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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 [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]
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“the population attributable risk of severe mental illnesses on violent criminal convictions in Sweden has been estimated at 5% [40].”
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“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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Sexual Offending in Women and Psychiatric Disorder: A National Case–Control Study
Fazel, S., Sjöstedt, G., Grann, M., & Långström, N. (2008) · Archives of Sexual Behavior · doi:10.1007/s10508-008-9375-4 · Cited by 58
Self-citationZhang, L., Zhu, N., Sjölander, A., Nourredine, M., Li, L., Garcia‐Argibay, M., Kuja‐Halkola, R., Brikell, I., Lichtenstein, P., D'Onofrio, B. M., et al. (2025) · BMJ · doi:10.1136/bmj-2024-083658 · Cited by 63
“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.”
Molero, Y., Lichtenstein, P., Zetterqvist, J., Gumpert, C. H., & Fazel, S. (2015) · BMJ · doi:10.1136/bmj.h2388 · Cited by 53
Self-citationSariaslan, A., Larsson, H., D'Onofrio, B. M., Långström, N., & Lichtenstein, P. (2014) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.113.136200 · Cited by 54
“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
Cutcliffe, J. R., & Riahi, S. (2013) · International Journal of Mental Health Nursing · doi:10.1111/inm.12029 · Cited by 51
Björkenstam, E., Björkenstam, C., Vinnerljung, B., Hallqvist, J., & Ljung, R. (2011) · International Journal of Epidemiology · doi:10.1093/ije/dyr127 · Cited by 51
Björkenstam, E., Hjern, A., Björkenstam, C., & Kosidou, K. (2017) · JAMA psychiatry · doi:10.1001/jamapsychiatry.2017.3788 · Cited by 44
Ayano, G., Solomon, M., Tsegay, L., Yohannes, K., & Abraha, M. (2020) · Psychiatric Quarterly · doi:10.1007/s11126-020-09746-1 · Cited by 51
The impact of psychopathy on violence among the household population of Great Britain
Coid, J., & Yang, M. (2010) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-010-0212-4 · Cited by 53
“level is very small [4, 29].”
Correlates of Crime and Violence among Persons with Mental Disorder: An Evidence-Based Review
Sirotich, F. (2008) · Brief Treatment and Crisis Intervention · doi:10.1093/brief-treatment/mhn006 · Cited by 51
“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
O’Reilly, L. M., Kuja‐Halkola, R., Rickert, M. E., Class, Q. A., Larsson, H., Lichtenstein, P., & D'Onofrio, B. M. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-0850-6 · Cited by 58
Lee, M., Bhimla, A., Lu, W., & Grace, X. (2020) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-020-09704-6 · Cited by 47
Sujan, A. C., Quinn, P. D., Rickert, M. E., Wiggs, K. K., Lichtenstein, P., Larsson, H., Almqvist, C., Öberg, A. S., & D'Onofrio, B. M. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002980 · Cited by 47
“The National Crime Register includes criminal convictions since 1973 [40,41].”
BackgroundWork and Unemployment as Stressors
Lennon, M. C., & Limonic, L. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.015 · Cited by 46
Mohr, P., Knytl, P., Voráčková, V., Bravermanová, A., & Melicher, T. (2017) · International journal of clinical practice · doi:10.1111/ijcp.12997 · Cited by 43
van Buitenen, N., van den Berg, C. J. W., Meijers, J., & Harte, J. M. (2020) · European Psychiatry · doi:10.1192/j.eurpsy.2020.63 · Cited by 48
Caman, S., Howner, K., Kristiansson, M., & Sturup, J. (2016) · Psychology of Violence · doi:10.1037/vio0000059 · Cited by 44
Faden, J., & Citrome, L. (2024) · Schizophrenia Research · doi:10.1016/j.schres.2023.11.008 · Cited by 45
Hodgins, S., & Klein, S. (2019) · Wiley eBooks · doi:10.1002/9781119139980.ch16 · Cited by 42
Manchia, M., & Fanos, V. (2017) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2017.03.024 · Cited by 42
“Patients affected by SMI commit 1 in 20 violent crimes (Fazel and Grann, 2006).”
BackgroundAlcohol Use Disorders in Schizophrenia
Jones, R. M., Lichtenstein, P., Grann, M., Långström, N., & Fazel, S. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10m06320 · Cited by 40
Self-citationSevere Non-Lethal Violence During Psychotic Illness
Yee, N., Large, M. M. B., Kemp, R. I., & Nielssen, O. B. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048674.2011.541417 · Cited by 44
A Handbook for the Study of Mental Health
(2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289 · Cited by 43
Horwitz, A. V. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511984945.004 · Cited by 40
Metadata
- 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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