A national study of violent behavior in persons with schizophrenia

Jeffrey W. Swanson, Marvin S. Swartz, Richard A. Van Dorn, Eric B. Elbogen, H. Ryan Wagner, Robert A. Rosenheck, T. Scott Stroup, Joseph Patrick McEvoy, Jeffrey A. Lieberman

Research output: Contribution to journalArticle

434 Citations (Scopus)

Abstract

Context: Violent behavior is uncommon, yet problematic, among schizophrenia patients. The complex effects of clinical, interpersonal, and social-environmental risk factors for violence in this population are poorly understood. Objective: To examine the prevalence and correlates of violence among schizophrenia patients living in the community by developing multivariable statistical models to assess the net effects of psychotic symptoms and other risk factors for minor and serious violence. Design: A total of 1410 schizophrenia patients were clinically assessed and interviewed about violent behavior in the past 6 months. Data comprise baseline assessments of patients enrolled in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness. Setting and Patients: Adult patients diagnosed as having schizophrenia were enrolled from 56 sites in the United States, including academic medical centers and community providers. Main Outcome Measures: Violence was classified at 2 severity levels: minor violence, corresponding to simple assault without injury or weapon use; and serious violence, corresponding to assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault. A composite measure of any violence was also analyzed. Results: The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. "Positive" psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while "negative" psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization. Conclusions: Particular clusters of symptoms may increase or decrease violence risk in schizophrenia patients. Violence risk assessment and management in community-based treatment should focus on combinations of clinical and nonclinical risk factors.

Original languageEnglish (US)
Pages (from-to)490-499
Number of pages10
JournalArchives of General Psychiatry
Volume63
Issue number5
DOIs
StatePublished - Dec 1 2006

Fingerprint

Violence
Schizophrenia
Weapons
Person
National Institute of Mental Health (U.S.)
Crime Victims
Wounds and Injuries
Risk Management
Statistical Models
Antipsychotic Agents
Substance-Related Disorders
Hand

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health

Cite this

Swanson, J. W., Swartz, M. S., Van Dorn, R. A., Elbogen, E. B., Wagner, H. R., Rosenheck, R. A., ... Lieberman, J. A. (2006). A national study of violent behavior in persons with schizophrenia. Archives of General Psychiatry, 63(5), 490-499. https://doi.org/10.1001/archpsyc.63.5.490

A national study of violent behavior in persons with schizophrenia. / Swanson, Jeffrey W.; Swartz, Marvin S.; Van Dorn, Richard A.; Elbogen, Eric B.; Wagner, H. Ryan; Rosenheck, Robert A.; Stroup, T. Scott; McEvoy, Joseph Patrick; Lieberman, Jeffrey A.

In: Archives of General Psychiatry, Vol. 63, No. 5, 01.12.2006, p. 490-499.

Research output: Contribution to journalArticle

Swanson, JW, Swartz, MS, Van Dorn, RA, Elbogen, EB, Wagner, HR, Rosenheck, RA, Stroup, TS, McEvoy, JP & Lieberman, JA 2006, 'A national study of violent behavior in persons with schizophrenia', Archives of General Psychiatry, vol. 63, no. 5, pp. 490-499. https://doi.org/10.1001/archpsyc.63.5.490
Swanson JW, Swartz MS, Van Dorn RA, Elbogen EB, Wagner HR, Rosenheck RA et al. A national study of violent behavior in persons with schizophrenia. Archives of General Psychiatry. 2006 Dec 1;63(5):490-499. https://doi.org/10.1001/archpsyc.63.5.490
Swanson, Jeffrey W. ; Swartz, Marvin S. ; Van Dorn, Richard A. ; Elbogen, Eric B. ; Wagner, H. Ryan ; Rosenheck, Robert A. ; Stroup, T. Scott ; McEvoy, Joseph Patrick ; Lieberman, Jeffrey A. / A national study of violent behavior in persons with schizophrenia. In: Archives of General Psychiatry. 2006 ; Vol. 63, No. 5. pp. 490-499.
@article{22e8eae4ed244c9ca116704ea6d2a747,
title = "A national study of violent behavior in persons with schizophrenia",
abstract = "Context: Violent behavior is uncommon, yet problematic, among schizophrenia patients. The complex effects of clinical, interpersonal, and social-environmental risk factors for violence in this population are poorly understood. Objective: To examine the prevalence and correlates of violence among schizophrenia patients living in the community by developing multivariable statistical models to assess the net effects of psychotic symptoms and other risk factors for minor and serious violence. Design: A total of 1410 schizophrenia patients were clinically assessed and interviewed about violent behavior in the past 6 months. Data comprise baseline assessments of patients enrolled in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness. Setting and Patients: Adult patients diagnosed as having schizophrenia were enrolled from 56 sites in the United States, including academic medical centers and community providers. Main Outcome Measures: Violence was classified at 2 severity levels: minor violence, corresponding to simple assault without injury or weapon use; and serious violence, corresponding to assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault. A composite measure of any violence was also analyzed. Results: The 6-month prevalence of any violence was 19.1{\%}, with 3.6{\%} of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. {"}Positive{"} psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while {"}negative{"} psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization. Conclusions: Particular clusters of symptoms may increase or decrease violence risk in schizophrenia patients. Violence risk assessment and management in community-based treatment should focus on combinations of clinical and nonclinical risk factors.",
author = "Swanson, {Jeffrey W.} and Swartz, {Marvin S.} and {Van Dorn}, {Richard A.} and Elbogen, {Eric B.} and Wagner, {H. Ryan} and Rosenheck, {Robert A.} and Stroup, {T. Scott} and McEvoy, {Joseph Patrick} and Lieberman, {Jeffrey A.}",
year = "2006",
month = "12",
day = "1",
doi = "10.1001/archpsyc.63.5.490",
language = "English (US)",
volume = "63",
pages = "490--499",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
number = "5",

