The association between violence and serious mental illness (SMI)—schizophrenia, other psychotic disorder, bipolar disorder, or major depressive disorder—was examined and guided by the I3 model to frame analysis of the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2, enrolling N = 34,653 participants representative of the U.S. population. SMI was related to subsequent violent behavior but in multivariable analysis had the weakest link to severe violence. Risk factors postulated to increase dispositional impellance (anger, perceived threats), situational impellance (recent divorce/separation, financial crisis, victimization), and disinhibition (alcohol/drug abuse) fully mediated the relationship between SMI and violence. Clinical research, interventions, and policies on violence should use conceptual models and consider SMI not in isolation but relative to other risk factors. Violence prevention targeting only psychiatric diagnosis is likely to have limited impact given lack of a strong or direct connection found between SMI and violent behavior.
AngermeyerM. C.MatschingerH. (1996). The effect of violent attacks by schizophrenic persons on the attitude of the public towards the mentally ill. Social Science and Medicine, 43, 1721–1728.
2.
AppelbaumP. S. (2013). Public safety, mental disorders, and guns. JAMA Psychiatry, 70, 565–566. doi:10.1001/jamapsychiatry.2013.315
3.
AppelbaumP. S.RobbinsP. C.MonahanJ. (2000). Violence and delusions: Data from the MacArthur Violence Risk Assessment Study. American Journal of Psychiatry, 157, 566–572.
4.
Arboleda-FlórezJ. J.HolleyH.CrisantiA. (1998). Understanding causal paths between mental illness and violence. Social Psychiatry and Psychiatric Epidemiology, 33, S38–S46.
5.
BaronR. M.KennyD. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
6.
BarryC. L.McGintyE. E.VernickJ. S.WebsterD. W. (2013). After Newtown—Public opinion on gun policy and mental illness. New England Journal of Medicine, 368, 1077–1081. doi:10.1056/NEJMp1300512
7.
BielerG. S.BrownG. G.WilliamsR. L.BroganD. J. (2010). Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data. American Journal of Epidemiology, 171, 618–623. doi:10.1093/aje/kwp440
8.
BroganD. J. (1998). Pitfalls of using standardized statistical software packages for sample survey data. In ArmitageP.ColtonT. (Eds.), Encyclopedia of biostatistics (pp. 4167–4174). New York, NY: John Wiley.
9.
CarpinielloB.GirauR.OrrùM. G. (2007). Mass-media, violence and mental illness. Evidence from some Italian newspapers. Epidemiologia e Psichiatria Sociale, 16, 251–255.
10.
CatalanoR.NovacoR.McConnellW. (1997). A model of the net effect of job loss on violence. Journal of Personality and Social Psychology, 72, 1440–1447.
11.
CohnJ. B.WilcoxC. S. (1983). Dangerousness as a standard for civil commitment. American Journal of Forensic Psychiatry, 4, 169–174.
12.
CoidJ. W.UllrichS.KallisC.KeersR.BarkerD.CowdenF.StampsR. (2013). The relationship between delusions and violence: Findings from the East London first episode psychosis study. JAMA Psychiatry, 70, 465–471.
13.
ComptonW. M.ThomasY. F.StinsonF. S.GrantB. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 64, 566–576.
14.
CorriganP. W.WatsonA. C. (2005). Findings from the National Comorbidity Survey on the frequency of violent behavior in individuals with psychiatric disorders. Psychiatry Research, 136, 153–162. doi:10.1016/j.psy chres.2005.06.005
15.
CorriganP. W.WatsonA. C.GraciaG.SlopenN.RasinskiK.HallL. L. (2005). Newspaper stories as measures of structural stigma. Psychiatric Services, 56, 551–556.
16.
CoverdaleJ.NairnR.ClaasenD. (2002). Depictions of mental illness in print media: A prospective national sample. Australian and New Zealand Journal of Psychiatry, 36, 697–700.
17.
DawsonD. A.GrantB. F.StinsonF. S.ChouP. S.HuangB.RuanW. J. (2005). Recovery from DSM-IV alcohol dependence: United States, 2001–2002. Addiction, 100, 281–292.
18.
DensonT. F.DeWallC. N.FinkelE. J. (2012). Self-control and aggression. Current Directions in Psychological Science, 21, 20–25. doi:10.1177/0963721411429451
19.
