Schizophrenia, Substance Abuse, and Violent Crime

Abstract

Context Persons with schizophrenia are thought to be at increased risk of committing violent crime 4 to 6 times the level of general population individuals without this disorder. However, risk estimates vary substantially across studies, and considerable uncertainty exists as to what mediates this elevated risk. Despite this uncertainty, current guidelines recommend that violence risk assessment should be conducted for all patients with schizophrenia. Objective To determine the risk of violent crime among patients diagnosed as having schizophrenia and the role of substance abuse in mediating this risk. Design, Setting, and Participants Longitudinal designs were used to link data from nationwide Swedish registers of hospital admissions and criminal convictions in 1973-2006. Risk of violent crime in patients after diagnosis of schizophrenia (n = 8003) was compared with that among general population controls (n = 80 025). Potential confounders (age, sex, income, and marital and immigrant status) and mediators (substance abuse comorbidity) were measured at baseline. To study familial confounding, we also investigated risk of violence among unaffected siblings (n = 8123) of patients with schizophrenia. Information on treatment was not available. Main Outcome Measure Violent crime (any criminal conviction for homicide, assault, robbery, arson, any sexual offense, illegal threats, or intimidation). Results In patients with schizophrenia, 1054 (13.2%) had at least 1 violent offense compared with 4276 (5.3%) of general population controls (adjusted odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). The risk was mostly confined to patients with substance abuse comorbidity (of whom 27.6% committed an offense), yielding an increased risk of violent crime among such patients (adjusted OR, 4.4; 95% CI, 3.9-5.0), whereas the risk increase was small in schizophrenia patients without substance abuse comorbidity (8.5% of whom had at least 1 violent offense; adjusted OR, 1.2; 95% CI, 1.1-1.4; P<.001 for interaction). The risk increase among those with substance abuse comorbidity was significantly less pronounced when unaffected siblings were used as controls (28.3% of those with schizophrenia had a violent offense compared with 17.9% of their unaffected siblings; adjusted OR, 1.8; 95% CI, 1.4-2.4; P<.001 for interaction), suggesting significant familial (genetic or early environmental) confounding of the association between schizophrenia and violence. Conclusions Schizophrenia was associated with an increased risk of violent crime in this longitudinal study. This association was attenuated by adjustment for substance abuse, suggesting a mediating effect. The role of risk assessment, management, and treatment in individuals with comorbidity needs further examination.

Violence and violent victimization in people with severe mental illness in a rural low-income country setting: A comparative cross-sectional community study

“…Violence perpetrated by people with severe mental illness (SMI: including bipolar disorder, schizophrenia and other psychotic disorders) has been the subject of research in high-income countries for decades (Elbogen and Johnson, 2009;Fazel et al, 2009a;Fazel et al, 2009b;Fazel et al, 2010;Swanson et al, 1990;Torrey, 1994;Vinokur et al, 2013). In high-income country settings, the presence of SMI is associated consistently with an increased risk of violence, although the extent to which this excess risk is explained by co-morbid substance misuse continues to be debated (Choe et al, 2008;Fazel et al, 2009a;Fazel et al, 2009b;Fazel et al, 2010;Short et al, 2013).…”

“…In high-income country settings, the presence of SMI is associated consistently with an increased risk of violence, although the extent to which this excess risk is explained by co-morbid substance misuse continues to be debated (Choe et al, 2008;Fazel et al, 2009a;Fazel et al, 2009b;Fazel et al, 2010;Short et al, 2013). The problem of violence carried out by people with SMI is often the focus of the public's attention in high-income countries; however, people with mental illness are more frequently the victims of violence ('violent victimization') than the general population (Hodgins et al, 2007;Maniglio, 2009;Sturup et al, 2011;Teplin et al, 2005;Walsh et al, 2003).…”

Changing the Landscape of an Urban Public Mental Health System: The 2008 New York State/New York City Mental Health-Criminal Justice Review Panel

“…[3][4][5][6][7] Clinical studies demonstrate poor outcomes, including discontinuing treatment and violent episodes, in this population. [8][9][10] The panel supported measures underway throughout the state by OMH and the NYS Office of Alcohol and Substance Abuse Services (OASAS) for mental health and substance abuse clinics to institute screening and assessment for co-occurring disorders and to link these to evidence based integrated dual diagnosis treatment.…”

The Relationship of Meta-Emotion Dimensions and Positive and Negative Symptoms in the Patients of Chronic Schizophrenia

“…However, among patients with a history of violent behavior early, psychotic symptoms have little influence [19]. Further, a research study found that schizophrenia predicted that the anger is accompanied by harassment and that drug abuse increases the risk [20]. Another research showed that the murder rate in patients with schizophrenia is much higher than after treatment [21].…”