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Violence and severe mental illness: the effects of substance abuse and nonadherence to medication.

Publication ,  Journal Article
Swartz, MS; Swanson, JW; Hiday, VA; Borum, R; Wagner, HR; Burns, BJ
Published in: Am J Psychiatry
February 1998

OBJECTIVE: Violent behavior among individuals with severe mental illness has become an important focus in community-based care. This study examines the joint effect of substance abuse and medication noncompliance on the greater risk of serious violence among persons with severe mental illness. METHOD: Involuntarily admitted inpatients with severe mental illness who were awaiting a period of outpatient commitment were enrolled in a longitudinal outcome study. At baseline, 331 subjects underwent an extensive face-to-face interview. Complementary data were gathered by a review of hospital records and a telephone interview with a family member or other informant. These data included subjects' sociodemographic characteristics, illness history, clinical status, medication adherence, substance abuse, insight into illness, and violent behavior during the 4 months that preceded hospitalization. Associations between serious violent acts and a range of individual characteristics and problems were analyzed by using multivariable logistic regression. RESULTS: The combination of medication noncompliance and alcohol or substance abuse problems was significantly associated with serious violent acts in the community, after sociodemographic and clinical characteristics were controlled. CONCLUSIONS: Alcohol or other drug abuse problems combined with poor adherence to medication may signal a higher risk of violent behavior among persons with severe mental illness. Reduction of such risk may require carefully targeted community interventions, including integrated mental health and substance abuse treatment.

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Published In

Am J Psychiatry

DOI

ISSN

0002-953X

Publication Date

February 1998

Volume

155

Issue

2

Start / End Page

226 / 231

Location

United States

Related Subject Headings

  • Violence
  • Treatment Refusal
  • Substance-Related Disorders
  • Severity of Illness Index
  • Risk Factors
  • Psychiatry
  • Outcome Assessment, Health Care
  • Multivariate Analysis
  • Middle Aged
  • Mental Disorders
 

Citation

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Chicago
ICMJE
MLA
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Swartz, M. S., Swanson, J. W., Hiday, V. A., Borum, R., Wagner, H. R., & Burns, B. J. (1998). Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. Am J Psychiatry, 155(2), 226–231. https://doi.org/10.1176/ajp.155.2.226
Swartz, M. S., J. W. Swanson, V. A. Hiday, R. Borum, H. R. Wagner, and B. J. Burns. “Violence and severe mental illness: the effects of substance abuse and nonadherence to medication.Am J Psychiatry 155, no. 2 (February 1998): 226–31. https://doi.org/10.1176/ajp.155.2.226.
Swartz MS, Swanson JW, Hiday VA, Borum R, Wagner HR, Burns BJ. Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. Am J Psychiatry. 1998 Feb;155(2):226–31.
Swartz, M. S., et al. “Violence and severe mental illness: the effects of substance abuse and nonadherence to medication.Am J Psychiatry, vol. 155, no. 2, Feb. 1998, pp. 226–31. Pubmed, doi:10.1176/ajp.155.2.226.
Swartz MS, Swanson JW, Hiday VA, Borum R, Wagner HR, Burns BJ. Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. Am J Psychiatry. 1998 Feb;155(2):226–231.
Journal cover image

Published In

Am J Psychiatry

DOI

ISSN

0002-953X

Publication Date

February 1998

Volume

155

Issue

2

Start / End Page

226 / 231

Location

United States

Related Subject Headings

  • Violence
  • Treatment Refusal
  • Substance-Related Disorders
  • Severity of Illness Index
  • Risk Factors
  • Psychiatry
  • Outcome Assessment, Health Care
  • Multivariate Analysis
  • Middle Aged
  • Mental Disorders