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1.
Joyal C, Dubreucq J-L, Grendon C, Millaud F. Major mental disorders and violence: a critical update.  Curr Psychiatry Rev. 2007;3:33-50Google ScholarCrossref
2.
Hodgins S. The major mental disorders and crime: stop debating and start treating and preventing.  Int J Law Psychiatry. 2001;24(4-5):427-44611521419PubMedGoogle ScholarCrossref
3.
Mullen P. Schizophrenia and violence: from correlations to preventive strategies.  Adv Psychiatr Treat. 2006;12:239-248Google ScholarCrossref
4.
Tiihonen J, Isohanni M, Räsänen P, Koiranen M, Moring J. Specific major mental disorders and criminality: a 26-year prospective study of the 1966 Northern Finland birth cohort.  Am J Psychiatry. 1997;154(6):840-8459167513PubMedGoogle Scholar
5.
Mullen P, Burgess P, Wallace C, Palmer S, Ruschena D. Community care and criminal offending in schizophrenia.  Lancet. 2000;355(9204):614-61710696982PubMedGoogle ScholarCrossref
6.
Steadman H, Mulvey E, Monahan J,  et al.  Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods.  Arch Gen Psychiatry. 1998;55(5):393-4019596041PubMedGoogle ScholarCrossref
7.
Räsänen P, Tiihonen J, Isohanni M, Rantakallio P, Lehtonen J, Moring J. Schizophrenia, alcohol abuse, and violent behavior: a 26-year followup study of an unselected birth cohort.  Schizophr Bull. 1998;24(3):437-4419718635PubMedGoogle ScholarCrossref
8.
Swanson J, Holzer C III, Ganju V, Jono R. Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys.  Hosp Community Psychiatry. 1990;41(7):761-7702142118PubMedGoogle Scholar
9.
Brennan P, Mednick S, Hodgins S. Major mental disorders and criminal violence in a Danish birth cohort.  Arch Gen Psychiatry. 2000;57(5):494-50010807490PubMedGoogle ScholarCrossref
10.
Kim-Cohen J, Caspi A, Taylor A,  et al.  MAOA, maltreatment, and gene-environment interaction predicting children's mental health: new evidence and a meta-analysis.  Mol Psychiatry. 2006;11(10):903-91316801953PubMedGoogle ScholarCrossref
11.
Swanson J, Swartz M, Van Dorn R,  et al.  A national study of violent behavior in persons with schizophrenia.  Arch Gen Psychiatry. 2006;63(5):490-49916651506PubMedGoogle ScholarCrossref
12.
Grann M, Fazel S. Substance misuse and violent crime: Swedish population study.  BMJ. 2004;328(7450):1233-123415155501PubMedGoogle ScholarCrossref
13.
Appelbaum PS, Robbins PC, Monahan J. Violence and delusions: data from the MacArthur Violence Risk Assessment Study.  Am J Psychiatry. 2000;157(4):566-57210739415PubMedGoogle ScholarCrossref
14.
Walsh E, Gilvarry C, Samele C,  et al; UK700 Group.  Predicting violence in schizophrenia: a prospective study.  Schizophr Res. 2004;67(2-3):247-25214984884PubMedGoogle ScholarCrossref
15.
Lichtenstein P, Björk C, Hultman C, Scolnick E, Sklar P, Sullivan P. Recurrence risks for schizophrenia in a Swedish National Cohort.  Psychol Med. 2006;36(10):1417-142516863597PubMedGoogle ScholarCrossref
16.
Hansson L, Vinding H, Mackeprang T,  et al.  Comparison of key worker and patient assessment of needs in schizophrenic patients living in the community: a Nordic multicentre study.  Acta Psychiatr Scand. 2001;103(1):45-5111202128PubMedGoogle ScholarCrossref
17.
Williams J, Farmer A, Ackenheil M, Kaufmann C, McGuffin P. A multicentre inter-rater reliability study using the OPCRIT computerized diagnostic system.  Psychol Med. 1996;26(4):775-7838817712PubMedGoogle ScholarCrossref
18.
Ekholm B, Ekholm A, Adolfsson R,  et al.  Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses.  Nord J Psychiatry. 2005;59(6):457-46416316898PubMedGoogle ScholarCrossref
19.
Dalman C, Broms J, Cullberg J, Allebeck P. Young cases of schizophrenia identified in a national inpatient register: are the diagnoses valid?  Soc Psychiatry Psychiatr Epidemiol. 2002;37(11):527-53112395142PubMedGoogle ScholarCrossref
20.
Fazel S, Grann M. The population impact of severe mental illness on violent crime.  Am J Psychiatry. 2006;163(8):1397-140316877653PubMedGoogle ScholarCrossref
21.
Hjern A, Lindblad F, Vinnerljung B. Suicide, psychiatric illness, and social maladjustment in intercountry adoptees in Sweden: a cohort study.  Lancet. 2002;360(9331):443-44812241716PubMedGoogle ScholarCrossref
22.
Bergman B, Belfrage H, Grann M. Mentally disordered offenders in Sweden: forensic and general psychiatric diagnoses.  Am J Forensic Psychiatry. 1999;20:27-37Google Scholar
23.
Grann M, Haggård U, Tengström A,  et al.  Some experiences from registers of interest to forensic research in Sweden.  Scand J Forensic Sci (Rettsmedisin). 1998;3:78-80Google Scholar
24.
Långström N, Grann M, Tengström A, Lindholm N, Woodhouse A, Kullgren G. Extracting data for register-based forensic psychiatric research in Sweden: some methodological considerations.  Nord J Psychiatry. 1999;53:61-67Google ScholarCrossref
