Psychosis as a risk factor for violence to others: a meta-analysis

The potential association between psychosis and violence to others has long been debated. Past research findings are mixed and appear to depend on numerous potential moderators. As such, the authors conducted a quantitative review (meta-analysis) of research on the association between psychosis and violence. A total of 885 effect sizes (odds ratios) were calculated or estimated from 204 studies on the basis of 166 independent data sets. The central tendency (median) of the effect sizes indicated that psychosis was significantly associated with a 49%-68% increase in the odds of violence. However, there was substantial dispersion among effect sizes. Moderation analyses indicated that the dispersion was attributable in part to methodological factors, such as study design (e.g., community vs. institutional samples), definition and measurement of psychosis (e.g., diagnostic vs. symptom-level measurement, type of symptom), and comparison group (e.g., psychosis compared with externalizing vs. internalizing vs. no mental disorder). The authors discuss these findings in light of potential causal models of the association between psychosis and violence, the role of psychosis in violence risk assessment and management, and recommendations for future research.