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Social Psychiatry and Psychiatric Epidemiology

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01.03.2012 | Original Paper

Mental disorder and violence: is there a relationship beyond substance use?

verfasst von: Richard Van Dorn, Jan Volavka, Norman Johnson

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 3/2012

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Abstract

Purpose

A general consensus exists that severe mental illness (SMI) increases violence risk. However, a recent report claimed that SMI “alone was not statistically related to future violence in bivariate or multivariate analyses.” We reanalyze the data used to make this claim with a focus on causal relationships between SMI and violence, rather than the statistical prediction of violence.

Methods

Data are from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a two-wave study (N = 34,653: Wave 1: 2001–2003; Wave 2: 2004–2005). Indicators of mental disorder in the year prior to Wave 1 were used to examine violence between Waves 1 and 2.

Results

Those with SMI, irrespective of substance abuse status, were significantly more likely to be violent than those with no mental or substance use disorders. This finding held in both bivariate and multivariable models. Those with comorbid mental and substance use disorders had the highest risk of violence. Historical and current conditions were also associated with violence, including childhood abuse and neglect, household antisocial behavior, binge drinking and stressful life events.

Conclusions

These results, in contrast to a recently published report, show that the NESARC data are consistent with the consensus view on mental disorder and violence: there is a statistically significant, yet modest relationship between SMI (within 12 months) and violence, and a stronger relationship between SMI with substance use disorder and violence. These results also highlight the importance of premorbid conditions, and other contemporaneous clinical factors, in violent behavior.

Given the wording of the NESARC interview question for “schizophrenia”, it is more accurate to refer to this cluster of mental disorders as “psychotic disorders” [41]. However, we will use the term “schizophrenia” in order to maintain a consistent reference point to the prior authors’ work.

The NESARC data are no longer available for independent analysis due to concerns regarding data confidentiality. Consequently, the NESARC data are now housed at the U.S. Census Bureau. All analyses were conducted by the third author of this paper, an employee of that agency, in constant consultation with the lead-author.

Data from the MacArthur Violence Risk Assessment study showed that patients without alcohol or drug symptoms, as assessed by the MAST and DAST, were not significantly more violent than comparison group subjects without alcohol or drug symptoms (4.7 vs. 3.3%). However, it is also important to note that the MacArthur study used a patient sample (i.e., recently discharge from the hospital), which differs from the NESARC sample.

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Titel: Mental disorder and violence: is there a relationship beyond substance use?
verfasst von: Richard Van Dorn
Jan Volavka
Norman Johnson
Publikationsdatum: 01.03.2012
Verlag: Springer-Verlag
Erschienen in: Social Psychiatry and Psychiatric Epidemiology / Ausgabe 3/2012
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-011-0356-x

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Mental disorder and violence: is there a relationship beyond substance use?

Abstract

Purpose

Methods

Results

Conclusions

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Abstract

Purpose

Methods

Results

Conclusions

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