DeWallC. N.FinkelE. J.DensonT. F. (2011). Self-control inhibits aggression. Social and Personality Psychology Compass, 5, 458–472.
20.
DouglasK. S.GuyL.HartS. D. (2009). Psychosis as a risk factor for violence to others: A meta-analysis. Psychological Bulletin, 135, 679–706.
21.
DouglasK.HartS.WebsterC.BelfrageH. (2013). HCR-20 V3 Historical, Clinical, Risk Management (Version 3): Professional guidelines for evaluating risk of violence. Sydney, Australia: ProActive ReSolutions.
22.
DouglasK. S.SkeemJ. L. (2005). Violence risk assessment: Getting specific about being dynamic. Psychology, Public Policy, and Law, 11, 347–383.
23.
ElbogenE. B.JohnsonS. C. (2009). The intricate link between violence and mental disorder: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 66, 152–161.
24.
EstroffS. E.SwansonJ. W.LachiocotteW. S.SwartzM.BolducM. (1998). Risk considered: Targets of violence in the social networks of people with serious Psychiatric disorders. Social Psychiatry and Psychiatric Epidemiology, 33, S95–S101.
25.
FazelS.GulatiG.LinsellL.GeddesJ. R.GrannM. (2009). Schizophrenia and violence: Systematic review and meta-analysis. PLoS Medicine, 6, 1–15.
26.
FazelS.LichtensteinP.GrannM.GoodwinG. M.LangstromN. (2010). Bipolar disorder and violent crime: New evidence from population-based longitudinal studies and systematic review. Archives of General Psychiatry, 67, 931–938.
27.
FinkelE. J. (2007). Dispositional impelling and inhibiting forces in the perpetration of intimate partner violence. Review of General Psychology, 11, 193–207. doi:10.1037/1089-2680.11.2.193
28.
FinkelE. J. (2013). The I3 model: Metamodel, model, and evidence. Advances in Experimental Social Psychology, 49, 1.
29.
FinkelE. J. (2014). The I3 model: Metatheory, theory, and evidence. Advances in Experimental Social Pyschology, 49, 1–104.
30.
FinkelE. J.DeWallC. N.SlotterE. B.McNultyJ. K.PondR. S.Jr.AtkinsD. C. (2012). Using I3 model to clarify when dispositional aggressiveness predicts intimate partner violence perpetration. Journal of Personality and Social Psychology, 102, 533–549. doi:10.1037/a0025651
31.
FriedmanR. A. (2006). Violence and mental illness—How strong is the link?New England Journal of Medicine, 355, 2064–2066. doi:10.1056/NEJMp068229
32.
FrostL. E.BonnieR. J. (Eds.). (2001). The evolution of mental health law. Washington, DC: American Psychological Association.
33.
GamitoP.OliveiraJ.LopesP.BritoR.MoraisD.SilvaD.. . . DeusA. (2014). Executive functioning in alcoholics following an mHealth cognitive stimulation program: Randomized controlled trial. Journal of Medical Internet Research, 16, 4.
34.
GoldmanH. H. (1982). Mental illness and family burden: A public health perspective. Psychiatric Services, 33, 557–560.
35.
GrantB. F.DawsonD. A.StinsonF. S.ChouP. S.KayW.PickeringR. (2003). The Alcohol Use Disorder and Associated Disabilities Interview Schedule–IV (AUDADIS-IV): Reliability of alcohol consumption, tobacco use, family history of depression and psychiatric diagnostic modules in a general population sample. Drug and Alcohol Dependence, 71, 7–16.
36.
GrantB. F.GoldsteinR. B.SahaT. D.ChouP.JungJ.ZhangH.. . . HasinD. S. (2015). Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry, 72, 757–766.
37.
GrantB. F.HasinD. S.StinsonF. S.DawsonD. A.ChouS. P.RuanW. J.HuangB. (2005). Co-occurrence of 12-month mood and anxiety disorders and personality disorders in the US: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Psychiatric Research, 39, 1–9.
38.
GrantB. F.StinsonF. S.HasinD. S.DawsonD. A.ChouS. P.RuanW. J.HuangB. (2005). Prevalence, correlates, and comorbidity of bipolar I disorder and axis I and II disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 66, 1205–1215.
