Violence and Severe Mental Disorder in Clinical and Community Populations: The Effects of Psychotic Symptoms, Comorbidity, and Lack of Treatment

Abstract

This paper examines links between violent behavior, type and severity of psychopathology, substance abuse comorbidity, and community mental health treatment, using matched data from two surveys: the National Institute of Mental Health Epidemiologic Catchment Area project and the Triangle Mental Health Survey (a North Carolina study of adults with severe and persistent mental illness). Multivariate logistic regression analysis was used to model the risk of violent acts attributable to three domains of independent variables: sociodemographic characteristics, clinical diagnoses and symptomatology, and mental health services utilization. Findings include: (1) Symptom severity was significantly greater in the clinically-selected sample than in the community survey of respondents with comparable diagnoses who self-reported using mental health services; (2) Violence risk was related to psychoticism/agitation in a curvilinear form; (3) In a multivariable model, violence was significantly associated with substance abuse comorbidity, particular psychotic symptoms (perceived threat and loss of internal cognitive controls), and absence of recent contact with a community mental health provider; (4) The relationship between lack of treatment and higher odds of violence was less pronounced among respondents with substance abuse comorbidity; (5) When clinical and services-use variables were taken into account, sociodemographic predictors were not significantly related to violence.

Psychotic symptoms and disorders and the risk of violent behaviour in the community

“…Thus, psychotic states and drug intoxication may each contribute independently to violent behaviour by producing abnormalities in perception and cognition and perhaps impulse control. But it is also plausible that psychoactive substance use may contribute to violence indirectly, in at least four other ways; first, by contributing (earlier in life) to the development of concurrent antisocial personality disorder which is often characterised by violent behaviour; second, by exacerbating or compounding chronic psychotic symptomalology which is already present in persons with mental disorder; third, by drawing such persons into threatening and hostile social environments in which violent crime and other social pathologies are more common; and fourth, by rendering them less responsive to, and less compliant with, outpatient medication therapies and other community-based mental health services which might otherwise prevent violence (see Drake, Bartels, Teague, Noordsy & Clark, 1993;Widiger & Trull, 1994;Owen, Fischer, Booth & Cuffel, 1996;Swanson, Estroff, Swartz, Borum, Lachicotte, Zimmer & Wagner, 1997).…”

Perpetration of Violence, Violent Victimization, and Severe Mental Illness: Balancing Public Health Concerns

“…Nearly 90% (27/31) of the studies of perpetration that we reviewed sampled patients from clinics or hospitals (11,12,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(46)(47)(48)(49)(50)(51); among studies that examined prevalence of victimization, all sampled persons in treatment. We need information on the estimated 5 million persons with severe mental illness in the United States who do not receive treatment (67).…”

Relação entre homicídio e transtornos mentais

“…[32][33] Certain psychotic symptoms, such as delusions of persecution 34 and auditory hallucinations, 33 have been shown to be more strongly associated with violent behavior. However, other authors have found no association between active psychotic symptoms and violent behavior.…”