Psychiatric symptoms and alcohol use in community violence by persons with a psychotic disorder or depression

Prior studies have shown a significant but modest association between mental disorders and violence and an increased risk in the presence of co-occurring substance use disorders. Categorical diagnoses, however, have limited utility when assessing dynamic risk state over time. This study used data from the MacArthur Violence Risk Assessment Study to examine the relationship of symptom levels and alcohol use to violence in repeated observations within two diagnostic groups.

Participants with a primary categorical diagnosis of depression (N=386) or a psychotic disorder (N=201) were identified. Subscale scores for affective or positive symptoms from the Brief Psychiatric Rating Scale and self-reported alcohol consumption were tested in panel logistic models over five ten-week intervals for their concurrent and lagged relationship to violence. An interaction term between each type of symptom and alcohol use was also tested.

In models including the amount of alcohol consumed and symptom levels, a high level of affective symptoms was associated with violence during the next follow-up period only for participants with depression. There was a significant interaction between alcohol use and affective symptoms for participants with depression.

The relationship of symptoms and alcohol use to community violence should be considered in the context of the individual's primary diagnosis. Further characterization of interactions between symptoms and substance use in relation to violent behavior may allow for more effective assessment of risk state and interventions for violence prevention.