39.
HasinD.StinsonF. S.OgburnE.GrantB. F. (2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry, 64, 830–842.
40.
HendersonC.ThornicroftG. (2009). Stigma and discrimination in mental illness: Time to change. Lancet, 373, 1928–1930.
41.
HeronK. E.SmythJ. M. (2010). Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. British Journal of Health Psychology, 15, 1–39.
42.
HidayV. A.SwansonJ. W.SwartzM. S.BorumR.WagnerH. R. (2001). Victimization: A link between mental illness and violence?International Journal of Law and Psychiatry, 24, 559–572. doi:10.1016/S0160-2527(01)00091-7
43.
HodginsS. (1996). The major mental disorders: New evidence requires new policy and practice. Canadian Psychology, 37, 95–111.
44.
HodginsS.JansonC.-G. (2002). Criminality and violence among the mentally disordered: The Stockholm Project Metropolitan. New York, NY: Cambridge University Press.
45.
HugueletP.PerroudN. (2010). Is there a link between mental disorder and violence? Reply. Archives of General Psychiatry, 67, 540.
46.
InselT.CuthbertB.GarveyM.HeinssenR.PineD. S.QuinnK.. . . WangP. (2010). Research Domain Criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167, 748–751.
47.
KesslerR. C.ChiuW. T.DemlerO.WaltersE. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.
48.
LiJ. B.NieY. G.BoardleyI. D.DouK.SituQ. M. (2015). When do normative beliefs about aggression predict aggressive behavior? An application of I3 model. Aggressive Behavior, 41, 544–555.
49.
LinasB. S.LatkinC.WestergaardR. P.ChangL. W.BollingerR. C.GenzA.KirkG. D. (2015). Capturing illicit drug use where and when it happens: An ecological momentary assessment of the social, physical and activity environment of using versus craving illicit drugs. Addiction, 110, 315–325.
50.
LinkB.PhelanJ.BresnahanM.StueveA.PescosolidoB. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health, 89, 1328–1333.
51.
LuettgenJ.ChrapkoW. E.ReddonJ. R. (1998). Preventing violent re-offending in not criminally responsible patients: An evaluation of a continuity of treatment program. International Journal of Law and Psychiatry, 21, 89–98.
52.
MacKinnonD. P.FairchildA. J.FritzM. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614.
53.
McNielD. E.BinderR. L.GreenfieldT. K. (1988). Predictors of violence in civilly committed acute psychiatric patients. American Journal of Psychiatry, 145, 965–970.
54.
MiktonC.TonmyrL.ScottD. (2012). Commentary: Exploring the complex links between violence, mental health, and substance abuse—From correlates, through risk factors, towards causal pathways. Advances in Mental Health, 11, 87–94. doi:10.5172/jamh.2012.11.1.87
55.
MonahanJ. (1992). Mental disorder and violent behavior: Perceptions and evidence. American Psychologist, 47, 511–521.
56.
MonahanJ.BonnieR. J.AppelbaumP. S.HydeP. S.SteadmanH. J.SwartzM. S. (2001). Mandated community treatment: Beyond outpatient commitment. Psychiatric Services, 52, 1198–1205.
57.
MonahanJ.SteadmanH. J. (1994). Violence and mental disorder: Developments in risk assessment. Chicago, IL: University of Chicago Press.
58.
MonahanJ.SteadmanH. J.AppelbaumP. S.RobbinsP. C.MulveyE. P.SilverE.. . . GrissoT. (2000). Developing a clinically useful actuarial tool for assessing violence risk. British Journal of Psychiatry, 176, 312–319.
59.
MulveyE. P.LidzC. W. (1993). Measuring patient violence in dangerousness research. Law and Human Behavior, 17, 277–288.
60.
MuthénL. K.MuthénB. O. (2012). Mplus user’s guide (7th ed.). Los Angeles, CA: Muthén & Muthén.
61.
NawkováL.NawkaA.AdámkováT.RukavinaT. V.HolcnerováP.KuzmanM. R.. . . RabochJ. (2012). The picture of mental health/illness in the printed media in three Central European countries. Journal of Health Communication, 17, 22–40. doi:10.1080/10810730.2011.571341
62.
