Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, Oxfordshire, United Kingdom.
PLoS One. 2013;8(2):e55942. doi: 10.1371/journal.pone.0055942. Epub 2013 Feb 13.
Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.
We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.
There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.
Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.
先前关于精神分裂症患者暴力风险和保护因素的综述得出了相互矛盾的结果。因此，有必要明确精神分裂症患者暴力结局的风险和保护因素的关联方向和强度。
我们使用 6 个电子数据库（CINAHL、EBSCO、EMBASE、全球健康、PsycINFO、PUBMED）和 Google Scholar 进行了系统评价和荟萃分析。我们确定了使用 DSM 或 ICD 标准诊断为精神分裂症和其他精神病的成年人的暴力相关因素的研究。我们考虑了非英语语言的研究和论文。如果有三篇或三篇以上的原始研究报告了风险和保护因素，则对其进行荟萃分析。荟萃回归分析了异质性的来源。采用一种新的荟萃流行病学方法将相似的风险因素分为 10 个领域之一。然后进行亚组分析，以调查针对报告严重暴力（而非攻击性或敌意）的研究和针对住院（而非门诊）环境的研究，风险领域是否存在差异。
共有 110 项符合条件的研究报告了 45533 名个体，其中 8439 名（18.5%）是暴力者。共有 39995 名（87.8%）被诊断为精神分裂症，209 名（0.4%）被诊断为双相情感障碍，5329 名（11.8%）被诊断为其他精神病。动态（或可改变）风险因素包括敌意行为、最近药物滥用、心理治疗不依从（p 值均<0.001）、冲动控制评分较高、近期物质滥用、近期酒精滥用（p 值均<0.01）和药物不依从（p 值<0.05）。我们还检查了一些静态因素，其中最强的是犯罪史因素。当将结果限制为严重暴力时，这些关联并没有实质性变化。在研究住院暴力的研究中，关联的强度不同，但方向相同。
某些动态风险因素与精神分裂症患者暴力风险增加密切相关，其在风险评估和管理中的作用值得进一步研究。
