Mental illness and violence: an epidemiological appraisal of the evidence

OBJECTIVE: To conduct a critical review of the literature on the matter of mental illness and violence, to examine whether there is enough evidence to establish a causal link, and to provide epidemiological background to measure the risk to the population. METHOD: Based on a computerized search of the literature on mental illness and violence previously conducted for Health Canada, studies in the area were critically reviewed and divided into 3 main categories: 1) studies of criminal and violent behaviour among psychiatric patients, 2) studies of psychiatric illness among offenders (prevalence studies in institutions, analytical studies, and community follow-up of offenders), and 3) epidemiological community-based studies on the issue of mental illness and violence (police-citizen encounters, representative samples, and other epidemiological studies). Causality rules and measures of risk were then applied to the evidence elicited. RESULTS: The review of the literature suggests that only a small minority of hospitalized patients, typically those suffering from acute psychotic symptoms, are involved in violent incidents. Formerly hospitalized patients are at a higher risk of committing violence if they are not properly treated and are experiencing threat/control-override psychotic symptoms. Substance abuse disorders significantly raise the risk for violence. Family members are the most at risk of being victimized. CONCLUSION: An association exists between mental illness and violence, but the many covariations that naturally affect the equation between them introduce uncertainties in establishing causality.     

Criminal thinking as a mediator of the mental illness–prison violence relationship: A path analytic study and causal mediation analysis.

Although mental illness and violence correlate, it has been speculated that this relationship is mediated by a series of third variables. The current study examined the possibility that the relationship between mental illness and prison violence is mediated by criminal thinking. General criminal thinking, as measured by the General Criminal Thinking (GCT) score of the Psychological Inventory of Criminal Thinking Styles (PICTS; Walters, 1995), was tested as a possible mediator of the mental illness–prison violence relationship. Using a prospective design and path analytic statistical technique, it was determined that general criminal thinking served as a partial mediator of the mental illness-institutional violence nexus in a sample of 2,487 male prison inmates. Causal mediation analysis also documented the presence of a small but statistically significant mediating role for general criminal thinking in this study. The implications of these results for understanding, predicting, and managing violent behavior in severely mentally ill inmates are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The role of histamine in platelet aggregation by physiological and immunological stimuli

This paper reviews the current state of the debate on the relationship between mental disorder and violent behaviour. Starting from the discussion of methodological approaches to assessing a possible association, the most important studies carried out on the issue in recent years are discussed. Their results concur in supporting the assumption that there is a moderate but reliable association between mental disorder and violence. However, this does not imply that people with mental illness are generally more likely to commit violent acts than members of the general population. An elevated risk of violent behaviour is only evident for specific psychiatric diagnoses and for particular symptom constellations. For schizophrenia and other psychotic disorders, a significant increase in the likelihood to commit violent acts is reported. Substance use disorder and antisocial personality disorder, however, represent a markedly higher risk for violent behaviour. The article further discusses possible determinant of violent behaviour such as psychotic symptoms and comorbidity with substance abuse, and considers who is at particular risk of becoming a target of violent acts.     

Assessing the risk of violence in released mental patients: A cross-validation study.

A statistical scale to assess the probability of violence in released mental patients was developed and cross-validated. A calibration sample of 251 adult males admitted as inpatients to a community mental health center and considered potentially violent was obtained. Data collected at admission (including demographics, family background, criminal justice and mental health system contacts, past violent behavior, and current situational measures) were used to predict subsequent violent arrests or readmissions during a 1-year follow-up period with multiple regression. A statistical equation of 5 variables was derived and applied to a cross-validation sample of 265 male patients. The correlation between the scores and subsequent violence in this sample was .32. Classification using a cutoff point obtained from the calibration sample yielded 75.8% correctly classified and a false positive rate of 47.6%. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violent thoughts and violent behavior following hospitalization for mental disorder.

