The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.
Schizophrenia, Substance Abuse, and Violent Crime
Open accessAbstract
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.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“This dual disorder often starts during youth and leads to significant societal costs, including lower employability rates, more hospitalizations, and higher risk of homelessness and of suicide attempts when compared to those with a serious mental illness without substance misuse.”
From Mobile intervention for individuals with psychosis, dual disorders, and their common comorbidities: A literature review (2019) · cites this paper as [12]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
The Measurement of Observer Agreement for Categorical Data
Landis, J. R., & Koch, G. G. (1977) · Biometrics · doi:10.2307/2529310 · Cited by 81,148
Steadman, H. J., Mulvey, E. P., Monahan, J. T., Robbins, P. C., Appelbaum, P. S., Grisso, T., Roth, L. H., & Silver, E. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.5.393 · Cited by 1,456
(1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.4.1 · Cited by 1,350
Swanson, J. W., Holzer, C. E., Ganju, V. K., & Jono, R. T. (1990) · Psychiatric Services · doi:10.1176/ps.41.7.761 · Cited by 1,277
Kim-Cohen, J., Caspi, A., Taylor, A., Williams, B., Newcombe, R., Craig, I. W., & Moffitt, T. E. (2006) · Molecular Psychiatry · doi:10.1038/sj.mp.4001851 · Cited by 1,158 · cited 1×
“Third, thepossiblecontribution of genetic and early environmental factors in mediating the link between schizophreniaandviolencehasnotbeen reliably studied.(10) Conceptual models of violence in schizophrenia postulate that patients with schizophrenia are violent as a consequence of the psychopathologic symptoms of the…”
Elbogen, E. B., & Johnson, S. C. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2008.537 · Cited by 868 · cited 1×
“However, when all patients in the NESARC study were examined, substance abuse comorbidity did increase the risk of violence in those with mental disorder.(35)”
A National Study of Violent Behavior in Persons With Schizophrenia
Swanson, J. W., Swartz, M. S., Dorn, R. A. V., Elbogen, E. B., Wagner, H. R., Rosenheck, R. A., Stroup, T. S., McEvoy, J. P., & Lieberman, J. A. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.5.490 · Cited by 816 · cited 1×
“It would also explain why attempts to find psychoticsymptomsassociatedwithviolence haveproducedcontradictoryresults.(11,13,14) Therefore,byusinglongitudinaldesigns, we examined the relationship of schizophrenia with violent crime in Sweden from 1973 until 2006.”
Mental Disorders and Violence in a Total Birth Cohort: Results From the Dunedin Study
Arseneault, L., Moffitt, T. E., Caspi, A., Taylor, P. J., & Silva, P. A. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.10.979 · Cited by 692 · cited 1×
“Although we relied on conviction data, other work has shown that the degree of underestimation of violence is similar in psychiatric patients and controls compared with self-report measures; hence, the risk estimates were not affected.(43) A further limitation is that we did not have data on whether treatment was rece…”
Violence and Severe Mental Illness: The Effects of Substance Abuse and Nonadherence to Medication
Swartz, M. S., Swanson, J. W., Hiday, V. A., Borum, R., Wagner, H. R., & Burns, B. J. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.2.226 · Cited by 628
Violence and schizophrenia: Examining the evidence
Walsh, E., Buchanan, A. W., & Fahy, T. A. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.180.6.490 · Cited by 564 · cited 2×
“Because substance abuse could be on the causal pathway between schizophrenia and violent crime, it has been argued that it is not appropriate to include it as a confounder in regression modeling.(31) Another argument for not including substance abuse as a confounder is whether effect modification occurred (whether the…”
The population impact of severe mental illness on violent crime
Fazel, S., & Grann, M. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.8.1397 · Cited by 539 · cited 3×
“Only about 1% of hospital admissions have missing personal identification numbers.(20) Consequently, the register has been widely used in psychiatric epidemiological investigations.”
Violence and Delusions: Data From the MacArthur Violence Risk Assessment Study
Appelbaum, P. S., Robbins, P. C., & Monahan, J. T. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.4.566 · Cited by 532 · cited 1×
“It would also explain why attempts to find psychoticsymptomsassociatedwithviolence haveproducedcontradictoryresults.(11,13,14) Therefore,byusinglongitudinaldesigns, we examined the relationship of schizophrenia with violent crime in Sweden from 1973 until 2006.”