NielssenO.BourgetD.LaajasaloT.LiemM.LabelleA.Häkkänen-NyholmH.. . . LargeM. M. (2011). Homicide of strangers by people with a psychotic illness. Schizophrenia Bulletin, 37, 572–579. doi:10.1093/schbul/sbp112
63.
NovacoR. W. (2003). The Novaco Anger Scale and Provocation Inventory. Los Angeles, CA: Western Psychological Services.
64.
ParabiaghiA.BonettoC.RuggeriM.LasalviaA.LeeseM. (2006). Severe and persistent mental illness: A useful definition for prioritizing community-based mental health service interventions. Social Psychiatry and Psychiatric Epidemiology, 41, 457–463. doi:10.1007/s00127-006-0048-0
65.
PescosolidoB. A.MonahanJ.LinkB. G.StueveA.KikuzawaS. (1999). The public’s view of the competence, dangerousness, and need for legal coercion of persons with mental health problems. American Journal of Public Health, 89, 1339–1345. doi:10.2105/AJPH.89.9.1339
66.
PickardH.FazelS. (2013). Substance abuse as a risk factor for violence in mental illness: Some implications for forensic psychiatric practice and clinical ethics. Current Opinion in Psychiatry, 26, 349–354.
67.
PreacherK. J.HayesA. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.
68.
PulayA. J.DawsonD. A.HasinD. S.GoldsteinR. B.RuanW. J.PickeringR. P.. . . GrantB. F. (2008). Violent behavior and DSM-IV psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69, 12–22. doi:10.4088/JCP.v69n0103
69.
QuanbeckA.ChihM. Y.IshamA.JohnsonR.GustafsonD. (2014). Mobile delivery of treatment for alcohol use disorders: A review of the literature. Alcohol Research: Current Reviews, 36, 111–122.
70.
ReaguS.JonesR.KumariV.TaylorP. J. (2013). Angry affect and violence in the context of a psychotic illness: A systematic review and meta-analysis of the literature. Schizophrenia Research, 146, 46–52. doi:10.1016/j.schres.2013.01.024
71.
Research Triangle Institute. (2001). SUDAAN user’s manual, release 8.0. Research Triangle Park, NC: Research Triangle Institute.
72.
RobillardJ. M.IllesJ. (2011). A link in the ink: Mental illness and criminal responsibility in the press. Journal of Ethics in Mental Health, 6(suppl.), 1–7.
73.
RuggeriM.LeeseM.ThornicroftG.BisoffiG.TansellaM. (2000). Definition and prevalence of severe and persistent mental illness. British Journal of Psychiatry, 177, 149–155. doi:10.1192/bjp.177.2.149
74.
SadehN.BinderR. L.McNielD. E. (2013). Recent victimization increases risk for violence in justice-involved persons with mental illness. Law and Human Behavior, 38, 119–125. doi:10.1037/lhb0000043
75.
SalesB. D.ShumanD. W. (Eds.). (1996). Law, mental health, and mental disorder. Belmont, CA: Brooks/Cole.
76.
SchinnarA. P.RothbardA. B.KanterR.JungY. S. (1990). An empirical literature review of definitions of severe and persistent mental illness. American Journal of Psychiatry, 147, 1602–1608.
77.
SchwartzJ. A.BeaverK. M.BarnesJ. C. (2015). The association between mental health and violence among a nationally representative sample of college students from the United States. PLOS ONE, 10, e0138914.
78.
ShiffmanS.StoneA. A.HuffordM. R. (2008). Ecological momentary assessment. Annual Review of Clinical Psychology, 4, 1–32.
79.
SilverE. (2006). Understanding the relationship between mental disorder and violence: The need for a criminological perspective. Law and Human Behavior, 30, 685–706. doi:10.1007/s10979-006-9018-z
80.
SilverE.ArseneaultL.LangleyJ.CaspiA.MoffittT. E. (2005). Mental disorder and violent victimization in a total birth cohort. American Journal of Public Health, 95, 2015–2021.
81.
SkeemJ.KennealyP.MonahanJ.PetersonJ.AppelbaumP. (2015). Psychosis uncommonly and inconsistently precedes violence among high-risk individuals. Clinical Psychological Science. Advance online publication. doi:10.1177/2167702615575879
82.
