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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    • "For example, people suffering from schizophrenia appear to have approximately four to five times higher propensity for violence (Swanson, Holzer III, Ganju, & Jono, 1990), especially when they experience specific positive psychotic symptoms (Angermeyer, 2000; Hiday, 1997; McNiel, Eisner, & Binder, 2000; Modestin, 1998). Moreover, for schizophrenic patients, the risk of becoming violent increases substantially in comorbidity with substance abuse (Beck, 2004; Elbogen & Johnson, 2009; Fazel, Långström, Hjern, Grann, & Lichtenstein, 2009; Steadman et al., 1998; Wallace, Mullen, & Burgess, 2004) and/or (antisocial ) personality disorders (Angermeyer, 2000; Hiday, 1997; Taylor et al., 1998). Also a history of violent behaviour and a long stay in an inpatient clinic are factors that are associated with an elevated risk of inpatient assaults (Cornaggia, Beghi, Pavone, & Barale, 2011; Grassi et al., 2006). "
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    DESCRIPTION: In this study, the prevalence, nature and consequences of violence against mental health care professionals are examined. Dutch mental health professionals working in clinical psychiatry were approached to fill in an online questionnaire on their personal experiences with physical violent incidents. It appeared that 67% of the 1534 respondents were victim of at least one physical violent incident in the past five years. In total, the 1534 respondents reported they had encountered 2648 physical violent incidents. In some cases, the consequences were very severe, not only for the victim but also for the employer. Some groups of professionals appear to have an increased risk of being victimized. The findings show that the violence that mental health professionals encounter is a substantial and severe problem that no longer should be disregarded.
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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.
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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
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