Wessely S C, Castle D, Douglas A J, Taylor P J
Department of Psychological Medicine, Institute of Psychiatry, London.
Psychol Med. 1994 May;24(2):483-502. doi: 10.1017/s0033291700027458.
We present a population-based, longitudinal study of all incident cases (N = 538) of schizophrenia in the London Borough of Camberwell between 1964 and 1984. Cases were selected from the Camberwell Cumulative Psychiatric Case Register. Case-notes were obtained, and further classified using a computerized operational check list for rating psychotic illness. Cases are not restricted to hospital discharges, as in previous studies, and account is taken of time at liberty to offend. In order to test the hypothesis that schizophrenia makes an independent contribution to criminality over other mental disorders, controls were chosen to be representative of nonschizophrenic mental disorders matched for age, sex and period. The rate of conviction is increased in women with schizophrenia compared to other mental disorders for most offence categories (rate ratio = 3.3). In men overall rates do not differ (rate ratio = 1.03), although there is an interaction between gender, schizophrenia and ethnicity, with young black men with schizophrenia being most at risk. The rate ratio for violent offences in men with schizophrenia is 3.8, confirming recent studies from Sweden. Subjects with schizophrenia were more likely to acquire any criminal record than those with other mental disorders. The rate of lifetime conviction was greater in those with schizophrenia than either a sample of working-class boys from the same area followed by Farrington & West, or National data. The risk of first conviction is increased by schizophrenia, unemployment, ethnic group, substance abuse and low social class, and decreased by being employed, married, female and older age of onset. Adjustment using survival analysis showed that schizophrenia made a small independent contribution to the risk of acquiring a criminal record (hazard ratio = 1.4) but gender, substance abuse, ethnicity and age of onset were more substantial. Previous criminality was the strongest independent association of post-illness conviction, with schizophrenia only a trend. Although subjects with schizophrenia were more likely to acquire a criminal record, criminal careers began later and were shorter than those of the controls. The risk of criminality increased throughout the study period, but suggestions of a specific increase in those with schizophrenia as a result of changes in community care were not confirmed. These results confirm that women with schizophrenia are at increased risk of acquiring a criminal record, but the effect in men is for violent convictions only. The strongest associations of criminal conviction remain those recognized in non-schizophrenic subjects.
我们开展了一项基于人群的纵向研究，研究对象为1964年至1984年间伦敦坎伯韦尔区所有新发精神分裂症病例（N = 538）。病例从坎伯韦尔累积精神病病例登记册中选取。获取了病例记录，并使用计算机化操作检查表对精神病性疾病进行进一步分类。与以往研究不同，病例不限于出院患者，且考虑了自由犯罪时间。为了检验精神分裂症相对于其他精神障碍对犯罪有独立影响这一假设，选择了年龄、性别和时期匹配的非精神分裂症性精神障碍患者作为对照。与其他精神障碍相比，大多数犯罪类别中，精神分裂症女性的定罪率有所增加（率比 = 3.3）。总体而言，男性的定罪率没有差异（率比 = 1.03），尽管性别、精神分裂症和种族之间存在相互作用，患有精神分裂症的年轻黑人男性风险最高。患有精神分裂症男性的暴力犯罪率比为3.8，证实了瑞典最近的研究结果。与其他精神障碍患者相比，精神分裂症患者更有可能有犯罪记录。精神分裂症患者的终身定罪率高于同一地区由法林顿和韦斯特跟踪研究的工人阶级男孩样本，也高于国家数据。首次定罪的风险因精神分裂症、失业、种族、药物滥用和低社会阶层而增加，因就业、已婚、女性和发病年龄较大而降低。使用生存分析进行调整后发现，精神分裂症对获得犯罪记录的风险有较小的独立影响（风险比 = 1.4），但性别、药物滥用、种族和发病年龄的影响更大。既往犯罪是病后定罪最强的独立关联因素，精神分裂症只是一种趋势。尽管精神分裂症患者更有可能有犯罪记录，但犯罪生涯开始得较晚，且比对照组短。在整个研究期间，犯罪风险增加，但社区护理变化导致精神分裂症患者犯罪率特别增加的说法未得到证实。这些结果证实，患有精神分裂症的女性获得犯罪记录的风险增加，但对男性的影响仅体现在暴力定罪方面。犯罪定罪最强的关联因素仍然是在非精神分裂症患者中所确认的那些因素。
