Reduction of crime in first-onset psychosis: a secondary analysis of the OPUS randomized trial

Violence and criminality are adverse outcomes for some persons who develop psychotic illnesses. The extent to which treatment can reduce offending has rarely been studied. The aim of this study was to evaluate whether assertive specialized treatment would reduce the rate of crime in patients with a first episode of psychotic illness.

From January 1998 to December 2000, a total of 547 patients aged 18-45 years with a first episode of schizophrenia spectrum disorder (ICD-10 diagnostic code within F2) were randomized to assertive specialized treatment or standard treatment in an outpatient setting. In the current secondary analysis of the data, levels of criminality during the 2-year treatment period and the 3 years following were assessed using official records from Danish registers. Main outcome measures were any offending and violent offending.

No significant reduction in violent offending or any offending was found in the assertive specialized treatment group (adjusted hazard ratio = 1.06; 95% CI, 0.72-1.56) compared with the control group. Prevalence of offending was low and had often commenced prior to inclusion in the trial.

While assertive specialized treatment has shown good treatment effects, it had no impact on rates of offending, thereby calling into question the potential efficacy of universally applied improvements in outpatient services with respect to reducing crime and violence. More specific interventions that address criminogenic needs in a more narrowly defined group of high-risk patients may be considered.