Wallace Cameron, Mullen Paul E, Burgess Philip
Victorian Institute of Forensic Mental Health, Fairfield, and Department of Psychological Medicine, Monash University, Victoria, Australia.
Am J Psychiatry. 2004 Apr;161(4):716-27. doi: 10.1176/appi.ajp.161.4.716.
This study examined the pattern of criminal convictions in persons with schizophrenia over a 25-year period marked by both radical deinstitutionalization and increasing rates of substance abuse problems among persons with schizophrenia in the community.
The criminal records of 2,861 patients (1,689 of whom were male) who had a first admission for schizophrenia in the Australian state of Victoria in 1975, 1980, 1985, 1990, and 1995 were compared for the period from 1975 to 2000 with those of an equal number of community comparison subjects matched for age, gender, and neighborhood of residence.
Relative to the comparison subjects, the patients with schizophrenia accumulated a greater total number of criminal convictions (8,791 versus 1,119) and were significantly more likely to have been convicted of a criminal offense (21.6% versus 7.8%) and of an offense involving violence (8.2% versus 1.8%). The proportion of patients who had a conviction increased from 14.8% of the 1975 cohort to 25.0% of the 1995 cohort, but a proportionately similar increase from 5.1% to 9.6% occurred among the comparison subjects. Rates of known substance abuse problems among the schizophrenia patients increased from 8.3% in 1975 to 26.1% in 1995. Significantly higher rates of criminal conviction were found for patients with substances abuse problems than for those without substance abuse problems (68.1% versus 11.7%).
A significant association was demonstrated between having schizophrenia and a higher rate of criminal convictions, particularly for violent offenses. However, the rate of increase in the frequency of convictions over the 25-year study period was similar among schizophrenia patients and comparison subjects, despite a change from predominantly institutional to community care and a dramatic escalation in the frequency of substance abuse problems among persons with schizophrenia. The results do not support theories that attempt to explain the mediation of offending behaviors in schizophrenia by single factors, such as substance abuse, active symptoms, or characteristics of systems of care, but suggest that offending reflects a range of factors that are operative before, during, and after periods of active illness.
本研究调查了25年间精神分裂症患者的刑事定罪模式，这一时期的特点是大规模去机构化，以及社区中精神分裂症患者药物滥用问题发生率不断上升。
比较了1975年、1980年、1985年、1990年和1995年在澳大利亚维多利亚州首次因精神分裂症入院的2861名患者（其中1689名男性）在1975年至2000年期间的犯罪记录，与年龄、性别和居住社区相匹配的同等数量的社区对照对象的犯罪记录。
与对照对象相比，精神分裂症患者累积的刑事定罪总数更多（8791起对1119起），并且被判定有罪的可能性显著更高（21.6%对7.8%），以及被判定犯有暴力罪行的可能性也显著更高（8.2%对1.8%）。有定罪记录的患者比例从1975年队列中的14.8%增加到1995年队列中的25.0%，但对照对象中也有类似比例的增加，从5.1%增加到9.6%。精神分裂症患者中已知药物滥用问题的发生率从1975年的8.3%增加到1995年的26.1%。有药物滥用问题的患者的刑事定罪率显著高于没有药物滥用问题的患者（68.1%对11.7%）。
研究表明精神分裂症与较高的刑事定罪率之间存在显著关联，尤其是暴力犯罪。然而，在25年的研究期间，尽管从主要的机构护理转变为社区护理，且精神分裂症患者药物滥用问题的发生率急剧上升，但精神分裂症患者和对照对象的定罪频率增加率相似。结果不支持试图用单一因素（如药物滥用、活跃症状或护理系统特征）来解释精神分裂症中犯罪行为调解的理论，而是表明犯罪反映了在活跃疾病期之前、期间和之后起作用的一系列因素。
