Article

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

ABSTRACT

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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    • "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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    • "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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