Community Violence in Persons with Major Psychiatric Disorders

Principal Investigator: Menahem Krakowski, M.D., Ph.D.

Violence presents obvious danger to victims and society in general, and has a major negative impact on all aspects of treatment for its perpetrators. If we are to improve treatment and delivery of services to persons with mental illness who are involved in situations of violence, we must better understand the interactions between their clinical symptoms, current treatments and the environmental determinants of violence. This project aims to follow such persons, establish what dispositional and situational characteristics are related to violent behavior in the community, and provide the groundwork for a larger study.

PROJECT GOALS

Statistical data on community violence indicate persons with major mental illness are over-represented in certain categories of violent behavior. The heterogeneity of violent behaviors related to a set of hypothesized interactions between clinical and environmental factors needs to be explored in order to develop appropriate community treatment.

As a first step in this direction, a pilot study is being conducted to assess the feasibility of following and assessing persons with major mental disorder and a history of violence. The goals of this study are to:

Determine the ease of locating and following these persons over a six-month period,
Assess the reliability of self-report as compared to clinicians' report in assessing violence,
Assess the ease of administering various psychometric scales in this population,
Establish how certain dispositional and situational characteristics are related to violent behavior in the community,
Estimate the effect size for a larger study.

RESEARCH ACTIVITIES AND RESULTS

Charts of 54 clients with severe mental illness who attend two Bellevue outpatient clinics were reviewed, and 11 were found to meet the inclusion criteria for entry in this study: a diagnosis of major psychiatric disorder and history of physical assaults. They were approached for consent; five refused to participate (one did not want to be interviewed, two did not give any reason, and two were too psychotic and uncooperative). Therefore, six clients were enrolled in the study initially, but one moved out of the area prior to the first interview.

The five clients presently followed are from diverse backgrounds with histories of varying degrees of violent behavior. During the first six months of this study, the ability to contact them on a regular basis has varied from client to client, and various adjustments to their scheduled appointments have had to be made.

Initial assessments have included psychosocial history taking, and assessments of psychiatric symptoms, neurocognitive functioning and anti-social traits. Six-week follow-up assessments also have been made encompassing psychiatric symptoms, reported occurrence of violence, substance abuse, treatment compliance and various indices of quality of life. All clients have been evaluated using a number of varied scales and instruments including:

Outcome measures:

Violence assessments based on the individual’s self-report of violence or its absence, and corroborated, to the extent possible, by information from collateral sources and staff reports.

Buss-Durkee Hostility Inventory (BDHI), an instrument that has been used in clinical populations to assess aggressive and hostile attitudes.

Dispositional variables:

Positive and Negative Symptoms Scale (PANSS), a scale to assess positive and negative psychiatric symptoms.

Quantified Neurological Scale, Purdue Pegboard to test neurological and motor-integrative function.

General demographic/historical information gathered for each subject including history of past psychiatric hospitalizations.

Situational variables:

Lehman’s Quality of Life Scale (QLS), a structured interview to evaluate important situational variables associated with violence by examining general life satisfaction, daily activities and functioning, family, social relations, finances, work and school, legal and safety issues, and health.

Barrat Impulsivity Scale

WAIS-R Vocabulary

Drug Use Scale to examine incidence of substance abuse.

SIGNIFICANCE OF FINDINGS/POLICY IMPLICATIONS

Violence presents obvious danger to victims and society in general. Furthermore, it has a major negative impact on all aspects of treatment for its perpetrators. If we are to improve treatment and delivery of services to persons with mental illness who are involved in situations of violence, we must better understand the interactions between their clinical symptoms, current treatments and the environmental determinants of violence.

PLANS

We will continue to evaluate the clients in the study group. An additional twelve clients at Rockland Psychiatric Center who meet the inclusion criteria for this study have been identified and will be contacted for consent and participation.

Updated: 5/17/99

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