SkeemJ. L.MonahanJ.MulveyE. (2002). Psychopathy, treatment involvement, and subsequent violence among civil psychiatric patients. Law and Human Behavior, 26, 577–603.
83.
SlotterE. B.FinkelE. J. (2011). I3 model: Instigating, dispositional impelling, and inhibiting factors in aggression. In ShaverP. R.MikulincerM. (Eds.), Human aggression and violence: Causes, manifestations, and consequences (pp. 35–52). Washington, DC: American Psychological Association.
84.
SlotterE. B.FinkelE. J.DeWallC. N.PondR. S.Jr.LambertN. M.BodenhausenG. V.FinchamF. D. (2012). Putting the brakes on aggression toward a romantic partner: The inhibitory influence of relationship commitment. Journal of Personality and Social Psychology, 102, 291–305. doi:10.1037/a0024915
85.
SteadmanH. J.MulveyE. P.MonahanJ.RobbinsP. C.AppelbaumP. S.GrissoT.. . . SilverE. (1998). Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighbourhoods. Archives of General Psychiatry, 55, 393–401.
86.
StopczynskiA.StahlhutC.PetersenM. K.LarsenJ. E.JensenC. F.IvanovaM. G.. . . HansenL. K. (2014). Smartphones as pocketable labs: Visions for mobile brain imaging and neurofeedback. International Journal of Psychophysiology, 91, 54–66.
87.
SwansonJ. (2013). Mental illness and new gun law reforms: The promise and peril of crisis-driven policy. JAMA, 309, 1233–1234. doi:10.1001/jama.2013.1113
88.
SwansonJ. W.HolzerC. E.GanjuV. K.JonoR. T. (1990). Violence and psychiatric disorder in the community: Evidence from the Epidemiologic Catchment Area surveys. Hospital and Community Psychiatry, 41, 761–770.
89.
SwansonJ. W.SwartzM. S.ElbogenE. B. (2004). Effectiveness of atypical antipsychotic medications in reducing violent behavior among persons with schizophrenia in community-based treatment. Schizophrenia Bulletin, 30, 3–20.
90.
SwansonJ. W.SwartzM. S.Van DornR. A.ElbogenE. B.WagnerH. R.RosenheckR. A.. . . LiebermanJ. A. (2006). A national study of violent behavior in persons with schizophrenia. Archives of General Psychiatry, 63, 490–499. doi:10.1001/archpsyc.63.5.490
91.
SwansonJ. W.Van DornR. A.MonahanJ.SwartzM. S. (2006). Violence and leveraged community treatment for persons with mental disorders. American Journal of Psychiatry, 163, 1404–1411.
92.
TorreyE. (2002). Stigma and violence. Psychiatric Services, 53, 1179.
93.
UllrichS.CoidJ. (2011). Protective factors for violence among released prisoners: Effects over time and interactions with static risk. Journal of Consulting and Clinical Psychology, 79, 381–390.
94.
Van DornR.VolavkaJ.JohnsonN. (2012). Mental disorder and violence: Is there a relationship beyond substance use?Social Psychiatry and Psychiatric Epidemiology, 47, 487–503. doi:10.1007/s00127-011-0356-x
95.
VolavkaJ.SwansonJ. W. (2010). Violent behavior in mental illness: The role of substance abuse. JAMA, 304, 563–564. doi:10.1001/jama.2010.1097
96.
WatkinsL. E.DiLilloD.MaldonadoR. C. (2015). The interactive effects of emotion regulation and alcohol intoxication on lab-based intimate partner aggression. Psychology of Addictive Behaviors, 29, 653–663.
97.
WeichS.LewisG. (1998). Poverty, unemployment, and common mental disorders: Population based cohort study. British Medical Journal, 317, 115–119.
98.
YangS.MulveyE. P. (2012). Violence risk: Re-defining variables from the first-person perspective. Aggression and Violent Behavior, 17, 198–207. doi:10.1016/j.avb.2012.02.001
99.
YangS.MulveyE. P.LoughranT. A.HanusaB. H. (2012). Psychiatric symptoms and alcohol use in community violence by persons with a psychotic disorder or depression. Psychiatric Services, 63, 262–269. doi:10.1176/appi.ps.201100354
