摘要：Objectives. In a large heterogeneous sample of adults with mental illnesses, we examined the 6-month prevalence and nature of community violence perpetration and victimization, as well as associations between these outcomes. Methods. Baseline data were pooled from 5 studies of adults with mental illnesses from across the United States (n = 4480); the studies took place from 1992 to 2007. The MacArthur Community Violence Screening Instrument was administered to all participants. Results. Prevalence of perpetration ranged from 11.0% to 43.4% across studies, with approximately one quarter (23.9%) of participants reporting violence. Prevalence of victimization was higher overall (30.9%), ranging from 17.0% to 56.6% across studies. Most violence (63.5%) was perpetrated in residential settings. The prevalence of violence-related physical injury was approximately 1 in 10 overall and 1 in 3 for those involved in violent incidents. There were strong associations between perpetration and victimization. Conclusions. Results provided further evidence that adults with mental illnesses experienced violent outcomes at high rates, and that they were more likely to be victims than perpetrators of community violence. There is a critical need for public health interventions designed to reduce violence in this vulnerable population. The risk of violence associated with mental illnesses is a topic of research, media coverage, and debate. Research indicates that between 11% and 52% of adults with mental illnesses have been violent within a 12-month period, 1–7 and data from the National Comorbidity Survey show that rates of violence for adults with mental illnesses are 2 to 8 times greater than in the general population. 8 Other studies show modest but significant relationships between mental illness and violence, 3,9,10 even after controlling for substance abuse. 11 Although highly publicized cases of violence perpetrated by adults with mental illnesses have highlighted their “dangerousness,” data suggest they experience victimization at rates comparable to or higher than their rates of perpetration. 12 Studies show 12-month prevalence rates between 20% and 44%, 7,12–15 and indicate the likelihood of experiencing violent victimization is 23 times higher in adults with mental illnesses compared with the general population. 12 Despite these findings, there remains a focus on violence perpetration to the neglect of victimization in this vulnerable population. The increased risk of violent outcomes that is associated with mental illnesses represents a substantial public health burden. Violence can be devastating to victims and perpetrators alike, as well as being costly to the public. 16,17 In addition to physical injury, violence may precipitate the loss of personal liberty because of incarceration 18 or civil commitment, 19 require implementation of expensive clinical and risk assessment and management strategies, 20 perpetuate the stigma associated with mental illness, 21 and disrupt continuity of care. 22 Consequently, an understanding of the prevalence and nature of community violence—both perpetration and victimization—among adults with mental illnesses is critical to public health research and practice. Unfortunately, the empirical literature is limited. First, there are many more studies of perpetration than victimization; a review of the literature found 3 times as many publications about the link between mental illness and violence compared with the link between mental illness and victimization. 23 Second, although they are risk factors for each other, 24–26 there have been few studies of community violence perpetration and victimization. Only a handful of peer-reviewed publications report on both outcomes in the same sample of adults with mental illnesses during the same reference period. 27–30 Third, studies that have examined both outcomes have restricted power and generalizability because of the relatively small, nonrepresentative samples. Fourth, there is heterogeneity in the operational definitions of violence, preventing meaningful comparisons or aggregation of findings. Fifth, violent outcomes are frequently measured with a single yes or no question (e.g., “Have you been victimized in the past 12 months?”), a measurement approach with limited sensitivity. 31
