Violence and Severe Mental Illness: The Effects of Substance Abuse and Nonadherence to Medication

• Published in: The American journal of psychiatry Vol. 155; no. 2; pp. 226 - 231
• Main Authors: Swartz, Marvin S., Swanson, Jeffrey W., Hiday, Virginia A., Borum, Randy, Wagner, H. Ryan, Burns, Barbara J.
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.02.1998; American Psychiatric Association
• Subjects: Adolescent; Adult; Adult and adolescent clinical studies; Alcoholism - diagnosis; Alcoholism - epidemiology; Awareness; Biological and medical sciences; Commitment of Mentally Ill; Diagnosis, Dual (Psychiatry); Drug abuse; Drug therapy; Factors; Female; Health Status; Hospitalization; Humans; Longitudinal Studies; Male; Medical sciences; Mental disorders; Mental Disorders - diagnosis; Mental Disorders - drug therapy; Mental Disorders - psychology; Mentally ill people; Middle Aged; Miscellaneous; Multivariate Analysis; Noncompliance; Outcome Assessment (Health Care); Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Severity of Illness Index; Substance abuse; Substance-Related Disorders - diagnosis; Substance-Related Disorders - epidemiology; Treatment; Treatment Refusal; Violence; Violence - psychology; Violence - statistics & numerical data; Human; Psychiatric hospital; Drug addiction; Abuse; Narcotic; Violence; Alcoholism; Forced hospitalization; Drug compliance; Alcoholic beverage; Mentally ill commitment; Mental disorder; Treatment compliance; Social behavior disorder
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/ajp.155.2.226

OBJECTIVE: Violent behavior among individuals with severe mental illness has become an important focus in community-based care. This study examines the joint effect of substance abuse and medication noncompliance on the greater risk of serious violence among persons with severe mental illness. METHOD: Involuntarily admitted inpatients with severe mental illness who were awaiting a period of outpatient commitment were enrolled in a longitudinal outcome study. At baseline, 331 subjects underwent an extensive face-to-face interview. Complementary data were gathered by a review of hospital records and a telephone interview with a family member or other informant. These data included subjects' sociodemographic characteristics, illness history, clinical status, medication adherence, substance abuse, insight into illness, and violent behavior during the 4 months that preceded hospitalization. Associations between serious violent acts and a range of individual characteristics and problems were analyzed by using multivariable logistic regression. RESULTS: The combination of medication noncompliance and alcohol or substance abuse problems was significantly associated with serious violent acts in the community, after sociodemographic and clinical characteristics were controlled. CONCLUSIONS: Alcohol or other drug abuse problems combined with poor adherence to medication may signal a higher risk of violent behavior among persons with severe mental illness. Reduction of such risk may require carefully targeted community interventions, including integrated mental health and substance abuse treatment. (Am J Psychiatry 1998; 155:226-231)