Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies
Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis. We conducted a systematic re...
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| description | Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.
We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.
There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values |
| doi_str_mv | 10.1371/journal.pone.0055942 |
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We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.
There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.
Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0055942</identifier><identifier>PMID: 23418482</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adults ; Aggression ; Alcoholic beverages ; Alcoholism ; Antipsychotics ; Bipolar disorder ; Bipolar Disorder - psychology ; Comorbidity ; Crime ; Crime prevention ; Drugs ; English language ; Epidemiology ; Global health ; Health aspects ; Humans ; Impulsive behavior ; Medical research ; Medicine ; Mental disorders ; Meta-analysis ; Neurobiology ; Neurosciences ; Personality disorders ; Psychiatry ; Psychoses ; Psychosis ; Psychotic Disorders - psychology ; Public health ; Regression analysis ; Reviews ; Risk analysis ; Risk Assessment ; Risk Factors ; Risk management ; Schizophrenia ; Schizophrenic Psychology ; Scientific papers ; Social and Behavioral Sciences ; Sociodemographics ; Studies ; Systematic review ; Violence ; Violence - psychology</subject><ispartof>PloS one, 2013-02, Vol.8 (2), p.e55942-e55942</ispartof><rights>COPYRIGHT 2013 Public Library of Science</rights><rights>2013 Witt et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: https://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2013 Witt et al 2013 Witt et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c743t-67c9674d4aa769cc8031c54ae5f4e2435de3580f9f0f60011ca1a20db5e72d33</citedby><cites>FETCH-LOGICAL-c743t-67c9674d4aa769cc8031c54ae5f4e2435de3580f9f0f60011ca1a20db5e72d33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572179/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572179/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23418482$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Zhang, Xiang Yang</contributor><creatorcontrib>Witt, Katrina</creatorcontrib><creatorcontrib>van Dorn, Richard</creatorcontrib><creatorcontrib>Fazel, Seena</creatorcontrib><title>Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.
We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.
There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.
Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.</description><subject>Adults</subject><subject>Aggression</subject><subject>Alcoholic beverages</subject><subject>Alcoholism</subject><subject>Antipsychotics</subject><subject>Bipolar disorder</subject><subject>Bipolar Disorder - psychology</subject><subject>Comorbidity</subject><subject>Crime</subject><subject>Crime prevention</subject><subject>Drugs</subject><subject>English language</subject><subject>Epidemiology</subject><subject>Global health</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Impulsive behavior</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Mental disorders</subject><subject>Meta-analysis</subject><subject>Neurobiology</subject><subject>Neurosciences</subject><subject>Personality disorders</subject><subject>Psychiatry</subject><subject>Psychoses</subject><subject>Psychosis</subject><subject>Psychotic Disorders - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Witt, Katrina</au><au>van Dorn, Richard</au><au>Fazel, Seena</au><au>Zhang, Xiang Yang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2013-02-13</date><risdate>2013</risdate><volume>8</volume><issue>2</issue><spage>e55942</spage><epage>e55942</epage><pages>e55942-e55942</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.
We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.
There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.
Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>23418482</pmid><doi>10.1371/journal.pone.0055942</doi><tpages>e55942</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adults Aggression Alcoholic beverages Alcoholism Antipsychotics Bipolar disorder Bipolar Disorder - psychology Comorbidity Crime Crime prevention Drugs English language Epidemiology Global health Health aspects Humans Impulsive behavior Medical research Medicine Mental disorders Meta-analysis Neurobiology Neurosciences Personality disorders Psychiatry Psychoses Psychosis Psychotic Disorders - psychology Public health Regression analysis Reviews Risk analysis Risk Assessment Risk Factors Risk management Schizophrenia Schizophrenic Psychology Scientific papers Social and Behavioral Sciences Sociodemographics Studies Systematic review Violence Violence - psychology |
| title | Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies |
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