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Violent behavior preceding hospitalization among persons with severe mental illness
1Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA. Jeff@psych.mc.duke.edu
Law and Human Behavior
|May 20, 1999
Summary
Violent behavior is common in individuals with severe mental illness (SMI) and involuntary outpatient commitment. Co-occurring substance abuse, past victimization, and younger age predict violence risk in this population.
Area of Science:
- Psychiatry
- Criminology
- Public Health
Background:
- Managing violence risk in severe mental illness (SMI) is crucial for community care.
- A subset of SMI patients exhibits "revolving door" institutional recidivism and poor treatment adherence.
- Limited research exists on the specific dimensions and context of violence in this SMI population.
Purpose of the Study:
- To describe characteristics of violent behavioral events in SMI patients.
- To identify factors associated with violence in individuals under involuntary outpatient commitment.
Main Methods:
- Study of 331 individuals with psychotic or major mood disorders on involuntary outpatient commitment.
- Pooled baseline data from self-report, collateral interviews, and hospital records.
- Multivariable analyses to determine predictors of violent behavior.
Main Results:
- Over half of the sample experienced violent behavior in the 4 months preceding hospitalization.
- Significant variability observed in violence frequency, severity, weapon use, and incident context.
- Co-occurring substance abuse, history of criminal victimization, and younger age were significantly associated with violence.
Conclusions:
- Clinical diagnosis and symptoms were not related to violence in this sample.
- Findings highlight the need to address substance abuse and victimization in violence risk management for SMI.
- Implications for service delivery priorities and future research in community mental health are discussed.