgroups with theoretically based sociodemographic, clinical, legal and risk-related variables.
    Australian and New Zealand Journal of Psychiatry 05/2015; DOI:10.1177/0004867415587745 · 3.41 Impact Factor
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    • "Some researchers have argued that methodological diversity across studies accounts for much of the discrepant findings reported in the literature (Douglas et al., 2009). One possible confounding factor is sample composition, such that serious mental illness is a risk factor for violence among the general population but this effect does not generalize to offenders. "
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    ABSTRACT: The importance of mental illness as a risk factor for violence has been debated with significant implications for mental health policy and clinical practice. In offender samples, mental health diagnoses tend to be unrelated to recidivism, although this effect has been questioned recently in sexual offenders. In the present, prospective investigation, the relevance of several mental health diagnoses and relevant co-morbidity is examined as predictors of various types of recidivism in two distinct samples of sexual offenders who were followed up to 27 years in the community. Results indicated that mental health diagnoses were not predictive of recidivism on their own or in multivariate categories, although comorbid substance-use disorders and some personality disorders showed some predictive validity. Results are discussed in the context of a social learning model of crime and in terms of the treatment of sexual offenders.
    International Journal of Mental Health 02/2015; 14(1):20-32. DOI:10.1080/14999013.2014.974088
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