Systematic Review and Meta-Analysis: Risk Factors of Violence During First-Episode Psychosis

Most people with a psychotic illness will never be violent; however, it is widely known that violence is more prevalent in this group compared to the general community, particularly during first-episode psychosis (FEP). Despite this, there is limited research into what contributes to this increased risk during FEP. The present systematic review aimed to identify whether certain risk factors are differentially associated with severity and timing of violence perpetration during FEP. The following databases were used to identify studies, up to March 8, 2024: MEDLINE, Embase, PsycINFO, CINAHL, and ProQuest. A total of 15 studies were included. Male gender, non-white ethnicity, history of violence, higher general psychopathology, and recent substance use were significantly associated with any violence, regardless of the time at which violence was committed. Serious violence was not associated with any risk factors. Higher general psychopathology was associated with any violence committed before presentation to services, while male gender was associated with violence perpetrated at service entry. Only male gender and unemployment were associated with violence committed after treatment. Based on our results, risk factors appear to vary according to the severity and timing of violence. These risk factors also overlap with those found associated with violence risk in the general community, and those correlated with the risk of psychosis. Past studies are limited in the range of risk factors studied and further work is needed to understand correlates of violence in people who have experienced FEP to inform treatment options.