Department of Psychosis Studies,King's College London, Institute of Psychiatry, Psychology and Neuroscience,London, SE5 8AF,UK.
School of Psychiatry, University of New South Wales,Australia.
Epidemiol Psychiatr Sci. 2019 Apr;28(2):168-178. doi: 10.1017/S2045796018000537. Epub 2018 Sep 10.
AimsAlthough violence is a vital public health problem, no prospective studies have tested for subsequent vulnerability to violence, as a victim or witness, in members of the general population with a range of psychiatric symptoms, or evaluated the importance of higher symptom burden on this vulnerability.
We used successive waves of a household survey of Southeast London, taken 2 years apart, to test if association exists between psychiatric symptoms (symptoms of psychosis, common mental disorders, post-traumatic stress disorder and personality disorder) and later victimisation, in the form of either witnessing violence or being physically victimised, in weighted logistic regression models. Statistical adjustment was made for prior violence exposure, sociodemographic confounders, substance/alcohol use and violence perpetration. Sensitivity analyses were stratified by violence perpetration, sex and history of mental health service use.
After adjustments, psychiatric symptoms were prospectively associated with reporting any subsequent victimisation (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.25-2.83), a two times greater odds of reporting witnessed violence (OR 2.24, 95% CI 1.33-3.76) and reporting physical victimisation (OR 1.76, 95% CI 1.01-3.06). One more symptom endorsed was accompanied by 47% greater odds of subsequent victimisation (OR 1.47, 95% CI 1.16-1.86). In stratified analyses, statistical associations remained evident in non-perpetrators, and among those without a history of using mental health services, and were similar in magnitude in both men and women.
Psychiatric symptoms increase liability to victimisation compared with those without psychiatric symptoms, independently of a prior history of violence exposure and irrespective of whether they themselves are perpetrators of violence. Clinicians should be mindful of the impact of psychiatric symptoms on vulnerability to victimisation, including among those with common psychiatric symptoms and among those who are not considered at risk of perpetrating violence.
尽管暴力是一个严重的公共卫生问题，但尚无前瞻性研究测试过一般人群中患有各种精神症状的个体随后是否容易成为暴力受害者或目击证人，也没有评估更高的症状负担对这种易感性的重要性。
我们使用伦敦东南部的家庭调查的连续波，每两年进行一次，以测试精神症状（精神病症状、常见精神障碍、创伤后应激障碍和人格障碍）与随后的受害情况（以目击暴力或身体受害的形式）之间是否存在关联，使用加权逻辑回归模型进行分析。在进行统计调整时，考虑了先前的暴力暴露、社会人口学混杂因素、物质/酒精使用和暴力行为。敏感性分析按暴力行为、性别和精神卫生服务使用史进行分层。
调整后，精神症状与报告任何后续受害情况具有前瞻性相关性（比值比 1.88，95%置信区间 1.25-2.83），报告目击暴力的几率增加两倍（比值比 2.24，95%置信区间 1.33-3.76），报告身体受害的几率增加（比值比 1.76，95%置信区间 1.01-3.06）。多一个症状与后续受害的几率增加 47%相关（比值比 1.47，95%置信区间 1.16-1.86）。在分层分析中，在非施害者中以及在没有使用精神卫生服务史的人群中，统计关联仍然明显，且在男性和女性中的程度相似。
与没有精神症状的个体相比，精神症状会增加受害的可能性，这种关联独立于先前的暴力暴露史，且无论他们本身是否有暴力行为。临床医生应注意精神症状对受害易感性的影响，包括常见精神症状的人群和那些不被认为有暴力行为风险的人群。