25.
Landis J, Koch G. The measurement of observer agreement for categorical data.  Biometrics. 1977;33(1):159-174843571PubMedGoogle ScholarCrossref
26.
Svensson A, Lichtenstein P, Sandin S, Hultman C. Fertility of first-degree relatives of patients with schizophrenia: a three generation perspective.  Schizophr Res. 2007;91(1-3):238-24517275261PubMedGoogle ScholarCrossref
27.
Statistics Sweden.  Flergenerationsregistret 2004: En Beskrivning av Innehåll och Kvalitet [The Multi-Generation Register 2004: A Description of Content and Quality]. Örebro: Statistics Sweden; 2005
28.
Frans EM, Sandin S, Reichenberg A, Lichtenstein P, Langstrom N, Hultman CM. Advancing paternal age and bipolar disorder.  Arch Gen Psychiatry. 2008;65(9):1034-104018762589PubMedGoogle ScholarCrossref
29.
Klein-Geltink J, Rochon P, Dyer S, Laxer M, Anderson G. Readers should systematically assess methods used to identify, measure and analyze confounding in observational cohort studies.  J Clin Epidemiol. 2007;60(8):766-77217606171PubMedGoogle ScholarCrossref
30.
Chen X, Ender P, Mitchell M, Wells C. Regression With Stata. http://www.ats.ucla.edu/stat/stata/webbooks/reg/default.htm. 2003. Accessed March 30, 2009
31.
Walsh E, Buchanan A, Fahy T. Violence and schizophrenia: examining the evidence.  Br J Psychiatry. 2002;180:490-49512042226PubMedGoogle ScholarCrossref
32.
Swartz M, Swanson J, Hiday V, Borum R, Wagner H, Burns B. Violence and severe mental illness: the effects of substance abuse and nonadherence to medication.  Am J Psychiatry. 1998;155(2):226-2319464202PubMedGoogle Scholar
33.
Johnson J, Cohen P, Smailes E,  et al.  Adolescent personality disorders associated with violence and criminal behavior during adolescence and early adulthood.  Am J Psychiatry. 2000;157(9):1406-141210964855PubMedGoogle ScholarCrossref
34.
Gunnell D, Middleton N, Whitley E, Dorling D, Frankel S. Influence of cohort effects on patterns of suicide in England and Wales, 1950-1999.  Br J Psychiatry. 2003;182:164-17012562746PubMedGoogle ScholarCrossref
35.
Elbogen E, Johnson S. The intricate link between violence and mental disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions.  Arch Gen Psychiatry. 2009;66(2):152-16119188537PubMedGoogle ScholarCrossref
36.
American Psychiatric Association.  Practice Guideline for the Treatment of Patients With Schizophrenia. Arlington, VA: American Psychiatric Association; 2004
37.
Cole T, Glass R. Mental illness and violent death: major issues for public health.  JAMA. 2005;294(5):623-62416077060PubMedGoogle ScholarCrossref
38.
Brewer RD, Swahn MH. Binge drinking and violence.  JAMA. 2005;294(5):616-61816077057PubMedGoogle ScholarCrossref
39.
Gosden N, Kramp P, Gabrielsen G, Andersen T, Sestoft D. Violence of young criminals predicts schizophrenia: a 9-year register-based follow up of 15- to 19-year-old criminals.  Schizophr Bull. 2005;31(3):759-76816123529PubMedGoogle ScholarCrossref
40.
Arseneault L, Cannon M, Murray R, Poulton R, Caspi A, Moffitt T. Childhood origins of violent behaviour in adults with schizophreniform disorder.  Br J Psychiatry. 2003;183:520-52514645023PubMedGoogle ScholarCrossref
41.
Eisenberger N, Way B, Taylor S, Welch W, Lieberman M. Understanding genetic risk for aggression: Clues from the brain's response to social exclusion.  Biol Psychiatry. 2007;61(9):1100-110817137563PubMedGoogle ScholarCrossref
42.
Swanson J, Swartz M, Van Dorn R,  et al; CATIE Investigators.  Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia.  Br J Psychiatry. 2008;193(1):37-4318700216PubMedGoogle ScholarCrossref
43.
Arseneault L, Moffitt T, Caspi A, Taylor P, Silva P. Mental disorders and violence in a total birth cohort: results from the Dunedin study.  Arch Gen Psychiatry. 2000;57(10):979-98611015816PubMedGoogle ScholarCrossref
44.
Dolmén L. Brottsligheten i Olika Länder [Criminality in Different Countries]. Stockholm, Sweden: National Council for Crime Prevention; 2001
45.
Farrington D, ed, Langan P, ed, Tonry M, edCross-National Studies in Crime and Justice. Washington, DC: US Dept of Justice, Bureau of Justice Statistics; 2004
46.
James A. Stigma of mental illness.  Lancet. 1998;352(9133):10489759764PubMedGoogle ScholarCrossref
47.
Angermeyer M, Matschinger H. The effect of violent attacks by schizophrenic persons on the attitude of the public towards the mentally ill.  Soc Sci Med. 1996;43(12):1721-17288961416PubMedGoogle ScholarCrossref
48.
Farnham F, James D. “Dangerousness” and dangerous law.  Lancet. 2001;358(9297):192611747914PubMedGoogle ScholarCrossref
49.
Satcher D. Global mental health: its time has come.  JAMA. 2001;285(13):169711277813PubMedGoogle ScholarCrossref
Original Contribution
May 20, 2009