}

TY - JOUR

T1 - A national study of violent behavior in persons with schizophrenia

AU - Swanson, Jeffrey W.

AU - Swartz, Marvin S.

AU - Van Dorn, Richard A.

AU - Elbogen, Eric B.

AU - Wagner, H. Ryan

AU - Rosenheck, Robert A.

AU - Stroup, T. Scott

AU - McEvoy, Joseph Patrick

AU - Lieberman, Jeffrey A.

PY - 2006/12/1

Y1 - 2006/12/1

N2 - Context: Violent behavior is uncommon, yet problematic, among schizophrenia patients. The complex effects of clinical, interpersonal, and social-environmental risk factors for violence in this population are poorly understood. Objective: To examine the prevalence and correlates of violence among schizophrenia patients living in the community by developing multivariable statistical models to assess the net effects of psychotic symptoms and other risk factors for minor and serious violence. Design: A total of 1410 schizophrenia patients were clinically assessed and interviewed about violent behavior in the past 6 months. Data comprise baseline assessments of patients enrolled in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness. Setting and Patients: Adult patients diagnosed as having schizophrenia were enrolled from 56 sites in the United States, including academic medical centers and community providers. Main Outcome Measures: Violence was classified at 2 severity levels: minor violence, corresponding to simple assault without injury or weapon use; and serious violence, corresponding to assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault. A composite measure of any violence was also analyzed. Results: The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. "Positive" psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while "negative" psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization. Conclusions: Particular clusters of symptoms may increase or decrease violence risk in schizophrenia patients. Violence risk assessment and management in community-based treatment should focus on combinations of clinical and nonclinical risk factors.

AB - Context: Violent behavior is uncommon, yet problematic, among schizophrenia patients. The complex effects of clinical, interpersonal, and social-environmental risk factors for violence in this population are poorly understood. Objective: To examine the prevalence and correlates of violence among schizophrenia patients living in the community by developing multivariable statistical models to assess the net effects of psychotic symptoms and other risk factors for minor and serious violence. Design: A total of 1410 schizophrenia patients were clinically assessed and interviewed about violent behavior in the past 6 months. Data comprise baseline assessments of patients enrolled in the National Institute of Mental Health Clinical Antipsychotic Trials of Intervention Effectiveness. Setting and Patients: Adult patients diagnosed as having schizophrenia were enrolled from 56 sites in the United States, including academic medical centers and community providers. Main Outcome Measures: Violence was classified at 2 severity levels: minor violence, corresponding to simple assault without injury or weapon use; and serious violence, corresponding to assault resulting in injury or involving use of a lethal weapon, threat with a lethal weapon in hand, or sexual assault. A composite measure of any violence was also analyzed. Results: The 6-month prevalence of any violence was 19.1%, with 3.6% of participants reporting serious violent behavior. Distinct, but overlapping, sets of risk factors were associated with minor and serious violence. "Positive" psychotic symptoms, such as persecutory ideation, increased the risk of minor and serious violence, while "negative" psychotic symptoms, such as social withdrawal, lowered the risk of serious violence. Minor violence was associated with co-occurring substance abuse and interpersonal and social factors. Serious violence was associated with psychotic and depressive symptoms, childhood conduct problems, and victimization. Conclusions: Particular clusters of symptoms may increase or decrease violence risk in schizophrenia patients. Violence risk assessment and management in community-based treatment should focus on combinations of clinical and nonclinical risk factors.

UR - http://www.scopus.com/inward/record.url?scp=33646925117&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646925117&partnerID=8YFLogxK

U2 - 10.1001/archpsyc.63.5.490

DO - 10.1001/archpsyc.63.5.490

M3 - Article

VL - 63

SP - 490

EP - 499

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 5

ER -