New research has identified a host of factors associated with the risk of adults with mental illness becoming victims of violence, as well as perpetrators of violence.
“This work builds on an earlier study that found almost one-third of adults with mental illness are likely to be victims of violence within a six-month period,” said Richard Van Dorn, a researcher at RTI International and lead author of a paper describing the work.
“In this study, we addressed two fundamental questions: If someone is victimized, is he or she more likely to become violent? And if someone is violent, is he or she more likely to be victimized? The answer is yes, to both questions.”
For the study, researchers from RTI, North Carolina State University, Arizona State University, and Duke University Medical Center analyzed information from a database of 3,473 adults with mental illnesses who had answered questions about both committing violence and being victims of violence.
Those studies had different research goals, but all asked identical questions related to violence and victimization.
For the new study, researchers used a baseline assessment of each study participant’s mental health and violence history as a starting point, and then tracked the data on each participant for up to 36 months.
Specifically, the researchers assessed each individual’s homelessness, inpatient mental-health treatment, psychological symptoms of mental illness, substance use, and as victims or perpetrators of violence.
The researchers noted they evaluated all of these items as both indicators and outcomes — i.e., as both causes and effects.
“We found that all of these indicators mattered, but often in different ways,” said Sarah Desmarais, an associate professor of psychology at North Carolina State and co-author of the paper. “For example, drug use was a leading indicator of committing violence, while alcohol use was a leading indicator of being a victim of violence.”
However, the researchers also found that one particular category of psychological symptoms was also closely associated with violence: Affective symptoms.
“By affect, we mean symptoms including anxiety, depressive symptoms, and poor impulse control,” Desmarais said. “The more pronounced affective symptoms were, the more likely someone was to both commit violence and be a victim of violence.
“This is particularly important because good practices already exist for how to help people, such as therapeutic interventions or medication,” she continued. “And by treating people who are exhibiting these symptoms, we could reduce violence. Just treating drug or alcohol use — which is what happens in many cases — isn’t enough. We need to treat the underlying mental illness that is associated with these affective symptoms.”
The research also highlighted how one violent event could cascade over time.
For example, on average, the researchers found that one event in which a person was a victim of violence triggered seven other effects, such as psychological symptoms, homelessness, and becoming perpetrators of violence. Those seven effects, on average, triggered an additional 39 additional effects.
“It’s a complex series of interactions that spirals over time, exacerbating substance use, mental-health problems and violent behavior,” Van Dorn said. “These results tell us that we need to evaluate how we treat adults with severe mental illness.”
“Investing in community-based mental health treatment programs would significantly reduce violent events in this population,” added Desmarais. “That would be more effective and efficient than waiting for people to either show up at emergency rooms in the midst of a mental-health crisis or become involved in the legal system as either victims or perpetrators of violence.
“We have treatments for all of these problems, we just need to make them available to the people that need them,” she concluded.
The paper was published in the journal Psychological Medicine.
Source: North Carolina State University