Schizophrenia, Substance Abuse, and Violent Crime

Author Affiliations

Author Affiliations: Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, England (Dr Fazel); Centre for Violence Prevention (Drs Fazel, Långström, and Grann) and Department of Medical Epidemiology and Biostatistics (Drs Långström and Lichtenstein), Karolinska Institutet, Centre for Epidemiology, National Board of Health and Welfare (Dr Hjern), and Department of Psychology, Stockholm University (Dr Grann), Stockholm, Sweden; and Department of Children's and Women's Health, University of Uppsala, Uppsala, Sweden (Dr Hjern).

JAMA. 2009;301(19):2016-2023. doi:10.1001/jama.2009.675
Abstract

Context Persons with schizophrenia are thought to be at increased risk of committing violent crime 4 to 6 times the level of general population individuals without this disorder. However, risk estimates vary substantially across studies, and considerable uncertainty exists as to what mediates this elevated risk. Despite this uncertainty, current guidelines recommend that violence risk assessment should be conducted for all patients with schizophrenia.

Objective To determine the risk of violent crime among patients diagnosed as having schizophrenia and the role of substance abuse in mediating this risk.

Design, Setting, and Participants Longitudinal designs were used to link data from nationwide Swedish registers of hospital admissions and criminal convictions in 1973-2006. Risk of violent crime in patients after diagnosis of schizophrenia (n = 8003) was compared with that among general population controls (n = 80 025). Potential confounders (age, sex, income, and marital and immigrant status) and mediators (substance abuse comorbidity) were measured at baseline. To study familial confounding, we also investigated risk of violence among unaffected siblings (n = 8123) of patients with schizophrenia. Information on treatment was not available.

Main Outcome Measure Violent crime (any criminal conviction for homicide, assault, robbery, arson, any sexual offense, illegal threats, or intimidation).

Results In patients with schizophrenia, 1054 (13.2%) had at least 1 violent offense compared with 4276 (5.3%) of general population controls (adjusted odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2). The risk was mostly confined to patients with substance abuse comorbidity (of whom 27.6% committed an offense), yielding an increased risk of violent crime among such patients (adjusted OR, 4.4; 95% CI, 3.9-5.0), whereas the risk increase was small in schizophrenia patients without substance abuse comorbidity (8.5% of whom had at least 1 violent offense; adjusted OR, 1.2; 95% CI, 1.1-1.4; P<.001 for interaction). The risk increase among those with substance abuse comorbidity was significantly less pronounced when unaffected siblings were used as controls (28.3% of those with schizophrenia had a violent offense compared with 17.9% of their unaffected siblings; adjusted OR, 1.8; 95% CI, 1.4-2.4; P<.001 for interaction), suggesting significant familial (genetic or early environmental) confounding of the association between schizophrenia and violence.

Conclusions Schizophrenia was associated with an increased risk of violent crime in this longitudinal study. This association was attenuated by adjustment for substance abuse, suggesting a mediating effect. The role of risk assessment, management, and treatment in individuals with comorbidity needs further examination.

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