Using a standardized schedule of questions, this study examined (a) the prevalence of self-report of violent thoughts by patients hospitalized for mental disorders compared with nonpatients, (b) the persistence of violent thoughts after discharge, and (c) the relation between patients' violent thoughts while hospitalized and violent acts within 20 weeks after hospital discharge. About 1/3 of the patients reported thoughts of violence while hospitalized, more than twice the proportion found among nonpatients. Reporting violent thoughts in hospital was significantly related to engaging in violent acts within 20 weeks after discharge for non-White patients, patients without major mental disorder but with substance abuse diagnoses, patients with high symptom severity, and patients whose reports of violent thoughts persisted after discharge. Reporting violent thoughts was significantly related to measures of psychopathy, anger, and impulsiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Laryngeal cancer: quality-of-life and cost-effectiveness

The purpose of this paper is to review the current literature in relation to mental illness and criminal behaviour. The material presented for discussion was selected from forensic and general psychiatric literature. However, a number of important publications, policy documents and independent reports were used to explore the debate surrounding this subject. Contemporary studies of prison populations in the UK and abroad illustrated the difficulty in relating mental illness to crime. Papers presenting research in the UK revealed important implications for mental health policy and the way in which the penal system deals with mentally disordered offenders. The literature reviewed provided arguments for and against an association between mental illness and criminal behaviour. Methodological problems associated with criminological and psychiatric research were addressed in relation to the exploration of whether people suffering from a mental illness are more dangerous or violent than other people. Research papers focusing on public reaction to mentally ill people living in the community provided important considerations when addressing mental illness and criminal behaviour in the context of care in the community policy. This paper will be of interest to a broad range of mental health professionals, particularly those working with individuals who have a history of mental illness and violent behaviour, or mental health professionals working with mentally disordered offenders.     

Interaction between birth complications and early maternal rejection in predisposing individuals to adult violence: specificity to serious, early-onset violence

OBJECTIVE: The authors previously reported that birth complications interact with early maternal rejection in predisposing individuals to violence at age 18 years. This study extended the follow-up period for violent offending from 18 years to 34 years, thus increasing the sample of violent offenders threefold and allowing more detailed analyses on onset and type of violence, the form of maternal rejection, and the effect of maternal mental illness. METHOD: Complications in the births of 4,269 males in Denmark, maternal rejection of these individuals before the age of 1 year, and their histories of criminal offenses at age 34 years were assessed. RESULTS: The biosocial interaction previously observed held for violent but not nonviolent crime, was specific to more serious forms of violence and not threats of violence, held for early-onset but not late-onset violence, and was not accounted for by psychiatric illness in the mothers. Being reared in a public care institution in the first year of life and the mother's attempt to abort the fetus were the key aspects of maternal rejection that interacted with birth complications in predisposing a subject to violence. CONCLUSIONS: These findings 1) indicate that the mechanisms underlying early-onset, serious violence differ from those for less serious, late-onset violence, 2) implicate very early factors in the development of violence, 3) highlight the potential importance of integrating psychosocial with biological factors in understanding and preventing violence, and 4) suggest that interventions to reduce birth complications and maternal rejection may help reduce violence.     

The treatment of mentally disordered offenders.

However narrowly defined, mentally disordered offenders (MDOs) are heterogeneous in demographics, diagnoses, offense characteristics, risk, and clinical needs. Treatment planning for MDOs should begin with an assessment of risk of future violent behavior in the community and risk of violence toward self or others inside an institution. Purposes of treatment among MDOs include treatments both to reduce risk of future violence and to alleviate the mental disorder. Relevant outcome measures include criminal and violent behavior, psychiatric symptomatology, admission to correctional or psychiatric facility, and quality of life. Clinical problems include aggression and problems of institutional management, criminal propensity, life skills deficits, substance abuse, active psychotic symptoms, social withdrawal, and depression. Because evidence relating them to risk of future violence is highest for the first 4 problems, it is argued that inpatient treatments should especially target them. Whenever risk levels and legal circumstances permit, community treatment is to be preferred. Sex offenders are discussed as a group for whom specialized services are indicated.… (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The violent 4-3 MMPI personality type.

Attempted to replicate and extend the study of K. R. Davis and J. O. Sines (see PA, Vol. 46:Issue 2) which found the MMPI high point pattern of 4-3 to be associated with commission of violent acts. 48 4-3 male inmates were compared with the 3 most frequently occurring other MMPI code types in a prison and with the institutional base rate for commission of violent criminal offenses. 4-3 Ss committed significantly more violent acts than any of the other personality groups and significantly more violence than the base rates of inmates in general. The other 3 personality groups did not differ from the base rate. Of the 4-3 Ss, 85% had a history of violence. Personality variables, e.g., guilt and anxiety, and race of the offender, are discussed. (24 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Level of anti-mouse-antibody response induced by bi-specific monoclonal antibody OC/TR in ovarian-carcinoma patients is associated with longer survival

