文章基本信息

标题：Mental Disorder and Violent Victimization in a Total Birth Cohort
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作者：Eric Silver ; Louise Arseneault ; John Langley 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2005
卷号：95
期号：11
页码：2015-2021
DOI：10.2105/AJPH.2003.021436
语种：English
出版社：American Public Health Association
摘要：Objective. We examined the association between mental disorder and violent victimization in a general population sample. Methods. We performed a multivariate analysis of violent victimization in a 12-month period on a total birth cohort with follow-up data that assessed, during their 21st year, males and females born in Dunedin, New Zealand, in the early 1970s. Results. Compared with people with no mental disorder, (1) people with anxiety disorders experienced more sexual assaults, (2) people with schizophreniform disorders experienced more threatened and completed physical assaults, (3) people with alcohol dependence disorders experienced more completed physical assaults, and (4) people with marijuana dependence disorders experienced more attempted physical assaults. These results held after control for psychiatric comorbidity, demographic characteristics, and the study participants’ own violent behavior. Conclusion. Mentally disordered young adults tend to experience more violent victimization in the community than those without a mental disorder. Mental disorder may be associated with violent victimization. Unfortunately, few empirical studies have investigated this relation, 1 and none has done so using general population data. Addressing this association is important for two reasons. First, most previous studies of mental disorder and violence depicted people with mental disorders as violent actors. 2 ^– 6 These studies showed that people with mental disorders engaged in violence more often than people without mental disorders, particularly when their disorders involved alcohol or drug use. However, by ignoring the victimization experiences of people with mental disorders, these studies inadvertently reinforced the belief that people with mental disorders are dangerous 7 when they also may be more vulnerable to harm from others than non–mentally disordered people. Second, understanding the association between mental disorder and violent victimization is important for designing community-based mental health services. Studies of treated samples indicate that victims with mental disorders exhibit unique symptom patterns, 8 ^– 10 require frequent use of emergency treatment services, 10 and experience victimization in substantial numbers that do not appear in their medical charts. 11 ^– 13 Ignoring victimization may therefore undermine treatment success and contribute to the physical and psychological harm experienced by people with mental disorders. Two hypotheses have been suggested for explaining the association between mental disorder and violent victimization. One hypothesis, enhanced vulnerability to attack, suggests that people with mental disorders are often unable to engage in alert self-protection and self-defense. 1 The second hypothesis, victimization as an informal social control, suggests that people with mental disorders often behave in ways that elicit grievances in others, which may lead to social control efforts that eventuate in victimization. 14 Both hypotheses predict a positive association between mental disorder and violent victimization. Examination of previous research revealed several methodological limitations that we wanted to overcome. First, previous studies of the association between mental disorder and victimization have operationalized mental disorders by examining current or former psychiatric patients. 1 ^, 8 ^– 16 Unfortunately, data on psychiatric patients can tell us little about associations in the general population, because most people with mental disorders do not receive mental health treatment. 17 In addition, mentally disordered victims of violence are more likely to seek psychiatric treatment than nonvictims, 10 thereby inflating observed victimization rates. Second, most previous studies did not include comparison data on non–mentally disordered people measured with the same research protocol. 1 ^, 16 A notable exception is a recent study 14 in which the 10-week prevalence of violent victimization among 270 discharged psychiatric patients was compared with 519 nonpatients drawn from the same neighborhoods as the patients. Violent victimization was significantly higher for patients than nonpatients (15.2% vs 6.9%, respectively). This finding has yet to be replicated with a general population sample. Third, most previous studies used small samples of patients, preventing reliable estimates of victimization rates to be calculated for different types of mental disorder. 8 ^, 9 ^, 11 ^– 13 ^, 15 Because half of all persons meeting the diagnostic criteria for mental disorder have at least one other disorder, 18 ^– 20 it is important to examine whether different types of mental disorder are uniquely associated with victimization. In addition, small samples prevent researchers from controlling for characteristics known to be associated with both mental disorder and violent victimization (e.g., gender, socioeconomic status [SES]) and may produce spurious results. Fourth, most previous studies failed to measure violence perpetration. 1 ^, 8 ^– 13 ^, 15 Because people with mental disorders are more likely to engage in violence than people without mental disorders, 2 ^– 6 they also may be more likely to become victims in situations in which their violent behavior is met with resistance or retaliation. 14 However, the degree to which violence perpetration explains the association between mental disorder and violent victimization remains unknown. To overcome these limitations, we estimated rates of violent victimization for a range of mental disorders in a total birth cohort of young adults at age 21. We examined unique associations between mental disorder and violent victimization, controlling for psychiatric comorbidity, demographic factors, and violence perpetration. 14 ^, 17 ^– 20