Friday, February 13, 2009

Mental Health Mythbusters: Violence

In a longitudinal study done by Eric Elbogen, PhD and Sally Johnson at the University of North Carolina, Chapel Hill School of Medicine, researchers look at the link between mental illness and violence. 35,000 people were interviewed in two “waves” a few years apart, and correlations between mental health, substance abuse, and violence were examined.

From the CBS News article, a few snippets:

In all, 2.9 percent of participants said they had been violent in the time between the first and second interviews.

When Elbogen evaluated the possible associations between mental illness, violence, and other factors, having a mental illness alone did not predict violence, but having a mental illness and a substance abuse problem did increase the risk of violence.

The risk was increased even more if the person had mental illness, substance abuse problems, and a history of violence….

…"I think a lot of people think mental illness is the usual cause if not the foremost cause of violence," Elbogen says, citing a survey in which 75 percent of respondents said they considered people with mental illness as dangerous.

But his study concludes that the findings say mental illness is relevant and you can see that throughout the data. But it's not really one of the foremost causes of violent behavior [by itself] in our society."….

…Experts who reviewed the paper for WebMD say they hope the new research may change mistaken perceptions toward those who are mentally ill.

"Having a severe mental illness alone doesn't predict anything," as far as violence, says Philip Muskin, MD, professor of clinical psychiatry at Columbia University in New York. The new results, he says, confirm some other studies with similar results.

For those affected by the severe mental illnesses evaluated in the study, Muskin says, "You are no more at risk for committing a violent act than anyone in the population."

Some thoughts:

  1. As I have always stated, the single biggest challenge to mental health is that of stigma. Nowhere is that more overt than in the perception of the mentally ill as being arbiters of violence. The individual reports of mentally ill individuals having violent behaviors tend to make the headlines, and skew the public opinion. Our media reports from a sensational point of view, and violence sells. The mentally ill are more likely to be presented as dangerous than beneficial in TV, movies, and literature.
  2. The science here is fairly sound, using bivariate and multivariate analyses, and is about as good as one can get for a mostly prospective longitudinal study. The study is published in the Archives of General Psychiatry.
  3. This data is not new, as researchers have been studying this link for years, and most studies have shown similar results. The number of participants and design of this study certainly appears to give it more power than its predecessors.
  4. I would be interested in seeing data that looks at further subgrouping of those with mental illness. Some illnesses, such as antisocial personality disorder, have violence included as part of their criteria for diagnosis. I imagine that the diagnoses of depression, and anxiety disorders alone (which make up the vast majority of those will mental illness) would show significantly less rates of violence.
  5. What of those mental illnesses that do have violent or impulsive/explosive behaviors listed in their criteria?
  6. Substance abuse, previous history of violence and being younger, male, recently financially or socially stressed, and of low income were all positively correlated with and increased chance for violence. Add mental illness to any of those factors, and there is an exponential rise in correlation; especially with substance abuse and violent history. It is important to screen individuals in the offices of psychiatrists for these factors. Likewise, the domains of social workers, family doctors, and the judicial system should be active in monitoring for and promoting treatment of mental health needs.

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