OBJECTIVE: The types and amounts of crime experienced by persons with severe mental illness were examined to better understand criminal victimization in this population. METHODS: Subjects were 331 involuntarily admitted psychiatric inpatients who were ordered by the court to outpatient commitment after discharge. Extensive interviews provided information on subjects' experience with crime in the previous four months and their perceived vulnerability to victimization, as well as on their living conditions and substance use. Medical records provided clinical data. RESULTS: The rate of nonviolent criminal victimization (22.4 percent) was similar to that in the general population (21.1 percent). The rate of violent criminal victimization was two and a half times greater than in the general population--8.2 percent versus 3.1 percent. Being an urban resident, using alcohol or drugs, having a secondary diagnosis of a personality disorder, and experiencing transient living conditions before hospitalization were significantly associated with being the victim of a crime. In the multivariate analysis, substance use and transient living conditions were strong predictors of criminal victimization; no demographic or clinical variable was a significant predictor. (Given the relatively high crime rates, subjects' perceived vulnerability to victimization was unexpectedly low; only 16.3 percent expressed concerns about personal safety. Those with a higher level of education expressed greater feelings of vulnerability. CONCLUSIONS: The study found a substantial rate of violent criminal victimization among persons with severe and persistent mental illness. Results suggest that substance use and homelessness make criminal victimization more likely.     

Gender differences in patterns of relationship violence in Alberta.

Gender differences in patterns of relationship violence were investigated in a sample of 356 men and 351 women. Respondents reported on their receipt and perpetration of violent acts in the year prior to the survey. Men and women, respectively, reported similar 1-yr prevalence rates of husband-to-wife violence and wife-to-husband violence. However, differential gender patterns of reporting were identified. On average, men reported that they and their female partners were equally likely to engage in violent acts and to initiate violent conflicts. In contrast, women reported lower levels of victimization than perpetration of violence, and they reported less male-only and male-initiated violence than did men. The majority of respondents in violent relationships reported a pattern of violence that was bidirectional, minor, infrequent, and not physically injurious. The discussion focuses upon the meaning of gender differences in reports of relationship violence, and the existence of distinct patterns of violence within intimate relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prediction of violent versus nonviolent recidivism from prior violent and nonviolent criminality.

Analyzed frequencies of prior violent and nonviolent criminal convictions among 198 adult male felony offenders (mean age 27 yrs) in relation to probation outcome defined as success, nonviolent failure, or violent failure. The probation follow-up was conducted after 32 mo. Only the results for prior nonviolent offenses were significant, and although nonviolent failures on probation were nearly 4 times more common than were violent failures, the nonviolent predictor set was equally sensitive to the 2 types of recidivism. The association between prior nonviolent offenses and probation outcome was attenuated by the influence of age. Persistent nonviolent criminality usually reflects a generalized propensity for social deviance and is therefore of some predictive value with heterogeneous groups of offenders. In contrast, because violence is often due to transitory psychological states that emerge in response to atypical circumstances, it is a relatively poor indicator of the likelihood of future similar behavior. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Violence classifications and their impact on observed relationships with key factors in young offenders.

The understanding of violent criminal behavior is hindered by definitional problems in both the legal and research communities. Different definitions of violent criminal behavior and different classifications of the severity of violence are fundamental problems that need to be resolved in order to develop better conceptual models of the precursors to criminal violence that can inform management and treatment of violent young offenders. This study evaluated 6 classifications of violent juvenile offenses derived from the legal system and published research. The authors compare frequencies from different classifications and examine the influence of classifications on observed associations with expected predictor variables. Differences in frequencies and perceived associations between classifications highlight the need to adopt a consistent method of coding violent offenses for research purposes in order to obtain valid results that are capable of informing policy, the judiciary, and the development of effective interventions. The final classification system offers a method of systematic coding based on the type, frequency, and outcome of the violent behavior that distinguishes between levels of violence severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increased epidermal growth factor-receptor protein in a human mesothelial cell line in response to long asbestos fibers

The burden of violence is born disproportionately by the youngest of our country. In this article, three important aspects of violence are discussed: premature death, violence recidivism, and violent criminality. The author emphasizes the role of the pediatrician in preventing these consequences.     

"Does violence beget violence? A critical examination of the literature": Clarification of publishing history.

