RESEARCH WEEKLY: Violence, Victimization, and People with Mental Illness – An Update
Two new research studies on the risks of committing violent acts and being targeted by violence in people with mental illness, in the United States and abroad, were published recently.
Although the methodological approaches were vastly different, both had similar findings – people with mental illness are more likely to be both perpetrators of violence and the target of violent acts compared to the general public. Both articles conclude that the risk of victimization as well as the risk of perpetration of violence by people with psychiatric disorders need to be acknowledged to better address these risks and behaviors.
Research in Sweden
Much of the population-level information on people with serious mental illness comes from Scandinavian countries due to their integrated data sets and ability to track information from people since birth with nationwide registers. In this study, researchers examined more than one-quarter of a million people (250,419) with psychiatric disorders from birth through adulthood. Perpetration of violence was measured based on court and criminal justice records. Being the target of violence was measured by an inpatient or outpatient healthcare episode where an injury occurred that was inflicted by another person.
The researchers compared violence perpetration and victimization by people who had psychiatric disorders versus those that did not. Importantly, the researchers were able to control for familial effects by using data from people’s full biological siblings who did not have a psychiatric disorder.
The authors found that patients with psychiatric disorders were three-times more likely to be subject to violence and four-times more likely to perpetrate violence than their siblings without a psychiatric disorder. They also found that a diagnosis of schizophrenia was the strongest risk factor for perpetration of violence. People with schizophrenia were seven-times more likely to perpetrate violence than their siblings with no mental illness.
Schizophrenia was the only psychiatric diagnosis that did not have an association with being a target of violence. The authors suggest this could be due to the fact that only severe victimization that resulted in a healthcare visit was measured. Another factor explaining this could be due to a lesser likelihood of seeking treatment for injury in people with schizophrenia compared to those with other mental illnesses.
Research in the United States
Large-scale research studies that combine data from multiple sectors, such as healthcare and criminal justice records, especially those that follow people over time starting at birth, are extremely difficult in the United States. In the study published from the United States, researchers instead surveyed 523 individuals with psychiatric disorders with an online survey. Questions included psychiatric diagnoses and having experienced violence or having committed violence towards other people, including family members.
The researchers found that 25% of respondents reported being a victim of violence by a close relative, whereas 26% of respondents have committed violence towards a close relative since they were first diagnosed with a mental illness. The violence between respondents with psychiatric disorders and their relatives was bidirectional, 40% of respondents who were a perpetrator of violence in the past six months also reported having been a victim of violence. The authors conclude that “assessing for risk of perpetrating family violence involving this population and intervening in such cases should entail assessing for and/or addressing victimization, and vice versa.”
Conclusion
Violence that is perpetrated by people with mental illness makes up an extremely small proportion of violent incidents, both in the United States and abroad. However, the results from these studies show that there is an increased risk of being a perpetrator of violence and the target of violent acts in people with a variety of mental illnesses.
Dr. Paul Applebaum of Columbia University wrote a piece accompanying the Swedish article about the data and its limits. “Evidence has accumulated over the last 40 years indicating increased rates of violent perpetration and being the target of violence among people with mental illness,” Dr. Applebaum begins. “Our focus going forward should be on identifying factors in the causal pathways to violence and being targeted by violence (not merely identifying correlates), testing interventions to find effective answers, and mustering the will and the resources to implement them.”
