The Intricate Link Between Violence and Mental Disorder – Eric B. Elbogen, PhD; Sally C. Johnson, MD

Vol. 66 No. 2, February 2009
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The Intricate Link Between Violence and Mental Disorder

Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Eric B. Elbogen, PhD; Sally C. Johnson, MD

Arch Gen Psychiatry. 2009;66(2):152-161.

Context  The relationship between mental illness and violencehas a significant effect on mental health policy, clinical practice,and public opinion about the dangerousness of people with psychiatricdisorders.

Objective  To use a longitudinal data set representativeof the US population to clarify whether or how severe mentalillnesses such as schizophrenia, bipolar disorder, and majordepression lead to violent behavior.

Design  Data on mental disorder and violence were collectedas part of the National Epidemiologic Survey on Alcohol andRelated Conditions (NESARC), a 2-wave face-to-face survey conductedby the National Institute on Alcohol Abuse and Alcoholism.

Participants  A total of 34 653 subjects completedNESARC waves 1 (2001-2003) and 2 (2004-2005) interviews. Wave1 data on severe mental illness and risk factors were analyzedto predict wave 2 data on violent behavior.

Main Outcome Measures  Reported violent acts committedbetween waves 1 and 2.

Results  Bivariate analyses showed that the incidence ofviolence was higher for people with severe mental illness, butonly significantly so for those with co-occurring substanceabuse and/or dependence. Multivariate analyses revealed thatsevere mental illness alone did not predict future violence;it was associated instead with historical (past violence, juveniledetention, physical abuse, parental arrest record), clinical(substance abuse, perceived threats), dispositional (age, sex,income), and contextual (recent divorce, unemployment, victimization)factors. Most of these factors were endorsed more often by subjectswith severe mental illness.

Conclusions  Because severe mental illness did not independentlypredict future violent behavior, these findings challenge perceptionsthat mental illness is a leading cause of violence in the generalpopulation. Still, people with mental illness did report violencemore often, largely because they showed other factors associatedwith violence. Consequently, understanding the link betweenviolent acts and mental disorder requires consideration of itsassociation with other variables such as substance abuse, environmentalstressors, and history of violence.
Author Affiliations: Forensic Psychiatry Program and Clinic, Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill.



This Month in Archives of General Psychiatry
Arch Gen Psychiatry. 2009;66(2):121.