Alerts APA researchers and readers that the article "Does violence beget violence? A critical examination of the literature" by C. S. Widom (Psychological Bulletin, 1989, Vol 106(1), Jul, 3–28) has been amplified and reprinted in a book chapter: Widom, C. S. (1989). The intergenerational transmission of violence. In N. A. Weinger & M. E. Wolfgang (Eds.), Pathways to criminal violence. Newbury Park, CA: Sage. Through an oversight, cross-reference between the two publications and information in the copyright for this article were omitted from the Sage book. The copyright is held by the American Psychological Association. (The following abstract of this article originally appeared in PA, Vol 76:36811.) Critically examines the "violence breeds violence" hypothesis broadly defined. Organized into 7 sections, the literature review includes (a) the abuse breeds abuse hypothesis; (b) reports of small numbers of violent/homicidal offenders; (c) studies examining the relationship of abuse and neglect to delinquency; (d) to violent behavior, and (e) to aggressive behavior in infants and young children; (f) abuse, withdrawal, and self-destructive behavior; and (g) studies of the impact of witnessing or observing violent behavior… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy in instrumental and reactive violent offenders.

Can violent offenders who commit acts of instrumental aggression for goal-oriented purposes such as robbery be distinguished from those who commit acts of reactive (or hostile) aggression in response to provocation? Because violent offenders often have a history of both instrumental and reactive aggression, this study distinguished between offenders with a history of at least 1 instrumental violent offense and offenders with a history of reactive violent offenses. Two studies tested the hypothesis that instrumental offenders would score higher than reactive offenders and nonviolent offenders on R. D. Hare's (1991) Psychopathy Checklist. The first study sample consisted of 106 violent and nonviolent offenders recruited from a medium-security correctional facility. The second study sample consisted of 50 violent offenders referred for pretrial forensic evaluation. In both samples, instrumental offenders could be reliably distinguished from reactive offenders on the basis of violent crime behavior and level of psychopathy. Group differences could not be attributed to participant age, race, length of incarceration, or extent of prior criminal record. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment on "Registered criminality in families with children at high risk for schizophrenia" by Kirkegaard-Sorensen and Mednick.

Argues that conclusions drawn from L. Kirkegaard-Sorenson and S. A. Mednick's (see record 1975-25536-001) recent study on criminality are weakened by inadequate selection of controls. The inclusion of siblings as Ss introduces the possibility of effects due to interaction between siblings. Such interaction would not affect experimental and control groups equally because the number of siblings per family included is not controlled. Further, separations of children from parents for less than 5 yrs are not controlled, although this is a factor on which high-risk and control Ss are likely to differ. Control ancestors were screened for mental illness, but the high-risk ancestors were not. Thus, the possibility of ancestor influences other than the mother's schizophrenia is not ruled out. Finally, the rejection of control children with mental illness is misguided and could select against potential criminal controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-genomic action of steroids in the nervous system

Past research on the importance of 'soft' neurological signs in schizophrenia has often not examined the relationship between specific groups of neurological signs and different dimensions of schizophrenia psychopathology. Gender differences in the reported relationships have never been explored. In this paper we describe a study of 100 DSM-III-R (65 male and 35 female) schizophrenic patients who were rated for neurological 'soft signs' with the Neurological Evaluation Scale (NES) (1), and for schizophrenic symptomatology with the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS). Following a factor analysis of NES items, differential relationships were examined between the five derived NES factors and three well-established dimensions of schizophrenic symptomatology, namely psychomotor poverty, disorganization and reality distortion. Our results failed to show any relationship between NES dimensions and either the reality distortion or disorganization dimensions. There was a modest but differentially significant relationship between psychomotor poverty and an extrapyramidal factor on the NES. This relationship was shown only by male subjects, and was influenced by duration of illness but not by age or neuroleptic medication. On the other hand, female subjects showed a significant relationship between psychomotor poverty and an NES factor reflecting attention and initiative, and between reality distortion and coordination/sequencing of motor activity. These relationships in female subjects were, relative to relationships for male subjects, more independent of the effect of medication and duration of illness.     

Schizophrenia--an illness and its treatment reflected in public attitude

Stigmatization with regard to mental illness and especially schizophrenia has been known from time immemorial. Meanwhile the negative attitudes have become metaphorical for unpredictability, violence, and bizarrely (grotesquely) contradictory behaviour. Persons concerned with these prejudices are excluded from the society and there is little willingness for contact. Particularly afflicted are also the relatives of schizophrenic persons. Media and motion pictures play an essential role in the maintenance of these negative attitudes. There will be suggestions (stimuli), especially by opinion leaders, to reach a change of the attitudes towards diseases and their methods of treatment.