Psychiatric Morbidity Among Homicide Offenders: A Swedish Population Study

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, U.K.
American Journal of Psychiatry (Impact Factor: 12.3). 11/2004; 161(11):2129-31. DOI: 10.1176/appi.ajp.161.11.2129
Source: PubMed


The authors examined psychiatric diagnoses of all individuals convicted of homicide and attempted homicide in Sweden from 1988 to 2001 (N=2,005).
High-quality national crime and hospital registers were linked to investigate standardized psychiatric diagnoses of homicide offenders.
The presence or absence of psychiatric diagnoses was ascertained for 1,625 (81%) of the homicide offenders; 1,464 (90%) of these offenders had a psychiatric diagnosis. Twenty percent (N=409) of all 2,005 offenders had a psychotic illness, and 54% (N=589) of a subgroup of 1,091 offenders with information on secondary diagnoses had a personality disorder as a principal or secondary diagnosis. Only 10% of the offenders for whom psychiatric diagnostic information was available had no diagnosis.
Using a comprehensive method for identifying psychiatric illness in homicide offenders, the authors found higher rates of psychiatric morbidity than previous studies. Their findings underline the importance of psychiatric assessment in homicide offenders and suggest that treatment might have a preventive role.

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    • "We were able to contact by email all but one [19] of the authors of epidemiological studies of homicide in schizophrenia published after 1981, but we were only able to contact the authors of one of the 8 studies published between published between 1960 and 1981. The authors of two studies were not able to provide further data because homicide recidivism was not part of their research design [27,32]. The authors of 10 studies provided previously unreported data about homicide recidivism. "
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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 Published data was supplemented with unpublished data about recidivism obtained by personal communication from the authors of published studies of homicide and schizophrenia.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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    • "Pour autant, les patients souffrant d'une schizophrénie sont surreprésentés parmi les meurtriers. Globalement, 20 % des cas d'homicides des pays scandinaves sont attribuables a ` des patients souffrant de troubles mentaux graves (schizophrénie, trouble délirant ou troubles affectifs majeurs) [9] [10] [11] [12] [13]. La métaanalyse de Large et al. retrouve une prévalence de 6,6 % des meurtriers répondant aux critères diagnostiques de schizophrénie [14]. "
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    ABSTRACT: The prevalence of homicide perpetrators with a diagnosis of schizophrenia is 6% in Western countries populations. The relationship between schizophrenia and homicide is complex and cannot be reduced to a simple causal link. The aim of this systematic review was to clarify the role of substance abuse in the commission of murder in people suffering from schizophrenia. A systematic English-French Medline and EMBASE literature search of cohort studies, case-control studies and transversal studies published between January 2001 and December 2011 was performed, combining the MeSH terms "schizophrenia", "psychotic disorders", "homicide", "violence", "substance use disorder", and the TIAB term "alcohol". Abstract selection was based on the STROBE and PRISMA checklist for observational studies and systematic and meta-analysis studies, respectively. Of the 471 selected studies, eight prospective studies and six systematic reviews and meta-analysis studies met the selection criteria and were included in the final analysis. Homicide committed by a schizophrenic person is associated with socio-demographic (young age, male gender, low socioeconomic status), historical (history of violence against others), contextual (a stressful event in the year prior to the homicide), and clinical risk factors (severe psychotic symptoms, long duration of untreated psychosis, poor adherence to medication). In comparison to the general population, the risk of homicide is increased 8-fold in schizophrenics with a substance abuse disorder (mainly alcohol abuse) and 2-fold in schizophrenics without any comorbidities. A co-diagnosis of substance abuse allows us to divide the violent schizophrenics into "early-starters" and "late-starters" according to the age of onset of their antisocial and violent behavior. The violence of the "early-starters" is unplanned, usually affects an acquaintance and is not necessarily associated with the schizophrenic symptoms. Substance abuse is frequent and plays an important role in the homicide commission. In addition, the risk of reoffending is high. In the "late-starters", the violence is linked to the psychotic symptoms and is directed to a member of the family. The reoffence risk is low and it depends on the pursuit of care or not. Defining subgroups of violent schizophrenic patients would avoid stigmatization and would help to prevent the risk of homicide by offering a multidisciplinary care which would take into account any substance abuse.
    Revue d Épidémiologie et de Santé Publique 06/2013; 61(4). DOI:10.1016/j.respe.2013.01.096 · 0.59 Impact Factor
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    • "Since the early 1990s, several large studies (Tiihonen et al., 1997; Fazel and Grann, 2004; Swanson et al., 2006), summarised in a 2009 systematic review (Fazel et al., 2009) have shown a modest association between schizophrenia (and other psychoses) and violence. Subsequent studies whilst invoking substance misuse as an important mediator, have offered yet further support (Elbogen and Johnson, 2009; Fazel et al., 2009). "
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    ABSTRACT: A small but significant relationship between schizophrenia and violence is well established, but not yet fully explained. Research has highlighted anger as an important factor in precipitating actual violence in general and psychiatric populations. However, anger has not been extensively studied as a risk factor for violence in people with schizophrenia and related psychoses. We evaluated published evidence on the relationship between anger and violence in patients with schizophrenia and related psychoses by means of a systematic review of the literature. A search of main online databases from inception till January 2012 was performed and supplemented with correspondence with authors and data available online. 11 studies which measured angry affect in patients with schizophrenia who had been violent were included in the review. 5 studies with a total of 510 individuals had anger data that were suitable to be pooled in a meta-analysis in form of standardised mean difference values comparing the anger scores of the non-violent groups with violent groups. All the studies included showed significantly higher scores for anger in the violent group compared with the non-violent group with the pooled result expressed as standardised mean difference of 0.74 95% CI (0.53, 0.94) and the Z value for overall effect=7.01. The studies not included in the meta-analysis which looked at 610 individuals, were analysed descriptively and all of them reported higher scores for anger for individuals with schizophrenia who acted violently. There is a consistency of significant association between angry affect and violent behaviour in the context of psychotic illness across various study designs, settings and populations. Theoretical support already exists for this relationship and this review lends further support to explore this relationship further.
    Schizophrenia Research 02/2013; 146(1-3). DOI:10.1016/j.schres.2013.01.024 · 3.92 Impact Factor
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