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Leading indicators of community-based violent events among adults with mental illness

  • R. A. Van Dorn (a1), K. J. Grimm (a2), S. L. Desmarais (a3), S. J. Tueller (a1), K. L. Johnson (a1) and M. S. Swartz (a4)...

Abstract

Background

The public health, public safety and clinical implications of violent events among adults with mental illness are significant; however, the causes and consequences of violence and victimization among adults with mental illness are complex and not well understood, which limits the effectiveness of clinical interventions and risk management strategies. This study examined interrelationships between violence, victimization, psychiatric symptoms, substance use, homelessness and in-patient treatment over time.

Method

Available data were integrated from four longitudinal studies of adults with mental illness. Assessments took place at baseline, and at 1, 3, 6, 9, 12, 15, 18, 24, 30 and 36 months, depending on the parent studies’ protocol. Data were analysed with the autoregressive cross-lag model.

Results

Violence and victimization were leading indicators of each other and affective symptoms were a leading indicator of both. Drug and alcohol use were leading indicators of violence and victimization, respectively. All psychiatric symptom clusters – affective, positive, negative, disorganized cognitive processing – increased the likelihood of experiencing at least one subsequent symptom cluster. Sensitivity analyses identified few group-based differences in the magnitude of effects in this heterogeneous sample.

Conclusions

Violent events demonstrated unique and shared indicators and consequences over time. Findings indicate mechanisms for reducing violent events, including trauma-informed therapy, targeting internalizing and externalizing affective symptoms with cognitive–behavioral and psychopharmacological interventions, and integrating substance use and psychiatric care. Finally, mental illness and violence and victimization research should move beyond demonstrating concomitant relationships and instead focus on lagged effects with improved spatio-temporal contiguity.

Copyright

Corresponding author

*Address for correspondence: R. A. Van Dorn, Ph.D., RTI International, 3040 E. Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709, USA. (Email: rvandorn@rti.org)