Major Mental Disorders and Criminal Violence in a Danish Birth Cohort
Brennan, P. A., Mednick, S. A., & Hodgins, S. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.5.494 · Cited by 518
Tiihonen, J., Isohanni, M. K., Räsänen, P. K., Koiranen, M., & Moring, J. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.6.840 · Cited by 441
Hjern, A., Lindblad, F., & Vinnerljung, B. (2002) · The Lancet · doi:10.1016/s0140-6736(02)09674-5 · Cited by 329 · cited 1×
“Consequently, the register has been widely used in psychiatric epidemiological investigations.(20,21) In relation to substance abuse diagnoses, prior validity studies have found fair agreement between substance abuse diagnoses in the HDR and more comprehensive inpatient assessments.”
Johnson, J. G., Cohen, P. R., Smailes, E., Kasen, S., Oldham, J. M., Skodol, A. E., & Brook, J. S. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.9.1406 · Cited by 272
Community care and criminal offending in schizophrenia
Mullen, P. E., Burgess, P. M., Wallace, C., Palmer, S., & Ruschena, D. (2000) · The Lancet · doi:10.1016/s0140-6736(99)05082-5 · Cited by 257
Advancing Paternal Age and Bipolar Disorder
Frans, E. M., Sandin, S., Reichenberg, A., Lichtenstein, P., Långström, N., & Hultman, C. M. (2008) · Archives of General Psychiatry · doi:10.1001/archpsyc.65.9.1034 · Cited by 249
Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses
Ekholm, B., Ekholm, A., Adolfsson, R., Vares, M., Ösby, U., Sedvall, G. C., & Jönsson, E. G. (2005) · Nordic Journal of Psychiatry · doi:10.1080/08039480500360906 · Cited by 242 · cited 2×
“However, the specificity is fair at best.(18) Hence, some individuals with schizophrenia are diagnosed as having other mental disorders during any particular inpatient episode, which forms the basis of our decision to use 2 diagnoses to define cases.”
Understanding Genetic Risk for Aggression: Clues From the Brain’s Response to Social Exclusion
Eisenberger, N. I., Way, B. M., Taylor, S. E., Welch, W. T., & Lieberman, M. D. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.08.007 · Cited by 229 · cited 1×
“One promising approach would be to use molecular genetic studies, wherein a host of putative genetic markers exist.(41) Regardless of the nature of the mechanism, adequate substance abuse treatment for individuals with schizophrenia is likely to reduce the risk of violence and should be part of the routine assessment…”
Räsänen, P. K., Tahonen, J., Isohanni, M. K., Rantakallio, P. T., Lehtonen, J., & Moring, J. (1998) · Schizophrenia Bulletin · doi:10.1093/oxfordjournals.schbul.a033338 · Cited by 226
Angermeyer, M. C., & Matschinger, H. (1996) · Social Science & Medicine · doi:10.1016/s0277-9536(96)00065-2 · Cited by 211 · cited 1×
“The public perception of the dangerousness of psychiatric patients is pervasive and is a key factor in their stigmatization,(46) partly influenced by selective media coverage of high-profile cases.(47) As a consequence, some western governments have introduced specific laws for offenders who have mental disorders that…”
Comparison of antipsychotic medication effects on reducing violence in people with schizophrenia
Swanson, J. W., Swartz, M. S., Dorn, R. A. V., Volavka, J., Monahan, J. T., Stroup, T. S., McEvoy, J. P., Wagner, H. R., Elbogen, E. B., & Lieberman, J. A. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.042630 · Cited by 206 · cited 2×
“Within a sample of individuals with schizophrenia, a recent US prospective investigation has confirmed the importance of substance abuse in predicting violence in patients with schizophrenia and also found that childhood conduct problems are a strong predictor.(42) However, the risk of violence in schizophrenia with c…”
Recurrence risks for schizophrenia in a Swedish National Cohort
LICHTENSTEIN, P., BJÖRK, C., HULTMAN, C. M., SCOLNICK, E., SKLAR, P., & SULLIVAN, P. F. (2006) · Psychological Medicine · doi:10.1017/s0033291706008385 · Cited by 197
Young cases of schizophrenia identified in a national inpatient register
Dalman, C., Broms, J., Cullberg, J., & Allebeck, P. (2002) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-002-0582-3 · Cited by 192 · cited 1×
“In another study, 86% of HDR schizophrenia diagnoses corresponded with DSM-IV diagnoses of schizophrenia made from file-based reviews by psychiatrists.(19) However, the specificity is fair at best.”
Lai, Y. M., Hong, C. P., & Chee, C. Y. I. (2001) · PubMed · Cited by 159
Brewer, R. D. (2005) · JAMA · doi:10.1001/jama.294.5.616 · Cited by 154 · cited 1×
“On the other hand, our data concur with the importance of effective psychiatric treatment from a public health perspective(37) and the importance of evidencebased prevention strategies for dealing with substance abuse.(38) The second main finding is the variation in violence risk depending on the degree of relatedness…”
Substance misuse and violent crime: Swedish population study
Grann, M., & Fazel, S. (2004) · BMJ · doi:10.1136/bmj.328.7450.1233 · Cited by 135
A multicentre inter-rater reliability study using the OPCRIT computerized diagnostic system
Williams, J. H., FARMER, A. E., Ackenheil, M., Kaufmann, C. A., & McGuffin, P. (1996) · Psychological Medicine · doi:10.1017/s003329170003779x · Cited by 135
Hansson, L. I., Vinding, H. R., Mackeprang, T., Sourander, A., Werdelin, G., Bengtsson‐Tops, A., Bjarnason, Ó., Dybbro, J., Nilsson, L.-L., Sandlund, M., et al. (2001) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2001.00083.x · Cited by 120
Schizophrenia and violence: from correlations to preventive strategies
Mullen, P. E. (2006) · Advances in Psychiatric Treatment · doi:10.1192/apt.12.4.239 · Cited by 116 · cited 1×
“Indeed, expert opinion has deemed that the evidence is sufficiently robust that new research should move beyond epidemiology and focus on treatment.(2,3) However,uncertaintiesremainregardingthereportedlink.”
Predicting violence in schizophrenia: a prospective study
Walsh, E., Gilvarry, C. M., Samele, C., Harvey, K., Manley, C., Tattan, T., Tyrer, P. J., Creed, F. H., Murray, R. M., & Fahy, T. A. (2003) · Schizophrenia Research · doi:10.1016/s0920-9964(03)00091-4 · Cited by 109
The major mental disorders and crime
Hodgins, S. (2001) · International Journal of Law and Psychiatry · doi:10.1016/s0160-2527(01)00077-2 · Cited by 101 · cited 1×
“Indeed, expert opinion has deemed that the evidence is sufficiently robust that new research should move beyond epidemiology and focus on treatment.(2,3) However,uncertaintiesremainregardingthereportedlink.”
Major Mental Disorders and Violence: A Critical Update
Joyal, C. C., Dubreucq, J.-L., Gendron, C., & Millaud, F. (2007) · Current Psychiatry Reviews · doi:10.2174/157340007779815628 · Cited by 96
Community care and criminal offending in schizophrenia
Mullen, P. E., Burgess, P. M., Wallace, C., & Palmer, S. (2000) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/000486700707 · Cited by 94
Influence of cohort effects on patterns of suicide in England and Wales, 1950–1999
Gunnell, D., Middleton, N., Whitley, E., Dorling, D., & Frankel, S. (2003) · The British Journal of Psychiatry · doi:10.1192/bjp.182.2.164 · Cited by 60 · cited 1×
“In addition, we accounted for cohort effects by adjusting for year of birth, previously found to be important in, for example, suicide research.(34) Our study has 2 main findings.”
Fertility of first-degree relatives of patients with schizophrenia: A three generation perspective
Svensson, A. C., Lichtenstein, P., Sandin, S., & Hultman, C. M. (2007) · Schizophrenia Research · doi:10.1016/j.schres.2006.12.002 · Cited by 53 · cited 2×
“The second comparison was unaffected full siblings compared with those with schizophrenia (n = 7780 full sibling controls and n=4674 individuals with schizophrenia), unmatched by age or sex and identified using the MGR.(26) The MGR connects each person born in Sweden in 1933 or later and ever registered as living in S…”
Gosden, N. P. (2005) · Schizophrenia Bulletin · doi:10.1093/schbul/sbi015 · Cited by 47
Childhood origins of violent behaviour in adults with schizophreniform disorder
Arseneault, L., Cannon, M. D., Murray, R. M., Poulton, R., Caspi, A., & Moffitt, T. E. (2003) · The British Journal of Psychiatry · doi:10.1192/bjp.183.6.520 · Cited by 43 · cited 1×
“Some support for the latter comes from longitudinal studies that have found that violence and serious aggression precede the diagnosis of schizophrenia,(39,40) even after controlling for preadolescent psychotic symptoms.(40) Although our data do not suggest one interpretation above the others, future work is necessary…”
Extracting data in file-based forensic psychiatric research: Some methodological considerations
Långström, N. (1999) · Nordic Journal of Psychiatry · doi:10.1080/080394899426747 · Cited by 37
“Dangerousness” and dangerous law
Farnham, F. R., & James, D. (2001) · The Lancet · doi:10.1016/s0140-6736(01)06977-x · Cited by 36 · cited 1×
“As a consequence, some western governments have introduced specific laws for offenders who have mental disorders that focus on the assessment of dangerousness and public protection.(48) Moreover, the stigma of mental illness is considered to be the most significant obstacle to the development of mental health care.”
Klein-Geltink, J., Rochon, P. A., Dyer, S., Laxer, M., & Anderson, G. (2007) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2006.11.008 · Cited by 34 · cited 1×
“05 level of significance.(29) Immigrant status was a confounder only for risk of violent crime in those with schizophrenia compared with general population controls.”
James, A. (1998) · The Lancet · doi:10.1016/s0140-6736(98)00019-1 · Cited by 25
Global Mental Health: Its Time Has Come
Satcher, D. (2001) · JAMA · doi:10.1001/jama.285.13.1697 · Cited by 25 · cited 1×
“Moreover, the stigma of mental illness is considered to be the most significant obstacle to the development of mental health care.(49) Our findings on the mediating role of substance abuse and the marginally increased risk of violent offense in patients without substance abuse should contribute to a more informed deba…”
Mental Illness and Violent Death
Cole, T. B., & Glass, R. M. (2005) · JAMA · doi:10.1001/jama.294.5.623 · Cited by 22
Cited by
Sorted by citations
External review and validation of the Swedish national inpatient register
Ludvigsson, J. F., Andersson, E., Ekbom, A., Feychting, M., Kim, J.-L., Reuterwall, C., Heurgren, M., & Olausson, P. O. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-450 · Cited by 5,055
“Fazel [25] 19454640 2009 Forensic psychiatric assessment”
BackgroundA Handbook for the Study of Mental Health Second Edition
Scheid, T. L., & Brown, T. N. (2009) · Cited by 1,320
Schizophrenia and Violence: Systematic Review and Meta-Analysis
Fazel, S., Gulati, G. M., Linsell, L., Geddes, J. R., & Grann, M. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000120 · Cited by 1,235
“2) in individuals with schizophrenia and no comorbid substance abuse compared with general population controls [52].”
BackgroundInfluentialBarnes, T. R. E., Drake, R., Paton, C., Cooper, S. J., Deakin, J. F. W., Ferrier, I. N., Gregory, C. J., Haddad, P. M., Howes, O. D., Jones, I. R., et al. (2019) · Journal of Psychopharmacology · doi:10.1177/0269881119889296 · Cited by 615
Witt, K., Dorn, R. A. V., & Fazel, S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0055942 · Cited by 630
“Our results are consistent, though, with several large epidemiological studies that suggest that criminal history factors such as previous violent behaviour and prior arrests are stronger predictors of risk [22,25] compared with substance misuse [47] and certain demographic factors [48].”
Result
Metadata
- Authors
- Fazel, S.
- Affiliations
- Warneford Hospital (GB)
- Corresponding author
- Fazel, Seena
- ORCID
- Fazel, Seena
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2009-05-20
- Volume
- 301
- Issue
- 19
- Pages
- 2016
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4905518
- OpenAlex
- W2073141569
- Cited by
- 726
- References
- 45
- Citations by year
- 2026: 36 · 2025: 22 · 2024: 37 · 2023: 24 · 2022: 45 · 2021: 25 · 2020: 38 · 2019: 46 · 2018: 48 · 2017: 73 · 2016: 32 · 2015: 49 · 2014: 49 · 2013: 50 · 2012: 55
- FWCI
- 53.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Wellcome Trust (095806)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Sociology and Political Science › Crime Patterns and Interventions
- Keywords
- schizophrenia, violent crime, substance use comorbidity, violence risk, criminal conviction, homicide, assault, unaffected siblings, familial confounding, risk factors for violence, Sweden, hospitalization, criminal records, mental illness and crime, risk assessment guidelines, family history of schizophrenia, income, marital status
- MeSH terms
- Adult, Crime, Female, Humans, Longitudinal Studies, Male, Registries, Risk, Schizophrenia, Socioeconomic Factors, Sweden, Violence, Comorbidity, Substance-Related Disorders, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
