Schizophrenia and violence: systematic review and meta-analysis.

<h4>Background</h4>Although expert opinion has asserted that there is an increased risk of violence in individuals with schizophrenia and other psychoses, there is substantial heterogeneity between studies reporting risk of violence, and uncertainty over the causes of this heterogeneity....

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Autores principales:	Seena Fazel, Gautam Gulati, Louise Linsell, John R Geddes, Martin Grann
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2009
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/f473c5325bd14fe9accb267708ecf166
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spelling	oai:doaj.org-article:f473c5325bd14fe9accb267708ecf1662021-11-25T05:37:33ZSchizophrenia and violence: systematic review and meta-analysis.1549-12771549-167610.1371/journal.pmed.1000120https://doaj.org/article/f473c5325bd14fe9accb267708ecf1662009-08-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19668362/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Although expert opinion has asserted that there is an increased risk of violence in individuals with schizophrenia and other psychoses, there is substantial heterogeneity between studies reporting risk of violence, and uncertainty over the causes of this heterogeneity. We undertook a systematic review of studies that report on associations between violence and schizophrenia and other psychoses. In addition, we conducted a systematic review of investigations that reported on risk of homicide in individuals with schizophrenia and other psychoses.<h4>Methods and findings</h4>Bibliographic databases and reference lists were searched from 1970 to February 2009 for studies that reported on risks of interpersonal violence and/or violent criminality in individuals with schizophrenia and other psychoses compared with general population samples. These data were meta-analysed and odds ratios (ORs) were pooled using random-effects models. Ten demographic and clinical variables were extracted from each study to test for any observed heterogeneity in the risk estimates. We identified 20 individual studies reporting data from 18,423 individuals with schizophrenia and other psychoses. In men, ORs for the comparison of violence in those with schizophrenia and other psychoses with those without mental disorders varied from 1 to 7 with substantial heterogeneity (I(2) = 86%). In women, ORs ranged from 4 to 29 with substantial heterogeneity (I(2) = 85%). The effect of comorbid substance abuse was marked with the random-effects ORs of 2.1 (95% confidence interval [CI] 1.7-2.7) without comorbidity, and an OR of 8.9 (95% CI 5.4-14.7) with comorbidity (p<0.001 on metaregression). Risk estimates of violence in individuals with substance abuse (but without psychosis) were similar to those in individuals with psychosis with substance abuse comorbidity, and higher than all studies with psychosis irrespective of comorbidity. Choice of outcome measure, whether the sample was diagnosed with schizophrenia or with nonschizophrenic psychoses, study location, or study period were not significantly associated with risk estimates on subgroup or metaregression analysis. Further research is necessary to establish whether longitudinal designs were associated with lower risk estimates. The risk for homicide was increased in individuals with psychosis (with and without comorbid substance abuse) compared with general population controls (random-effects OR = 19.5, 95% CI 14.7-25.8).<h4>Conclusions</h4>Schizophrenia and other psychoses are associated with violence and violent offending, particularly homicide. However, most of the excess risk appears to be mediated by substance abuse comorbidity. The risk in these patients with comorbidity is similar to that for substance abuse without psychosis. Public health strategies for violence reduction could consider focusing on the primary and secondary prevention of substance abuse. Please see later in the article for Editors' Summary.Seena FazelGautam GulatiLouise LinsellJohn R GeddesMartin GrannPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 6, Iss 8, p e1000120 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Seena Fazel Gautam Gulati Louise Linsell John R Geddes Martin Grann Schizophrenia and violence: systematic review and meta-analysis.
description	<h4>Background</h4>Although expert opinion has asserted that there is an increased risk of violence in individuals with schizophrenia and other psychoses, there is substantial heterogeneity between studies reporting risk of violence, and uncertainty over the causes of this heterogeneity. We undertook a systematic review of studies that report on associations between violence and schizophrenia and other psychoses. In addition, we conducted a systematic review of investigations that reported on risk of homicide in individuals with schizophrenia and other psychoses.<h4>Methods and findings</h4>Bibliographic databases and reference lists were searched from 1970 to February 2009 for studies that reported on risks of interpersonal violence and/or violent criminality in individuals with schizophrenia and other psychoses compared with general population samples. These data were meta-analysed and odds ratios (ORs) were pooled using random-effects models. Ten demographic and clinical variables were extracted from each study to test for any observed heterogeneity in the risk estimates. We identified 20 individual studies reporting data from 18,423 individuals with schizophrenia and other psychoses. In men, ORs for the comparison of violence in those with schizophrenia and other psychoses with those without mental disorders varied from 1 to 7 with substantial heterogeneity (I(2) = 86%). In women, ORs ranged from 4 to 29 with substantial heterogeneity (I(2) = 85%). The effect of comorbid substance abuse was marked with the random-effects ORs of 2.1 (95% confidence interval [CI] 1.7-2.7) without comorbidity, and an OR of 8.9 (95% CI 5.4-14.7) with comorbidity (p<0.001 on metaregression). Risk estimates of violence in individuals with substance abuse (but without psychosis) were similar to those in individuals with psychosis with substance abuse comorbidity, and higher than all studies with psychosis irrespective of comorbidity. Choice of outcome measure, whether the sample was diagnosed with schizophrenia or with nonschizophrenic psychoses, study location, or study period were not significantly associated with risk estimates on subgroup or metaregression analysis. Further research is necessary to establish whether longitudinal designs were associated with lower risk estimates. The risk for homicide was increased in individuals with psychosis (with and without comorbid substance abuse) compared with general population controls (random-effects OR = 19.5, 95% CI 14.7-25.8).<h4>Conclusions</h4>Schizophrenia and other psychoses are associated with violence and violent offending, particularly homicide. However, most of the excess risk appears to be mediated by substance abuse comorbidity. The risk in these patients with comorbidity is similar to that for substance abuse without psychosis. Public health strategies for violence reduction could consider focusing on the primary and secondary prevention of substance abuse. Please see later in the article for Editors' Summary.
format	article
author	Seena Fazel Gautam Gulati Louise Linsell John R Geddes Martin Grann
author_facet	Seena Fazel Gautam Gulati Louise Linsell John R Geddes Martin Grann
author_sort	Seena Fazel
title	Schizophrenia and violence: systematic review and meta-analysis.
title_short	Schizophrenia and violence: systematic review and meta-analysis.
title_full	Schizophrenia and violence: systematic review and meta-analysis.
title_fullStr	Schizophrenia and violence: systematic review and meta-analysis.
title_full_unstemmed	Schizophrenia and violence: systematic review and meta-analysis.
title_sort	schizophrenia and violence: systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2009
url	https://doaj.org/article/f473c5325bd14fe9accb267708ecf166
work_keys_str_mv	AT seenafazel schizophreniaandviolencesystematicreviewandmetaanalysis AT gautamgulati schizophreniaandviolencesystematicreviewandmetaanalysis AT louiselinsell schizophreniaandviolencesystematicreviewandmetaanalysis AT johnrgeddes schizophreniaandviolencesystematicreviewandmetaanalysis AT martingrann schizophreniaandviolencesystematicreviewandmetaanalysis
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Schizophrenia and violence: systematic review and meta-analysis.

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