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.
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“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]
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Citations
Cites
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“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…”
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
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