Skip to main content Accessibility help

Post-illness-onset risk of offending across the full spectrum of psychiatric disorders

  • H. Stevens (a1), T. M. Laursen (a1) (a2), P. B. Mortensen (a1) (a2) (a3), E. Agerbo (a1) (a3) and K. Dean (a4)...



The link between psychotic disorders and violent offending is well established; knowledge about risk of post-illness-onset offending across the full spectrum of psychiatric disorders is lacking. We aimed to compare rates of any offending and violent offending committed after the onset of illness, according to diagnostic group, with population controls.


A 25% random sample of the Danish population (n = 521 340) was followed from their 15th birthday until offending occurred. Mental health status was considered as a time-varying exposure in a Poisson regression model used to examine the duration from service contact to the offence.


Males with any psychiatric contact had an incidence rate ratio (IRR) of 2.91 [95% confidence interval (CI) 2.80–3.02] for any offending; 4.18 (95% CI 3.99–4.38) for violent offending. Associations were stronger for women (IRR 4.17, 95% CI 3.95–4.40 for any offending; 8.02, 95% CI 7.20–8.94 for violent offending). Risk was similar across diagnostic groups for any offending in males, while variation between diagnostic groups was seen for male violent and female offending, both any and violent.


Risk of offending, particularly violent offending, was elevated across a range of mental disorders following first contact with mental health services. The extent of variation in strength of effect across diagnoses differed by gender.


Corresponding author

* Address for correspondence: K. Dean, MRCPsych, RANZCP, Ph.D., School of Psychiatry, University of New South Wales, C/- Justice Health & Forensic Mental Health Network, Roundhouse, Long Bay Complex, PO Box 150, Matraville, 2036, NSW, Australia. (Email:


Hide All
Andersen, PK, Keiding, N (2002). Multi-state models for event history analysis. Statistical Methods in Medical Research 11, 91115.
Andersen, TF, Madsen, M, Jørgensen, J, Mellemkjær, L, Olsen, JH (1999). The Danish National Hospital Register. A valuable source of data for modern health sciences. Danish Medical Bulletin 46, 263268.
Arseneault, L, Moffitt, TE, Caspi, A, Taylor, PJ, Silva, PA (2000). Mental disorders and violence in a total birth cohort: results from the Dunedin Study. Archives of General Psychiatry 57, 979986.
Brennan, PA, Mednick, SA, Hodgins, S (2000). Major mental disorders and criminal violence in a Danish birth cohort. Archives of General Psychiatry 57, 494500.
Choe, JY, Teplin, LA, Abram, KM (2008). Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatric Services 59, 153–64.
Clayton, D, Hills, M (1993). Statistical Models in Epidemiology. Oxford University Press: Oxford.
Coid, JW, Ullrich, S, Kallis, C, Keers, R, Barker, D, Cowden, F, Stamps, R (2013). The relationship between delusions and violence: findings from the east London First Episode Psychosis Study. JAMA Psychiatry 70, 465471.
Dalsgaard, S, Mortensen, PB, Frydenberg, M, Thomsen, PH (2013). Long-term criminal outcome of children with attention deficit hyperactivity disorder. Criminal Behaviour and Mental Health: CBMH 23, 8698.
Dean, K, Mortensen, PB, Stevens, H, Murray, RM, Walsh, E, Agerbo, E (2012). Criminal conviction among offspring with parental history of mental disorder. Psychological Medicine 42, 571581.
Dean, K, Stevens, H, Mortensen, PB, Murray, RM, Walsh, E, Pedersen, CB (2010). Full spectrum of psychiatric outcomes among offspring with parental history of mental disorder. Archives of General Psychiatry 67, 822829.
Elbogen, EB, Johnson, SC (2009). The intricate link between violence and mental disorder. Archives of General Psychiatry 66, 152161.
Fazel, S, Grann, M (2004). Psychiatric morbidity among homicide offenders: a Swedish population study. American Journal of Psychiatry 161, 21292131.
Fazel, S, Gulati, G, Linsell, L, Geddes, JR, Grann, M (2009 a). Schizophrenia and violence: systematic review and meta-analysis. PLoS Medicine 6, e1000120.
Fazel, S, Långström, N, Hjern, A, Grann, M, Lichtenstein, P, Langstrom, N (2009 b). Schizophrenia, substance abuse, and violent crime. JAMA 301, 20162023.
Fazel, S, Lichtenstein, P, Grann, M, Goodwin, GM, Langstrom, N (2010). Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review. Archives of General Psychiatry 67, 931938.
Fergusson, DM, Horwood, LJ, Ridder, EM (2005). Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. Journal of Child Psychology and Psychiatry, and Allied Disciplines 46, 837849.
Grann, M, Fazel, S (2004). Substance misuse and violent crime: Swedish population study. British Medical Journal 328, 12331234.
Greenland, S (2008). Applications of stratified analysis methods. In Modern Epidemiology, 3rd edn. (ed. Rothman, K. J., Greenland, S. and Lash, T. L.), pp. 283302. Lippincott Williams & Wilkins: Philadelphia, PA.
Hansen, SS, Munk-Jørgensen, P, Guldbaek, B, Solgård, T, Lauszus, KS, Albrechtsen, N, Borg, L, Egander, A, Faurholdt, K, Gilberg, A, Gosden, NP, Lorenzen, J, Richelsen, B, Weischer, K, Bertelsen, A (2000). Psychoactive substance use diagnoses among psychiatric in-patients. Acta Psychiatrica Scandinavica 102, 432438.
Hodgins, S, Janson, C-G (2002). Criminality and Violence Among the Mentally Disordered: The Stockholm Metropolitan Project, pp. 108140. Cambridge University Press: West Nyack, NY.
Hodgins, S, Mednick, SA, Brennan, PA, Schulsinger, F, Engberg, M (1996). Mental disorder and crime: evidence from a Danish birth cohort. Archives of General Psychiatry 53, 489496.
Hodgins, S, Tiihonen, J, Ross, D (2005). The consequences of conduct disorder for males who develop schizophrenia: associations with criminality, aggressive behavior, substance use, and psychiatric services. Schizophrenia Research 78, 323335.
Jakobsen, KD, Frederiksen, JN, Hansen, T, Jansson, LB, Parnas, J, Werge, T (2005). Reliability of clinical ICD-10 schizophrenia diagnoses. Nordic Journal of Psychiatry 59, 209212.
Jensen, MF, Greve, V, Høyer, G, Spencer, M (2006). The Principal Danish Criminal Acts, 3rd edn. DJØF Publishing: Copenhagen.
Kessing, LV (1998). Validity of diagnoses and other clinical register data in patients with affective disorder. European Psychiatry 13, 392398.
Kooyman, I, Walsh, E, Stevens, H, Burns, T, Tyrer, P, Tattan, T, Dean, K (2012). Criminal offending before and after the onset of psychosis: examination of an offender typology. Schizophrenia Research 140, 198203.
Látalová, K (2009). Bipolar disorder and aggression. International Journal of Clinical Practice 63, 889899.
Lindsay, WR, Dernevik, M (2013). Risk and offenders with intellectual disabilities: reappraising Hodgins (1992) classic study. Criminal Behaviour and Mental Health 23, 151157.
Mors, O, Perto, GP, Mortensen, PB (2011). The Danish Psychiatric Central Research Register. Scandinavian Journal of Public Health 39, 5457.
Pedersen, CB, Gotzsche, H, Moller, JO, Mortensen, PB (2006). The Danish Civil Registration System. A cohort of eight million persons. Danish Medical Bulletin 53, 441449.
Phung, TKT, Andersen, BB, Høgh, P, Kessing, LV, Mortensen, PB, Waldemar, G (2007). Validity of dementia diagnoses in the Danish hospital registers. Dementia and Geriatric Cognitive Disorders 24, 220228.
Robbins, PC, Monahan, J, Silver, E (2003). Mental disorder, violence, and gender. Law and Human Behavior 27, 561571.
Statistics Denmark (2007). Integrated Database for Labour Market Research (IDA). Statistics Denmark Press: Copenhagen.
Stevens, H, Agerbo, E, Dean, K, Nordentoft, M, Nielsen, PR, Mortensen, PB (2012). Offending prior to first psychiatric contact: a population-based register study. Psychological Medicine 42, 26732684.
Swanson, JW, Holzer, CE, Ganju, VK, Jono, RT (1990). Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys. Hospital and Community Psychiatry 41, 761770.
Tiihonen, J, Isohanni, M, Räsänen, P, Koiranen, M, Moring, J, Rasanen, P (1997). Specific major mental disorders and criminality: a 26-year prospective study of the 1966 northern Finland birth cohort. American Journal of Psychiatry 154, 840845.
Van Dorn, RA, Volavka, J, Johnson, N (2012). Mental disorder and violence: is there a relationship beyond substance use? Social Psychiatry and Psychiatric Epidemiology 47, 487503.
Wallace, C, Mullen, PE, Burgess, P (2004). Criminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders. American Journal of Psychiatry 161, 716727.
Wessely, SC, Castle, D, Douglas, AJ, Taylor, PJ (1994). The criminal careers of incident cases of schizophrenia. Psychological Medicine 24, 483502.
Winsper, C, Singh, SP, Marwaha, S, Amos, T, Lester, H, Everard, L, Jones, P, Fowler, D, Marshall, M, Lewis, S, Sharma, V, Freemantle, N, Birchwood, M (2013). Pathways to violent behavior during first-episode psychosis: a report from the UK National EDEN Study. JAMA Psychiatry 70, 12871293.
World Health Organization (1982). Klassification af sygdomme, 8. revision (Classification of Diseases, 8th revision). Sundhedsstyrrelsen: Copenhagen.
World Health Organization (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.


Post-illness-onset risk of offending across the full spectrum of psychiatric disorders

  • H. Stevens (a1), T. M. Laursen (a1) (a2), P. B. Mortensen (a1) (a2) (a3), E. Agerbo (a1) (a3) and K. Dean (a4)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed