Homeless men and women: Differential associations among substance abuse, psychosocial factors, and severity of homelessness.

Latent variable multiple-group confirmatory factor analyses assessed gender differences in relationships among drug and alcohol use, measures indicating severity of homelessness, criminal history, prior institutionalization, and mental illness (N?=?531 homeless persons; 386 men and 145 women). Severity was indicated by length of time homeless, housing quality, and victimization. Men reported more substance use, a longer time homeless, poorer housing quality, greater criminal involvement, and less likelihood of living with a child. Constrained multiple-group models surfaced 5 significantly different relationships between latent constructs. Men had stronger relationships between mental illness and prior institutionalization, drug use and mental illness, and drug use and victimization, whereas women had stronger relationships between drug use and alcohol use, and criminal involvement and drug use. Service delivery implications and suggestions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevalence of allergic rhinitis and nasal symptoms in Nottingham

An overview of the most important older and newer results regarding the relationship between violent and criminal behavior on the one hand and schizophrenic illness on the other hand is presented. Four different methods are available to study this relationship: (i) study of the prevalence of mental illness in criminal/violent populations; (ii) study of criminality/violence rate in samples of psychiatric patients; (iii) study of criminality/violence in community samples comparing mental patients with non-patient community residents; and (iv) study of criminality/violence in birth cohorts prospectively. All these methods have been used; but samples composed of schizophrenic patients exclusively were only exceptionally studied. The results indicate that there is a modest but significant relationship between schizophrenia and violence and crime which persists even after controlling for demographic and socio-economic variables. The probability of schizophrenic patients to be criminal or violent depends on the acuity of their illness and is increased by their use of psychoactive substances. Generally, however, violent and criminal acts directly attributable to mental illness account only for a very small proportion of such acts in the society.     

Viscoelastic adherence to corneal endothelium following phacoemulsification

OBJECTIVE: The study examined the prevalence and correlates of criminal victimization and the relationship between victimization and client outcomes for homeless clients with mental illness. METHODS: Subjects were clients in community treatment programs participating in the Access to Community Care and Effective Services and Supports (ACCESS) program of the Center for Mental Health Services. Data were obtained through interviews conducted at program entry and at three and 12 months after entry with ACCESS clients in 18 sites during the first year of program operation (N = 1,839). Self-reports of victimization during the past two months as well as data on sociodemographic, health, and social adjustment indicators were obtained at each time point. Multiple regression was used to determine both the correlates of victimization among this population and the effect of recent victimization on client outcomes three and 12 months after program entry. RESULTS: Forty-four percent of the clients were the victims of at least one crime during the two months before entering the program. Women were significantly more likely than men to have been victimized. Multivariate analysis showed that the more severe the client's psychotic symptoms, alcohol abuse, and criminal history, the more likely he or she was to have been victimized. Recent victimization had a significant impact on client outcomes in terms of increased homelessness and decreased quality of life. Victimization shortly before program entry was also the single most important predictor of victimization at both follow-up points. CONCLUSIONS: These findings suggest the critical need for service providers who work with homeless people with serious mental illness to assess the extent to which they have been victims of crime and to address issues of victimization and safety along with psychiatric and social adjustment problems.     

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.     

Mental illness and substance use among sheltered homeless persons in lower-density population areas

OBJECTIVE: The prevalence of mental illness and substance abuse in homeless populations has been studied primarily in large urban areas. This study examines a sheltered homeless population in two counties of lower-density population, Dauphin and Cumberland counties in central Pennsylvania, to assess the prevalence of mental illness and substance abuse. METHODS: A total of 81 homeless adults from nine emergency shelters were interviewed using a structured questionnaire. RESULTS: The estimated lifetime prevalence rate of major depressive disorder was 26.6 percent; 6.4 percent of the sample showed evidence of psychotic thinking. Almost one-third reported previous hospitalization for emotional problems, and about one-third reported a suicide attempt. The estimated lifetime prevalence rate of alcohol or drug abuse or dependence was almost 60 percent. CONCLUSIONS: Although mental illness, especially psychosis, and substance abuse may be somewhat less prevalent among homeless persons in lower-density population areas than in large urban areas, they are nevertheless significant problems.     

