摘要：Objectives. This study examined the prevalence and correlates of violent behavior by individuals with severe mental illness. Methods. Participants (N = 802) were adults with psychotic or major mood disorders receiving inpatient or outpatient services in public mental health systems in 4 states. Results. The 1-year prevalence of serious assaultive behavior was 13%. Three variables—past violent victimization, violence in the surrounding environment, and substance abuse—showed a cumulative association with risk of violent behavior. Conclusions. Violence among individuals with severe mental illness is related to multiple variables with compounded effects over the life span. Interventions to reduce the risk of violence need to be targeted to specific subgroups with different clusters of problems related to violent behavior. Recent studies bearing on the relationship between psychiatric disorder and violent behavior suggest that although risk of violence is elevated somewhat in persons with severe mental illness (SMI), 1– 4 the large majority of these persons do not commit violent acts, 5 and the causal determinants of violent behavior in this group are perhaps as varied and complex as those in the general population. 6– 10 Psychopathology per se seldom leads to assaultiveness, but it may converge with other risk factors that, together, significantly increase the likelihood of violent behavior. 11, 12 Numerous surveys of psychiatric inpatients, outpatients, homeless and mentally ill persons, and emergency room patients have found that a large proportion of persons in treatment for mental health problems have at some time been victims of violent physical or sexual abuse. 13– 20 The long-term psychological effects of victimization and trauma exposure may be compounded by substance abuse, homelessness, adverse social environments, and treatment noncompliance—with the net result that risk of violence is markedly increased in certain subgroups of persons with SMI. 21– 28 To what degree does each of these kinds of variables contribute—independently or in convergence—to violent actions by persons with mental illness? We examined this question using a multivariate analysis of pooled samples of treated individuals with SMI in 4 states N= 802).
