The population impact of severe mental illness on violent crime
Open accessAbstract
OBJECTIVE: This study aimed to determine the population impact of patients with severe mental illness on violent crime. METHOD: Sweden possesses high-quality national registers for all hospital admissions and criminal convictions. All individuals discharged from the hospital with ICD diagnoses of schizophrenia and other psychoses (N=98,082) were linked to the crime register to determine the population-attributable risk of patients with severe mental illness to violent crime. The attributable risk was calculated by gender, three age bands (15-24, 25-39, and 40 years and over), and offense type. RESULTS: Over a 13-year period, there were 45 violent crimes committed per 1,000 inhabitants. Of these, 2.4 were attributable to patients with severe mental illness. This corresponds to a population-attributable risk fraction of 5.2%. This attributable risk fraction was higher in women than men across all age bands. In women ages 25-39, it was 14.0%, and in women over 40, it was 19.0%. The attributable risk fractions were lowest in those ages 15-24 (2.3% for male patients and 2.9% for female patients). CONCLUSIONS: The population impact of patients with severe mental illness on violent crime, estimated by calculating the population-attributable risk, varies by gender and age. Overall, the population-attributable risk fraction of patients was 5%, suggesting that patients with severe mental illness commit one in 20 violent crimes.
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The increased prevalence for drug dependence in both sexes may contribute to the reported increased crime rates in the homeless.
“The increased prevalence for drug dependence in both sexes may contribute to the reported increased crime rates in the homeless [20,21,22], as substance abuse and dependence is an important risk factor, either alone [71] or comorbid with psychosis [21].”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [22]
The population attributable risk of severe mental illnesses on violent criminal convictions in Sweden has been estimated at 5%.
“the population attributable risk of severe mental illnesses on violent criminal convictions in Sweden has been estimated at 5% [40].”
Mental disorder among homeless people in high income countries is associated with increased vulnerability, including violent victimisation and criminality.
“2) increased vulnerability of the homeless person, including violent victimisation [20] and criminality [21–23];”
From Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia (2014) · cites this paper as [22]
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“Conviction for violent crime Obtained from the National Crime Register, violent crime was defined as homicide, assault, robbery, arson, sexual offense (rape, sexual coercion, child molestation, indecent exposure or sexual harassment), illegal threats or intimidation (Fazel and Grann, 2006).”
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Association Between Maternal Smoking During Pregnancy and Severe Mental Illness in Offspring
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“Yet weekends and out-of-office hours have been previously indicated as high risk periods to child protection agencies (Dolan et al., 2003).”
BackgroundMarital Status and Mental Health
Williams, K., Frech, A., & Carlson, D. L. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.020 · Cited by 68 · see citing works
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“Studies focusing on violent offending have found even higher risks, compared to the general population (5).”
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“On the other hand, the registries used in the present study, the patient National Patient Register and the National Crime Register, have been found to be nearly complete (Fazel & Grann, 2006; Ludvigsson et al., 2011).”
MethodSenior, M., Fazel, S., & Tsiachristas, A. (2020) · The Lancet Public Health · doi:10.1016/s2468-2667(19)30245-2 · Cited by 62 · see citing works
Self-citationDe-escalation techniques for psychosis-induced aggression or agitation
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Psychosis and Violence: Stories, Fears, and Reality
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Psychiatrists’ Practices and Perceptions Regarding Anticipatory Guidance on Firearms
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Well-Being across the Life Course
Mirowsky, J., & Ross, C. E. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.023 · Cited by 60 · see citing works
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“05% of crimes had incomplete personal identification numbers in 1988–2000.[41]”
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“Arguably, the emphasis on cognitive distortion further stigmatises mental illnesses by linking psychological disturbance with rage and extraordinary violence, although people with mental illnesses commit just 4% of violent crimes (Fazel and Grann 2006).”
BackgroundMental disorders of male parricidal offenders
Liettu, A., Säävälä, H., Hakko, H. H., Räsänen, P. K., & Joukamaa, M. I. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0419-9 · Cited by 60 · see citing works
“However, mental disorders account for only a minor proportion of the violence in society [17].”
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“Fazel and Grann (2006) later found thatmost of the risk for violence associated with schizophrenia and other psychoses was mediated by co-morbid substance misuse.”
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“In line with other work (21, 22), we defined violent crime a conviction for homicide, assault, robbery, threats and violence against an officer, gross violation of a person’s integrity, recurrent intimate partner violence directed at a woman (23), unlawful threats, unlawful coercion, kidnapping,…”
Self-citationA Comprehensive Study of Mass Murder Precipitants and Motivations of Offenders
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Sexual Offending in Women and Psychiatric Disorder: A National Case–Control Study
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“40 41 Follow-up began at the time of ADHD diagnosis—that is, time zero—and continued until the outcome of interest, death, emigration, two years after baseline, or 31 December 2020, whichever came first.”
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“Measures: Outcome variables Violent crime was defined as a conviction for homicide, assault, robbery, threats and violence against an officer, gross violation of a person’s/woman’s integrity, unlawful threats, unlawful coercion, kidnapping, illegal confinement, arson, intimidation, or sexual offences (rape, indecent a…”
BackgroundFirst report from the Swedish National Forensic Psychiatric Register (SNFPR)
Innocenti, A. D., Hassing, L. B., Bagge, A. L., Andersson, H., Eriksson, L., Hagelbäck-Hansson, F., Möller, N., Nilsson, T., Hofvander, B., & Anckarsäter, H. S. (2013) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2013.11.013 · Cited by 53 · see citing works
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“level is very small [4, 29].”
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“In a population case register study in Sweden covering the period 1988–2000, Fazel and Grann (2006) found that the overall crude odds ratio for patients with severe mental illness acquiring violent convictions during the study period was 3.8, but the population attributable risk fraction of these…”
BackgroundInfluentialThe intergenerational transmission of suicidal behavior: an offspring of siblings study
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“The National Crime Register includes criminal convictions since 1973 [40,41].”
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“Patients affected by SMI commit 1 in 20 violent crimes (Fazel and Grann, 2006).”
BackgroundAlcohol Use Disorders in Schizophrenia
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A Handbook for the Study of Mental Health
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- Authors
- Fazel, S., & Grann, M.
- Affiliations
- Warneford Hospital (GB)
- Karolinska Institutet (SE)
- ORCID
- Fazel, Seena
- Venue
- American Journal of Psychiatry
- Published
- 2006-08
- Volume
- 163
- Issue
- 8
- Pages
- 1397-1403
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W1833357926
- Cited by
- 539
- References
- 30
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 16 · 2023: 23 · 2022: 30 · 2021: 17 · 2020: 30 · 2019: 27 · 2018: 15 · 2017: 68 · 2016: 29 · 2015: 45 · 2014: 28 · 2013: 45 · 2012: 27
- FWCI
- 24.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Sociology and Political Science › Crime Patterns and Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- severe mental illness, violent crime, population attributable risk, schizophrenia, psychosis, hospital discharge, criminal conviction, gender differences, age differences, crime types
- MeSH terms
- Adolescent, Adult, Age Factors, Mental Disorders, Crime, Female, Forensic Psychiatry, Hospital Records, Humans, Male, Patient Discharge, Psychotic Disorders, Registries, Risk Factors, Schizophrenia, Schizophrenic Psychology, Sex Factors, Sweden, Violence, Cohort Studies, Age Distribution, Sex Distribution
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