Treatment engagement and violence risk in mental disorders

Duke University, Durham, North Carolina, United States
The British Journal of Psychiatry (Impact Factor: 7.99). 11/2006; 189(4):354-60. DOI: 10.1192/bjp.bp.105.017913
Source: PubMed


Research has uncovered many characteristics related to violence committed by people with mental illness. However, relatively few studies have focused on understanding the connection between violence and dynamic, malleable variables such as a patient's level of treatment engagement.
To explore the link between community violence and patients'beliefs about psychiatric treatment benefit.
A sample of 1011 adults receiving out-patient treatment for a psychiatric disorder in the public mental health systems of five US states were interviewed.
Bivariate analyses revealed community violence was inversely related to treatment adherence, perceived treatment need and perceived treatment effectiveness. Multivariate analyses showed these three variables were associated with reduced odds of violent and other aggressive acts.
The results suggest clinical consideration of patients' perceptions of treatment benefit can help enhance violence risk assessment in psychiatric practice settings.

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Available from: Richard Van Dorn, Nov 17, 2015
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    • "The ECA, MVRAS, and five-state findings tended to support that view, in part. At the same time, there is evidence that psychiatric symptomsdand particular combinations of symptoms such as delusions, suspiciousness, and extreme angerdcan increase violence risk under certain conditions in certain individuals, and that treatment such as antipsychotic medication to reduce these symptoms can, in turn, reduce violence risk [33] [34]. A recent large meta-analysis identified a range of risk factors for violence in persons with psychotic symptoms, which notably included concurrent substance abuse (especially polysubstance abuse) along with antisocial or criminal history, but also identified treatment nonadherence as a significant risk factor in these individuals [35]. "
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    ABSTRACT: Purpose This article describes epidemiological evidence concerning risk of gun violence and suicide linked to psychiatric disorders, in contrast to media-fueled public perceptions of the dangerousness of mentally ill individuals, and evaluates effectiveness of policies and laws designed to prevent firearms injury and mortality associated with serious mental illnesses and substance use disorders. Methods Research concerning public attitudes towards persons with mental illness is reviewed and juxtaposed with evidence from benchmark epidemiological and clinical studies of violence and mental illness and of the accuracy of psychiatrists’ risk assessments. Selected policies and laws designed to reduce gun violence in relation to mental illness are critically evaluated; evidence-based policy recommendations are presented. Results Media accounts of mass shootings by disturbed individuals galvanize public attention and reinforce popular belief that mental illness often results in violence. Epidemiological studies show that the large majority of people with serious mental illnesses are never violent. However, mental illness is strongly associated with increased risk of suicide, which accounts for over half of US firearms-related fatalities. Conclusion Policymaking at the interface of gun violence prevention and mental illness should be based on epidemiological data concerning risk, to improve the effectiveness, feasibility, and fairness of policy initiatives.
    Full-text · Article · Apr 2014 · Annals of Epidemiology
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    • "Slope measured in average number of patients lost to treatment contact for 5 weeks or longer per week for the period between that and the previous point in the survival plot b Slopes are not listed for 100 % survival points as these represent the beginning points of the survival plots, with no previous points on the line with which to generate a slope Community Ment Health J need for treatment by the patients in the study, a factor important in supporting treatment engagement (Elbogen et al. 2006). While the relationship between short-term and long-term engagement may be due in part to an overlap in the measurement of these variables, it is interesting to note that the treatment behaviors associated with care retention all had a social interaction component, while the behavior unrelated to time to attrition (medication pickup) is performed in isolation. "
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    ABSTRACT: Disengagement from outpatient care following psychiatric hospitalization is common in high-utilizing psychiatric patients and contributes to intensive care utilization. To investigate variables related to treatment attrition, a range of demographic, diagnostic, cognitive, social, and behavioral variables were collected from 233 veterans receiving inpatient psychiatric services who were then monitored over the following 2 years. During the follow-up period, 88.0 % (n = 202) of patients disengaged from post-inpatient care. Attrition was associated with male gender, younger age, increased expectations of stigma, less short-term participation in group therapy, and poorer medication adherence. Of those who left care, earlier attrition was predicted by fewer prior-year inpatient psychiatric days, fewer lifetime psychiatric hospitalizations, increased perceived treatment support from family, and less short-term attendance at psychiatrist appointments. Survival analyses were used to analyze the rate of attrition of the entire sample as well as the sample split by short-term group therapy attendance. Implications are discussed.
    Full-text · Article · Oct 2012 · Community Mental Health Journal
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    • "However, clinical studies require written informed consent due to ethical reasons. In hospital settings, violent behaviour of patients with psychoses is associated with involuntary treatment [8], lack of insight into their illness and treatment [9, 10], cognitive distortion [11], disorganisation [12] and positive symptoms [13]. According to the nature of the disorder and the severely disturbed behaviour, violent psychotic patients are mostly uncooperative and distrustful, and lack the ability to understand and appropriately process new information. "
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    ABSTRACT: Studies on violence in schizophrenia use two different approaches: use of epidemiological data, and clinical studies recording direct patient data after gaining informed consent. With regard to informed consent requiring agreement and cooperation, the question arises as to what extent participants represent patients with schizophrenia and violent behaviour (external validity). We conducted a systematic literature research. In most of the studies, aggression or violence, respectively, were poorly defined. Only 5 (15.2%) studies used a cut-off score on an aggression scale. Only 6 studies (18.2%) reported the number of patients who refused to participate, and 16 (48.5%) reported the number of drop-outs. Only 3 studies (9.1%) reported a systematic comparison of participants and non-participants. We found that data which allow for the assessment of representativeness of the investigated samples are poorly reported. For most studies, doubts regarding external validity seem justified and generalisability is questionable due to possible selection bias.
    Full-text · Article · Aug 2012 · Clinical Practice and Epidemiology in Mental Health
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