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    1 Comment for this article
    Stigma reinforced
    Elizabeth Haase-Meyers, Associate Professor | CTRMC
    While the various models are impressive here and show that environmental and parental factors largely more Increase risk than a psych diagnosis , this study will be used by the press and understood by the public to convey only one message, that the mentally ill are the baddies. If you take all the people with any kind of mental distress including personality and drug problems and leave behind a group of totally non-distressed people in any way and then compare them, these would be the results you would expect, but it’s a bit tautological and I think will lead to gross misuse of data. Few will drill down to see that the highest risks of perpetration include character-disordered people, alcoholics and drug users, and as far as I can tell the groups were not stratified to look at people who had more that one high risk diagnosis versus one low risk diagnosis. A sad day for stigma against the mentally ill.
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    Original Investigation
    January 15, 2020

    Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden

    Author Affiliations
    • 1Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
    • 2Social and Public Policy Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
    • 3Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
    • 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    • 5Orebro University School of Medical Sciences, Orebro, Sweden
    JAMA Psychiatry. Published online January 15, 2020. doi:10.1001/jamapsychiatry.2019.4275
    Key Points

    Question  What is the incidence of subjection to violence or perpetration of violence in persons with psychiatric disorders?

    Findings  In this nationwide cohort study of 250 419 individuals with psychiatric disorders in Sweden, in the decade after the onset of their conditions, fewer than 7% of patients had either been subjected to violence severe enough to require specialist medical treatment or had perpetrated violence.

    Meaning  Persons with psychiatric disorders were approximately 3 to 4 times more likely than their siblings without psychiatric disorders to be either subjected to violence or to perpetrate violence.


    Importance  Key outcomes for persons with psychiatric disorders include subjection to violence and perpetration of violence. The occurrence of these outcomes and their associations with psychiatric disorders need to be clarified.

    Objective  To estimate the associations of a wide range of psychiatric disorders with the risks of subjection to violence and perpetration of violence.

    Design, Setting, and Participants  A total of 250 419 individuals born between January 1, 1973, and December 31, 1993, were identified to have psychiatric disorders using Swedish nationwide registers. Premorbid subjection to violence was measured since birth. The patients were matched by age and sex to individuals in the general population (n = 2 504 190) and to their full biological siblings without psychiatric disorders (n = 194 788). The start date for the patients and control groups was defined as the discharge date of the first psychiatric episode. The participants were censored either when they migrated, died, experienced the outcome of interest, or reached the end of the study period on December 31, 2013. Data were analyzed from January 15 to September 14, 2019.

    Exposures  Patients with common psychiatric disorders (eg, schizophrenia, bipolar disorder, depression, and anxiety) were differentiated using a hierarchical approach. Patients with personality disorders and substance use disorders were also included.

    Main Outcomes and Measures  Subjection to violence was defined as an outpatient visit (excluding a primary care visit), inpatient episode, or death associated with any diagnosis of an injury that was purposefully inflicted by other persons. Perpetration of violence was defined as a violent crime conviction. Stratified Cox regression models were fitted to account for the time at risk, a range of sociodemographic factors, a history of violence, and unmeasured familial confounders (via sibling comparisons).

    Results  Among 250 419 patients (55.4% women), the median (interquartile range) age at first diagnosis ranged from 20.0 (17.4-24.0) years for alcohol use disorder to 23.7 (19.9-28.8) years for anxiety disorder. Compared with 2 504 190 matched individuals without psychiatric disorders from the general population, patients with psychiatric disorders were more likely to be subjected to violence (7.1 [95% CI, 6.9-7.2] vs 1.0 [95% CI, 0.9-1.0] per 1000 person-years) and to perpetrate violence (7.5 [95% CI, 7.4-7.6] vs 0.7 [95% CI, 0.7-0.7] per 1000 person-years). In the fully adjusted models, patients with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to be either subjected to violence (adjusted hazard ratio [aHR], 3.4 [95% CI, 3.2-3.6]) or to perpetrate violence (aHR, 4.2 [95% CI, 3.9-4.4]). Diagnosis with any of the specific disorders was associated with higher rates of violent outcomes, with the sole exception of schizophrenia, which was not associated with the risk of subjection to violence.

    Conclusions and Relevance  In this study, persons with psychiatric disorders were 3 to 4 times more likely than their siblings without psychiatric disorders to have been subjected to violence or to have perpetrated violence after the onset of their conditions. The risks of both outcomes varied by specific psychiatric diagnosis, history of violence, and familial risks. Clinical interventions may benefit from targeted approaches for the assessment and management of risk of violence in people with psychiatric disorders.