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Psychiatric disorders associated with varying risks of subjection to and perpetration of violence

Dr Margaret Shi
26 Feb 2020

Persons with psychiatric disorders were 3–4 times more likely than their siblings without psychiatric disorders to have been subjected to or to have perpetrated violence after the onset of their conditions, with the risks varying by specific psychiatric diagnoses, history of violence and familial risks, according to a study done in Sweden.

Individuals with any psychiatric disorder of interest in the study (namely, schizophrenia, bipolar disorder, depression, and anxiety as well as personality disorders and substance misuse disorders) were found to have significantly increased risks of subjection to violence (adjusted hazard ratio [aHR], 3.4; 95 percent confidence interval [CI], 3.2 to 3.6; p<0.001) and perpetration of violence (aHR, 4.2; 95 percent CI, 3.9 to 4.4; p<0.001) compared with their siblings without psychiatric disorders. [JAMA Psychiatry 2020, doi: 10.1001/jamapsychiatry.2019.4275]

Women with any psychiatric disorder had 4.3 times and 4.6 times the risks of subjection to violence and perpetration of violence, respectively, compared with their siblings without psychiatric disorders. In men, the corresponding risks were 2.8 times and 3.8 times, respectively.

Women and men with any psychiatric disorder were 19.8 times (95 percent CI, 6.4 to 61.7; p<0.001) and 8.6 times (95 percent CI, 6.8 to 10.8; p<0.001) more likely than their siblings without psychiatric disorders to be both subjected to violence and to perpetrate violence.

Persons diagnosed with substance (drug and alcohol) misuse disorders had the highest incidence of subjection to violence events (12–17 per 1,000 person-years) and perpetration of violence events (13–27 per 1,000 person-years) compared with other diagnostic groups.

All psychiatric conditions were associated with variable increases in risks of both outcomes compared with siblings without psychiatric disorders, except for persons diagnosed with schizophrenia (aHR, 0.9; 95 percent CI, 0.5 to 1.6; p=0.79).

The incidence rate of subjection to violence and perpetration of violence in individuals diagnosed with psychiatric disorders were 7.1 per 1,000 person-years and 7.5 per 1,000 person-years, respectively.

In this large longitudinal cohort study using data retrieved from Swedish nationwide registers, cases (n=250,419; median age range at first diagnosis, 20.0–23.7 years) were patients diagnosed with psychiatric disorders during the 20-year study period of 1973–1993. Matched controls were individuals in the general population (n=2,504,190) and the patients’ full biological siblings with no record of the psychiatric disorders of interest (n=194,788).

Patients diagnosed with depression (n=103,814) and alcohol use disorder (n=69,116) accounted for the largest patient groups. Requirement of medical treatment and conviction of a crime due to violence were required in less than half of the individuals with any psychiatric disorders.

“Clinical interventions may benefit from targeted approaches for the assessment and management of risk of violence in people with psychiatric disorders,” concluded the authors.

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