Relation of criminal victimization to health perceptions among women medical patients.

The relation of criminal victimization to health perceptions (self-rated current health) was determined among women health maintenance organization patients. Data were survey responses from 2,291 women (45% response rate), 57% of whom had experienced crime. Reliability was evaluated by assessing 241 respondents both by survey and by interview. Data were analyzed by hierarchical multiple regression, which indicated that criminal victimization was an important predictor of health perceptions even after accounting for the contributions of demographics and other stressful life events with known links to illness. Validity was supported because medical care was actually sought by 92% of crime victims during the 1st year following the crime and by 100% during the 2nd year. Conclusions included the following: (a) Crime victimization history is relevant to health status assessment, and (b) primary care medical populations are an important locus from which crime victims could be identified and their treatment options considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of current and lifetime substance use in schizophrenia

A structured interview and standardized rating scales were used to assess a sample of 194 outpatients with schizophrenia in a regional Australian mental health service for substance use, abuse, and dependence. Case manager assessments and urine drug screens were also used to determine substance use. Additional measurements included demographic information, history of criminal charges, symptom self-reports, personal hopefulness, and social support. The sample was predominantly male and showed relative instability in accommodations, and almost half had a history of criminal offenses, most frequently drug or alcohol related. The 6-month and lifetime prevalence of substance abuse or dependence was 26.8 and 59.8 percent, respectively, with alcohol, cannabis, and amphetamines being the most commonly abused substances. Current users of alcohol comprised 77.3 percent and current users of other nonprescribed substances (excluding tobacco and caffeine) comprised 29.9 percent of the sample. Rates of tobacco and caffeine consumption were high. There was a moderate degree of concordance between case manager determinations of a substance-use problem and research diagnoses. Subjects with current or lifetime diagnoses of substance abuse/dependence were predominantly young, single males with higher rates of criminal charges; however, there was no evidence of increased rates of suicide attempts, hospital admissions, or daily doses of antipsychotic drugs in these groups compared with subjects with no past or current diagnosis of substance abuse or dependence. Subjects with a current diagnosis of substance use were younger at first treatment and currently more symptomatic than those with no past or current substance use diagnosis. The picture emerging from this study replicates the high rate of substance abuse in persons with schizophrenia reported in North American studies but differs from the latter in finding a slightly different pattern of substances abused (i.e., absence of cocaine), reflecting relative differences in the availability of certain drugs.     

Gender differences in homeless persons with schizophrenia and substance abuse

The purpose of this study was to test the generalizability of previous research on gender differences between men and women with co-occurring schizophrenia and substance abuse. One hundred eight patients with schizophrenia or schizo-affective disorder involved in a study of treatment for homeless persons were interviewed for information regarding substance use, social functioning and support, comorbid disorders, victimization, medical illness, and legal troubles. We found that women had more children and were more socially connected than men. Women also had higher rates of sexual and physical victimization, comorbid anxiety and depression, and medical illness than men. We conclude that homeless women with dual disorders, like women with substance use disorders in the general population, have distinct characteristics, vulnerabilities, and treatment needs compared with men. In addition to comprehensive treatment of psychiatric and substance use disorders, gender-specific services should be developed, including prevention and treatment of victimization and related problems as well as help with accessing medical services.     

Impact of directly and indirectly experienced events: The origin of crime-related judgments and behaviors.

