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Risk factors for interpersonal violence: an umbrella review of meta-analyses

  • Seena Fazel (a1), E. Naomi Smith (a2), Zheng Chang (a3) and John Richard Geddes (a4)



Interpersonal violence is a leading cause of morbidity and mortality. The strength and population effect of modifiable risk factors for interpersonal violence, and the quality of the research evidence is not known.


We aimed to examine the strength and population effect of modifiable risk factors for interpersonal violence, and the quality and reproducibility of the research evidence.


We conducted an umbrella review of systematic reviews and meta-analyses of risk factors for interpersonal violence. A systematic search was conducted to identify systematic reviews and meta-analyses in general population samples. Effect sizes were extracted, converted into odds ratios and synthesised, and population attributable risk fractions (PAF) were calculated. Quality analyses were performed, including of small study effects, adjustment for confounders and heterogeneity. Secondary analyses for aggression, intimate partner violence and homicide were conducted, and systematic reviews (without meta-analyses) were summarised.


We identified 22 meta-analyses reporting on risk factors for interpersonal violence. Neuropsychiatric disorders were among the strongest in relative and absolute terms. The neuropsychiatric risk factor that had the largest effect at a population level were substance use disorders, with a PAF of 14.8% (95% CI 9.0–21.6%), and the most important historical factor was witnessing or being a victim of violence in childhood (PAF = 12.2%, 95% CI 6.5–17.4%). There was evidence of small study effects and large heterogeneity.


National strategies for the prevention of interpersonal violence may need to review policies concerning the identification and treatment of modifiable risk factors.

Declarations of interest

J.R.G. is an NIHR Senior Investigator. The views expressed within this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Seena Fazel, MD, FRCPsych, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. Email:


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Risk factors for interpersonal violence: an umbrella review of meta-analyses

  • Seena Fazel (a1), E. Naomi Smith (a2), Zheng Chang (a3) and John Richard Geddes (a4)


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Risk factors for interpersonal violence: an umbrella review of meta-analyses

  • Seena Fazel (a1), E. Naomi Smith (a2), Zheng Chang (a3) and John Richard Geddes (a4)
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