The Association of Stigma With Violence

This letter was accepted for publication in January 2011.
American Journal of Psychiatry (Impact Factor: 12.3). 03/2011; 168(3):325; author reply 325-6. DOI: 10.1176/appi.ajp.2011.10121710
Source: PubMed
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    • "A second homicide by a mentally ill homicide offender is not only a potentially avoidable tragedy, but has been described by Dietz as a form of ‘sensational homicide’ [39] with the potential to increase stigma experienced by people with severe mental illness and to reduce the prospects of conditional release for other mentally ill offenders [40]. While the prevention of rare events such as homicide is intrinsically difficult and the prediction of very rare events is impossible [41,42], mental health services do have some role in preventing homicides [43,44], including by focusing on co-morbid substance use of patients with an established diagnosis of psychotic illness [18,45] and by earlier treatment of first episode psychosis [46]. "
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    ABSTRACT: The aim of this study was to estimate the proportion of homicide recidivists among population studies of homicide offenders with schizophrenia. Systematic review and meta-analysis of published studies of homicide associated with schizophrenia conducted in defined populations and indexed in Medline, PsychINFO, or Embase between January 1960 and November 2013. Published data was supplemented with unpublished data about recidivism obtained by personal communication from the authors of published studies of homicide and schizophrenia. Random effects meta-analysis was used to calculate a pooled estimate of the proportion of homicide recidivists. Three studies reported that 4.3%, 4.5%, and 10.7% of homicide offenders with schizophrenia had committed an earlier homicide. Unpublished data were obtained from the authors of 11 studies of homicide in schizophrenia published in English between 1980 and 2013. The authors of 2 studies reported a single case of homicide recidivism and the authors of 9 studies reported no cases. The rates of homicide recidivism between studies were highly heterogeneous (I-square = 79). The pooled estimate of the proportion of homicide offenders with schizophrenia who had committed an earlier homicide was 2.3% (95% CI (Confidence Interval) 0.07% to 7.2%), a figure that was not reported in any individual study. The pooled proportion of homicide recidivists from published reports was more than ten times greater (8.6%, 95% CI 5.7%-12.9%) than the pooled proportion of homicide recidivists estimated from data provided by personal communication (0.06%, 95% CI 0.02% to 1.8%). In most jurisdictions, homicide recidivism by people with schizophrenia is less common than published reports have suggested. The reasons for the variation in the rates of homicide recidivism between studies are unclear, although in most jurisdictions long-term secure treatment and supervision after release appears to be effective in preventing homicide recidivism. A prospective study conducted in a large population or in multiple jurisdictions over a long period of time might result in a more accurate estimate the risk of a second homicide by a person with schizophrenia.
    BMC Psychiatry 02/2014; 14(1):46. DOI:10.1186/1471-244X-14-46 · 2.21 Impact Factor
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    American Journal of Psychiatry 07/2011; 168(7):749; author reply 749. DOI:10.1176/appi.ajp.2011.11030412 · 12.30 Impact Factor
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    ABSTRACT: The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to help make sense of this confusion, the present review focuses on research on one of the most commonly measured components - belief in dangerousness. The review examines: measurement of belief in dangerousness; prevalence of belief in dangerousness; characteristics of people who believe in dangerousness; experiences associated with belief in dangerousness; characteristics of people that elicit belief in dangerousness; the effects of psychiatric labelling; the effects of causal explanations; interventions to reduce belief in dangerousness; and effects on help-seeking. It is concluded that future research needs to focus on rigorous evaluation of interventions to reduce belief in dangerousness and the impact of this belief on people affected by mental disorders.
    Australian and New Zealand Journal of Psychiatry 03/2012; 46(11). DOI:10.1177/0004867412442406 · 3.41 Impact Factor
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