Used data collected from 1,862 adults in 2 surveys of crime victimization to examine the integration of 1st-hand and indirect experiences with crime into crime-related judgments and behaviors. Analysis revealed 2 independent levels of judgment: general judgments of the base rate of crime and individual judgments of personal vulnerability to crime. Examination of the effect of 1st-hand and indirect experiences on these judgments counters the conventional wisdom that 1st-hand experiences have greater influence than indirect experiences and suggests that the relative influence of different modalities of experience depends on the level of the judgment being considered. The role of the perceived informativeness, memorability, and affectivity of a crime victimization experience in mediating its impact was also explored. Results suggest that informativeness was generally the most important mediator of impact. Results also suggest that different characteristics mediated the impact of experiences on judgments and on behaviors. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological distress following criminal victimization in the general population: Cross-sectional, longitudinal, and prospective analyses.

Samples of 105 violent crime victims, 227 property crime victims, and 190 nonvictims provided normative data regarding levels of psychological distress following criminal victimization. At points approximately 3, 9, and 15 mo post-crime, symptoms of depression, somatization, hostility, anxiety, phobic anxiety, fear of crime, and avoidance were assessed. Although crime victims showed substantial improvement between 3 and 9 mo, thereafter they did not. Over the course of the study, violent crime victims remained more distressed than did property crime victims who, in turn, remained more distressed than nonvictims. Regression analyses revealed that the effects of crime could not be accounted for by pre-crime differences between victims and nonvictims in either social status or psychological functioning. However, lasting effects were often contingent on the occurrence of subsequent crimes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of cocaine and other substance dependence to well-being of high-risk psychiatric patients

OBJECTIVE: The co-occurrence of substance dependence disorders was determined in a sample of 160 frequently hospitalized adults with severe mental illness, and the relationship between substance dependence and psychosocial functioning and well-being was examined. METHODS: A structured interview was used to assess subjects for co-occurring current DSM-III-R substance dependence disorders during an acute psychiatric hospitalization. They were administered a structed interview that included the subscales of the Addiction Severity Index, the Center for Epidemiological Studies-Depression Scale, Lehman's Quality of Life Interview, Rosenberg's Self-Esteem Scale, the Mastery Scale, and questions about service needs. RESULTS: Seventy-eight of the subjects (48.8 percent) were diagnosed as having at least one current substance dependence disorder. Most subjects with comorbid substance dependence were polysubstance dependent (55.1 percent), and almost half (44.9 percent) met criteria for cocaine dependence. Subjects who were substance dependent were significantly overrepresented among those diagnosed with bipolar disorder, psychotic disorder not otherwise specified, and major depression. When the analysis controlled for demographic characteristics and primary diagnosis, comorbidity was related to depressive symptoms, adverse life conditions, and diminished life satisfaction in several domains. Substance-dependent subjects were significantly more likely to have been arrested and jailed than nondependent subjects. Cocaine-dependent subjects were significantly less satisfied than all other subjects with their living situation and personal safety and more likely to request assistance for their drug and alcohol use problems. CONCLUSIONS: The findings corroborate high rates of co-occurring substance dependence disorders among frequently hospitalized patients with severe mental illness. They also reveal a high prevalence of cocaine dependence and a dramatic pattern of negative correlates of cocaine dependence. The findings suggest that successful interventions for substance dependence may improve these patients' life circumstances and that psychiatric patients may be particularly receptive to such interventions during hospitalization.     

Ethnic and racial differences in perceptions of dangerousness of persons with mental illness

Ethnic and racial differences in the stigma associated with mental illness in the general population were examined through secondary analysis of data from a survey of a nationally representative sample (N = 1,468) on attitudes toward homeless and homeless mentally ill people. American Indian (1 percent of the sample), Asian-Pacific Islander (1.5 percent), black (10 percent), and Hispanic respondents (4 percent) were compared with white respondents (82 percent) to determine if the groups differed in their perception of the dangerousness of mental patients and if contact with mentally ill persons moderated ethnic and racial differences in perceptions of dangerousness. Asian and Hispanic respondents perceived mental patients as significantly more dangerous than did white respondents. Increased contact with mentally ill people was associated with lower levels of perceived dangerousness among white respondents but not among black respondents.     

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.     

Does psychiatric disorder predict violent crime among released jail detainees? A six-year longitudinal study.

