School of Psychology and Psychiatry, Monash University, 505 Hoddle Street, Clifton Hill Melbourne, 3068, Australia.
BMC Psychiatry. 2013 Feb 20;13:66. doi: 10.1186/1471-244X-13-66.
Despite high rates of self-reported crime victimisation, no study to date has compared official victimisation records of people with severe mental illness with a random community sample. Accordingly, this study sought to determine whether persons with schizophrenia-spectrum disorders have higher rates of recorded victimisation than the general population, and to explore whether there have been changes in rates of recorded victimisation over a period of deinstitutionalisation.
The schizophrenia-spectrum cases were drawn from a state-wide public mental health register, comprising all persons first diagnosed with a schizophrenic illness in five year cohorts between 1975 - 2005. The criminal histories of 4,168 persons diagnosed with schizophrenic-spectrum disorders were compared to those of a randomly selected community sample of 4,641 individuals.
Compared to community controls, patients with schizophrenia-spectrum disorders were significantly more likely to have a record of violent (10.1% vs. 6.6%, odds ratio 1.4) and sexually violent victimisation (1.7% vs. 0.3%, odds ratio 2.77), but less likely to have an official record of victimisation overall (28.7% vs. 39.1%, odds ratio 0.5). Over the approximate period of deinstitutionalisation, the rate of recorded victimisation has more than doubled in schizophrenia-spectrum patients, but stayed relatively constant in the general community.
People with schizophrenic-spectrum disorders are particularly vulnerable to violent crime victimisation; although co-morbid substance misuse and criminality both heighten the chances of victimisation, they cannot fully account for the increased rates. Deinstitutionalisation may have, in part, contributed to an unintended consequence of increasing rates of victimisation amongst the seriously mentally ill.
尽管有很高的自我报告犯罪受害率,但迄今为止尚无研究将严重精神疾病患者的官方受害记录与随机社区样本进行比较。因此,本研究旨在确定精神分裂症谱系障碍患者的记录受害率是否高于一般人群,并探讨在去机构化期间记录受害率是否发生变化。
精神分裂症谱系病例来自全州公共精神卫生登记册,包括在 1975 年至 2005 年的五年队列中首次被诊断为精神分裂症的所有人。对 4168 名被诊断为精神分裂症谱系障碍的患者的犯罪史与 4641 名随机选择的社区样本进行了比较。
与社区对照相比,精神分裂症谱系障碍患者有暴力记录的可能性明显更高(10.1%对 6.6%,优势比 1.4)和性暴力受害的可能性更高(1.7%对 0.3%,优势比 2.77),但总体上有官方受害记录的可能性较小(28.7%对 39.1%,优势比 0.5)。在大约去机构化的时期内,精神分裂症谱系患者的记录受害率增加了一倍多,但在一般社区中相对保持不变。
精神分裂症谱系障碍患者特别容易受到暴力犯罪的侵害;尽管合并的物质滥用和犯罪会增加受害的可能性,但它们不能完全解释增加的比率。去机构化可能在某种程度上导致严重精神疾病患者受害率的意外增加。