Stressful trigger events associated with risk of violent crime

A study published online by JAMA Psychiatry of patients in Sweden suggests trigger events, including exposure to violence, were associated with increased risk of violent crime in the week following exposure among patients with schizophrenia and bipolar disorder and among individuals without psychiatric diagnoses who were included for comparison.

Patients diagnosed with schizophrenia spectrum and bipolar disorders have higher rates of criminal convictions than the general population. The identification of triggers for violence could be potentially important for risk assessment. But there is a lack of evidence of triggers for violence in patients with psychosis.

Seena Fazel, M.D., of the University of Oxford, United Kingdom, and coauthors used nationwide Swedish data for individuals born between 1958 and 1988 to examine a range of triggers for violent acts in patients with psychotic disorders and individuals without a psychiatric diagnosis.

The study sample included more than 2.8 million people - 34,903 patients with , 29,692 patients with and more than 2.7 million unaffected control individuals for comparison. The study examined six triggers: exposure to violence, parental bereavement, self-harm, , unintentional injuries and substance intoxication.

Absolute risks (the incidence in a population) for in the week following exposure to a trigger were typically highest among individuals diagnosed with schizophrenia, followed by those with bipolar disorder and then control participants who did not have , according to the results. Exposure to violence contributed to the largest absolute risks of a violent offense in the week following exposure to the trigger.

Relative risks (a ratio of the risk of those exposed to a trigger to the risk of those not exposed) were generally similar across the three groups for most triggers, according to the study.

The authors noted several limitations, including that other factors might explain exposure to triggers and violent crime.

"These findings support the hypothesis that recent exposure to a stressful life event, an intentional or unintentional injury, or having been diagnosed with substance intoxication increases the short-term risk of interpersonal violence in individuals with and in controls," the study concludes.

"Clinically, these findings imply that patients with schizophrenia or bipolar disorder should receive a psychiatric assessment for the risk of violence if they sustain an experience similar to one of the triggers tested in this study. ... This study raises questions for future research. We need to understand the mechanisms underpinning the trigger effect on ," writes Jan Volavka, M.D., Ph.D., of the New York University School of Medicine, in a related editorial.

Explore further

Antipsychotic medication associated with reduced rate of violent crime

More information: JAMA Psychiatry. Published online July 13, 2016. DOI: 10.1001/jamapsychiatry.2016.1349

JAMA Psychiatry. Published online July 13, 2016. DOI: 10.1001/jamapsychiatry.2016.1348

Journal information: JAMA Psychiatry

Citation: Stressful trigger events associated with risk of violent crime (2016, July 13) retrieved 15 January 2021 from
This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Feedback to editors

User comments