References

Hide All
Citrome, L, Volavka, J (1997). Psychopharmacology of violence: Part II: beyond the acute episode. Psychiatric Annals 27, 696703.
Citrome, L, Volavka, J, Czobor, P, Sheitman, B, Lindenmayer, J-P, McEvoy, J, Cooper, TB, Chakos, M, Lieberman, JA (2001). Effects of clozapine, olanzapine, risperidone, and haloperidol on hostility among patients with schizophrenia. Psychiatric Services 52, 15101514.
Coid, JW, Kallis, C, Doyle, M, Shaw, J, Ullrich, S (2015). Identifying causal risk factors for violence among discharged patients. PLOS ONE 10, e0142493.
Curran, PJ, Hussong, AM (2009). Integrative data analysis: the simultaneous analysis of multiple data sets. Psychological Methods 14, 81100.
Cuthbert, BN, Insel, TR (2010). Toward new approaches to psychotic disorders: the NIMH Research Domain Criteria project. Schizophrenia Bulletin 36, 10611062.
Dack, C, Ross, J, Papadopoulos, C, Stewart, D, Bowers, L (2013). A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatrica Scandinavica 127, 255268.
Denson, TF (2015). Four promising psychological interventions for reducing reactive aggression. Current Opinion in Behavioral Sciences 3, 136141.
Desmarais, SL, Van Dorn, RA, Johnson, KL, Grimm, KJ, Douglas, KS, Swartz, MS (2014). Community violence perpetration and victimization among adults with mental illnesses. American Journal of Public Health 104, 23422349.
Drake, RE, Osher, FC, Noordsy, DL, Hurlbut, SC, Teague, GB, Beaudett, MS (1990). Diagnosis of alcohol use disorders in schizophrenia. Schizophrenia Bulletin 16, 5767.
Fazel, S, Långström, N, Hjern, A, Grann, M, Lichtenstein, P (2009). Schizophrenia, substance abuse, and violent crime. JAMA 301, 20162023.
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for Axes I and II DSM-IV Disorders-Patient Edition (SCID-I/P). Biometrics Research Department, New York State Psychiatric Institute: New York.
Glass, GV (1976). Primary, secondary, and meta-analysis. Educational Researcher 5, 38.
Glickman, ME, Rao, SR, Schultz, MR (2014). False discovery rate control is a recommended alternative to Bonferroni-type adjustments in health studies. Journal of Clinical Epidemiology 67, 850857.
Goldman-Rakic, PS (1994). Working memory dysfunction in schizophrenia. Journal of Neuropsychiatry and Clinical Neurosciences 6, 348357.
Grimm, KJ, Ram, N (2009). Nonlinear growth models in M plus and SAS. Structural Equation Modeling 16, 676701.
Grubaugh, AL, Zinzow, HM, Paul, L, Egede, LE, Frueh, BC (2011). Trauma exposure and posttraumatic stress disorder in adults with severe mental illness: a critical review. Clinical Psychology Review 31, 883899.
Kay, SR, Flszbein, A, Opfer, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Kraemer, HC, Kazdin, AE, Offord, DR, Kessler, RC, Jensen, PS, Kupfer, DJ (1997). Coming to terms with the terms of risk. Archives of General Psychiatry 54, 337343.
Lieberman, JA, Stroup, TS, McEvoy, JP, Swartz, MS, Rosenheck, RA, Perkins, DO, Keefe, RS, Davis, SM, Davis, CE, Lebowitz, BD (2005). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine 353, 12091223.
Lindenmayer, J-P, Liu-Seifert, H, Kulkarni, PM, Kinon, BJ, Stauffer, V, Edwards, SE, Chen, L, Adams, DH, Ascher-Svanum, H, Buckley, PF (2009). Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. Journal of Clinical Psychiatry 70, 990996.
Mayfield, D, McLeod, G, Hall, P (1974). The CAGE questionnaire: validation of a new alcoholism screening instrument. American Journal of Psychiatry 131, 11211123.
McArdle, JJ (1994). Structural factor analysis experiments with incomplete data. Multivariate Behavioral Research 29, 409454.
Michie, C, Cooke, DJ (2006). The structure of violent behavior a hierarchical model. Criminal Justice and Behavior 33, 706737.
Moberg, T, Nordström, P, Forslund, K, Kristiansson, M, Åsberg, M, Jokinen, J (2011). CSF 5-HIAA and exposure to and expression of interpersonal violence in suicide attempters. Journal of Affective Disorders 132, 173178.
Monahan, J, Redlich, AD, Swanson, J, Robbins, PC, Appelbaum, PS, Petrila, J, Steadman, HJ, Swartz, M, Angell, B, McNiel, DE (2005). Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatric Services 56, 3744.
Nestor, PG (2014). Mental disorder and violence: personality dimensions and clinical features. American Journal of Psychiatry 159, 19731978.
Nolan, KA, Volavka, J, Czobor, P, Sheitman, B, Lindenmayer, J-P, Citrome, LL, McEvoy, J, Lieberman, JA (2005). Aggression and psychopathology in treatment-resistant inpatients with schizophrenia and schizoaffective disorder. Journal of Psychiatric Research 39, 109115.
Odgers, CL, Mulvey, EP, Skeem, JL, Gardner, W, Lidz, CW, Schubert, C (2009). Capturing the ebb and flow of psychiatric symptoms with dynamical systems models. American Journal of Psychiatry 166, 575582.
