Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
PLoS One. 2019 Apr 16;14(4):e0214924. doi: 10.1371/journal.pone.0214924. eCollection 2019.
The management of mentally ill offenders in the community is one of the great challenges imposed on community psychiatry.
The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders.
This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients' profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment.
The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls.
Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services.
精神障碍罪犯的社区管理是社区精神病学面临的重大挑战之一。
本研究旨在分析社会人口学、临床和心理社会因素与严重精神障碍门诊患者暴力行为之间的关系。
这是一项前瞻性队列研究，采用基线横断面设计对患者的特征进行详细分析，然后采用纵向设计在 1 年的随访期间测量攻击和暴力行为。将有或没有暴力史的严重精神障碍患者纳入意大利四个心理健康部门，并进行全面的多维评估。
样本包括 247 名门诊患者，共 126 例病例和 121 例对照。与对照组相比，有暴力史的患者有更高的终生家庭暴力发生率、更高的终生药物滥用倾向和更多的强制入院。在 1 年的随访期间，每两周进行一次监测，结果显示两组在攻击和暴力行为发生率方面存在统计学显著差异。言语攻击与攻击物体和身体攻击显著相关。此外，有暴力史的门诊患者的 MOAS 评分明显高于本项目第一波评估的有暴力史的住院患者和所有对照者。
有暴力史的患者具有特定的特征，并且在 1 年的观察期内发生额外的社区暴力的几率更高。我们的研究结果可能有助于临床医生在门诊心理健康服务中实施标准化的患者评估和暴力监测方法，并促使不同社区服务之间的合作得到改善。
