Domestic and sexual violence against patients with severe mental illness.

H Khalifeh,L M Howard,P Moran,J Hogg,K Dean,S Johnson,R Borschmann,C Hart,D Osborn

doi:10.1017/s0033291714001962

H Khalifeh, L M Howard + Show 7 more

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https://doi.org/10.1017/s0033291714001962

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Abstract

Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population. Three hundred and three randomly recruited psychiatric patients, in contact with community services for ⩾ 1 year, were interviewed using the British Crime Survey domestic/sexual violence questionnaire. Prevalence and correlates of violence in this sample were compared with those from 22 606 general population controls participating in the contemporaneous 2011/12 national crime survey. Past-year domestic violence was reported by 27% v. 9% of SMI and control women, respectively [odds ratio (OR) adjusted for socio-demographics, aOR 2.7, 95% confidence interval (CI) 1.7-4.0], and by 13% v. 5% of SMI and control men, respectively (aOR 1.6, 95% CI 1.0-2.8). Past-year sexual violence was reported by 10% v. 2.0% of SMI and control women respectively (aOR 2.9, 95% CI 1.4-5.8). Family (non-partner) violence comprised a greater proportion of overall domestic violence among SMI than control victims (63% v. 35%, p < 0.01). Adulthood serious sexual assault led to attempted suicide more often among SMI than control female victims (53% v. 3.4%, p < 0.001). Compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.

Highlights

Past research on violence and mental illness has focused on violence perpetrated by patients with psychotic disorders (Choe et al 2008; Maniglio, 2009)
Note that all reported ‘adjusted odds ratios’ below refer to ORs adjusted for socio-demographics
We comment separately on ORs adjusted for substance misuse

Summary

Introduction

Past research on violence and mental illness has focused on violence perpetrated by patients with psychotic disorders (Choe et al 2008; Maniglio, 2009). Patients with SMI experience high rates of domestic and sexual violence, but the prevalence and health burden of these experiences compared with non-psychiatric controls is unknown (Hughes et al 2012; Trevillion et al 2012; Oram et al 2013). In a recent systematic review of 42 studies, the median prevalence of adulthood domestic violence among female psychiatric patients was 30%, but no studies included control populations and there was little evidence on male victims, emotional abuse, and violence perpetrated by family members (other than partners) (Oram et al 2013). Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population

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