Overall, JE (1974). The Brief Psychiatric Rating Scale in psychopharmacology research. In Psychological Measurements in Psychopharmacology (ed. Olivier-Martin, R), pp. 6778. Karger: Oxford.
Oxman, AD, Clarke, MJ, Stewart, LA (1995). From science to practice: meta-analyses using individual patient data are needed. JAMA 274, 845846.
Peduzzi, P, Concato, J, Kemper, E, Holford, TR, Feinstein, AR (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology 49, 13731379.
Pescosolido, BA, Monahan, J, Link, BG, Stueve, A, Kikuzawa, S (1999). The public's view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. American Journal of Public Health 89, 13391345.
Rhemtulla, M, Brosseau-Liard, PE, Savalei, V (2012). When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions. Psychological Methods 17, 354373.
Scheller-Gilkey, G, Moynes, K, Cooper, I, Kant, C, Miller, AH (2004). Early life stress and PTSD symptoms in patients with comorbid schizophrenia and substance abuse. Schizophrenia Research 69, 167174.
Silver, E, Piquero, AR, Jennings, WG, Piquero, NL, Leiber, M (2011). Assessing the violent offending and violent victimization overlap among discharged psychiatric patients. Law and Human Behavior 35, 4959.
Singh, MM, Kay, SR (1975). A comparative study of haloperidol and chlorpromazine in terms of clinical effects and therapeutic reversal with benztropine in schizophrenia. Theoretical implications for potency differences among neuroleptics. Psychopharmacologia 43, 103113.
Skeem, JL, Schubert, C, Odgers, C, Mulvey, EP, Gardner, W, Lidz, C (2006). Psychiatric symptoms and community violence among high-risk patients: a test of the relationship at the weekly level. Journal of Consulting and Clinical Psychology 74, 967979.
Smith, ML, Glass, GV (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist 32, 752760.
Steadman, HJ, Mulvey, EP, Monahan, J, Robbins, PC, Appelbaum, PS, Grisso, T, Roth, LH, Silver, E (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Archives of General Psychiatry 55, 393401.
Swanson, J, Swartz, M, Elbogen, E, Van Dorn, R, Ferron, J, Wagner, H, McCauley, B, Kim, M (2006 a). Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. American Journal of Psychiatry 163, 19431951.
Swanson, JW, Swartz, MS, Elbogen, EB (2004). Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Schizophrenia Bulletin 30, 320.
Swanson, JW, Swartz, MS, Van Dorn, RA, Elbogen, EB, Wagner, HR, Rosenheck, RA, Stroup, TS, McEvoy, JP, Lieberman, JA (2006 b). A national study of violent behavior in persons with schizophrenia. Archives of General Psychiatry 63, 490499.
Swanson, JW, Swartz, MS, Van Dorn, RA, Volavka, J, Monahan, J, Stroup, TS, McEvoy, JP, Wagner, HR, Elbogen, EB, Lieberman, JA (2008). Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia. British Journal of Psychiatry 193, 3743.
Tueller, SJ, Johnson, KL, Grimm, KJ, Desmarais, SL, Sellers, BG, Van Dorn, RA (2016). Effects of sample size and distributional assumptions on competing models of the factor structure of the PANSS and BPRS. International Journal of Methods in Psychiatric Research. Published online 2 December 2016. doi:10.1002/mpr.1549.
Van Dorn, R, Volavka, J, Johnson, N (2012). Mental disorder and violence: is there a relationship beyond substance use? Social Psychiatry and Psychiatric Epidemiology 47, 487503.
Van Dorn, RA, Desmarais, SL, Grimm, KJ, Tueller, SJ, Johnson, KL, Sellers, BG, Swartz, MS (2016). The latent structure of psychiatric symptoms across mental disorders as measured with the PANSS and BPRS. Psychiatry Research 245, 8390.
Virkkunen, M, Linnoila, M (1990). Serotonin in early onset, male alcoholics with violent behaviour. Annals of Medicine 22, 327331.
Virkkunen, M, Nuutila, A, Goodwin, FK, Linnoila, M (1987). Cerebrospinal fluid monoamine metabolite levels in male arsonists. Archives of General Psychiatry 44, 241247.
Volavka, J (1999). The neurobiology of violence: an update. Journal of Neuropsychiatry and Clinical Neurosciences 11, 307314.
Volavka, J (2008). Neurobiology of Violence. American Psychiatric Publishing, Inc.: Washington, DC.
Volavka, J, Czobor, P, Citrome, L, Van Dorn, RA (2014). Effectiveness of antipsychotic drugs against hostility in patients with schizophrenia in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study. CNS Spectrums 19, 374381.
Witt, K, Van Dorn, R, Fazel, S (2013). Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies. PLOS ONE 8, e55942.

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Leading indicators of community-based violent events among adults with mental illness

  • R. A. Van Dorn (a1), K. J. Grimm (a2), S. L. Desmarais (a3), S. J. Tueller (a1), K. L. Johnson (a1) and M. S. Swartz (a4)...

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