Article

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

ABSTRACT

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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    • "Besides studying childhood experiences of physical, sexual abuse and neglect, we also included witnessing domestic violence and being the victim of bullying which may be associated with an elevated risk of adult violent behavior (Brockenbrough, Dewey, & Loper, 2002), but have often been omitted from existing explanatory studies. In addition to antisocial personality disorder, we also examined substance dependence and psychotic disorder as potential mediators, since these are associated both with childhood maltreatment and adult violence (Douglas, Guy, & Hart, 2009;Pickard & Fazel, 2013), but have been overlooked in previous studies. We aimed, firstly, to investigate whether direct associations existed between different types of early maltreatment and violence perpetration, and whether there was an incremental degree of association from exposure to multiple maltreatment types. "
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    ABSTRACT: Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21–34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.
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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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    • "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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