Examined whether jail detainees with schizophrenia, major affective disorders, alcohol or drug use disorders, or psychotic symptoms (hallucinations and delusions) are arrested more often for violent crimes 6 yrs after release than are detainees with no disorders. Trained interviewers assessed 728 randomly selected male jail detainees using the National Institute of Mental Health Diagnostic Interview Schedule and then obtained follow-up arrest data for 6 yrs. Neither severe mental disorder nor substance abuse or dependence predicted the probability of arrest or the number of arrests for violent crime. Ss with symptoms of both hallucinations and delusions had a slightly higher number of arrests for violent crime, but not significantly so. These findings held even after controlling for prior violence and age. The findings do not support the stereotype that mentally ill criminals invariably commit violent crimes after they are released. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of perceived vulnerability in adjustment to lower extremity amputation: A preliminary investigation.

Objective: To examine the role of feelings of vulnerability in postamputation adjustment problems such as depression and diminished quality of life. Participants: Eighty-four patients with a lower extremity amputation. Setting: Five affiliated prosthetic clinics in Chicago. Main Measures: The Center for Epidemiologic Studies Depression Scale (CES-D), a 3-item quality-of-life measure, and a 2-item vulnerability measure. Participants' prosthetists completed a single-item rating of perceived adjustment. Results: Vulnerability accounted for significant portions of the variance in CES-D scores, quality-of-life ratings, and prosthetists' adjustment ratings. Conclusion: Feelings of vulnerability significantly affect adjustment in persons with amputations, and this impact is not limited to a single domain. Clinicians should assess feelings of vulnerability, the degree to which such feelings are realistic, and any past experiences with victimization. These issues need to be addressed with both individual counseling and community interventions aimed at reducing victimization of individuals with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness.

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual diagnosis: a review of etiological theories

The etiology of the high prevalence of substance use disorders in patients with severe mental illness (schizophrenia or bipolar disorder) is unclear. We review the evidence of different theories of increased comorbidity, organized according to four general models: common factor models, secondary substance use disorder models, secondary psychiatric disorder models, and bidirectional models. Among common factor models, evidence suggests that antisocial personality disorder accounts for some increased comorbidity. Among secondary substance use disorder models, there is support for the supersensitivity model, which posits that biological vulnerability of psychiatric disorders results in sensitivity to small amounts of alcohol and drugs, leading to substance use disorders. There is minimal support for the self-medication model, but the accumulation of multiple risk factors related to mental illness, including dysphoria, may increase the risk of substance use disorder. Secondary psychiatric disorder models remain to be convincingly demonstrated. Bidirectional models have not been systematically examined. Further clarification of etiologic factors, including the identification of subtypes of dual diagnosis, may have implications for developing more effective prevention efforts and treatment.     

A comparison of federal definitions of severe mental illness among children and adolescents in four communities

OBJECTIVE: Using data from an epidemiological survey, the study compared existing definitions of severe mental illness and serious emotional disturbance among children and adolescents to demonstrate the range of prevalence rates resulting from application of different definitions to the same population. METHODS: Three definitions of severe mental illness and serious emotional disturbance were applied to data from the Methods for the Epidemiology of Child and Adolescent Mental Disorders survey, with a sample of 1,285, conducted in 1991-1992 by the National Institute of Mental Health. The resulting proportions of cases identified, demographic characteristics, service use, and perceived need for services were compared. RESULTS: From 3 to 23 percent of the sampled youth met criteria for severe mental illness or serious emotional disturbance. From 40 percent to as many as 78 percent of the defined youth used a mental health service in the year before the survey. School and ambulatory specialty settings were used most frequently. Generally, more than half of the parents of children with severe mental illness or serious emotional disturbance thought that their child needed services. CONCLUSIONS: The prevalence and characteristics of severe mental illness and serious emotional disturbance among children are sensitive to the definition used and its operationalization. Care should be taken by policy makers and service planners to avoid either over- or underestimating the prevalence of impaired youth in need of intensive interventions.     

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)