Doc Gurley

Finally, a whopping, thorough, well-designed study of over 34,000 people looks at whether or not our assumptions about mental illness and violence have any basis in fact. Here’s the result, as well-reported in Medscape -

“Future violence, such as fighting, sexual assault, or arson, was statistically more likely among individuals with severe mental illness only in the presence of comorbid substance abuse and/or dependence, according to data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

‘Factors such as young age, male sex, parental criminal history, recent divorce, and recent unemployment were stronger predictors of future violence than mental illness,’ study author Eric B. Elbogen, PhD, from the University of North Carolina at Chapel Hill, told Medscape Psychiatry.

However, having 3 combined factors — severe mental illness, substance abuse or dependence, and a history of violence — was linked with a nearly 10-fold greater risk of future violence than having mental illness alone. “

In a succinct summary, the report concludes, “Although a recent national survey showed that 75% of the population view people with mental illness as dangerous, the current study showed that ‘if a person has severe mental illness without substance abuse and history of violence, he or she has the same chances of being violent during the next 3 years as any other person in the general population,’ the authors write.

The 8 strongest predictors of violence, in order of strength of prediction, were younger age, history of a violent act, male sex, history of juvenile detention, divorce or separation in the past year, history of physical abuse, parental criminal history, and unemployment for the past year. Co-occurring mental illness and substance use was ninth on the list, followed by victimization in the past year.

‘The data shows it is simplistic as well as inaccurate to say the cause of violence among mentally ill individuals is the mental illness itself,’ the authors write.

‘Instead, the current study finds that mental illness is clearly relevant to violence risk but that its causal roles are complex, indirect, and embedded in a web of other (and arguably more) important individual and situational cofactors to consider,’ they add.”

Kudos to all involved in this report for that rare combination of 1) excellent study, 2) accurate and nuanced interpretation of study results and, finally 3) superb coverage (Medscape).

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