Steadman H J, Mulvey E P, Monahan J, Robbins P C, Appelbaum P S, Grisso T, Roth L H, Silver E
Policy Research Associates Inc, Delmar, NY 12054, USA.
Arch Gen Psychiatry. 1998 May;55(5):393-401. doi: 10.1001/archpsyc.55.5.393.
The public perception that mental disorder is strongly associated with violence drives both legal policy (eg, civil commitment) and social practice (eg, stigma) toward people with mental disorders. This study describes and characterizes the prevalence of community violence in a sample of people discharged from acute psychiatric facilities at 3 sites. At one site, a comparison group of other residents in the same neighborhoods was also assessed.
We enrolled 1136 male and female patients with mental disorders between the ages of 18 and 40 years in a study that monitored violence to others every 10 weeks during their first year after discharge from the hospital. Patient self-reports were augmented by reports from collateral informants and by police and hospital records. The comparison group consisted of 519 people living in the neighborhoods in which the patients resided after hospital discharge. They were interviewed once about violence in the past 10 weeks.
There was no significant difference between the prevalence of violence by patients without symptoms of substance abuse and the prevalence of violence by others living in the same neighborhoods who were also without symptoms of substance abuse. Substance abuse symptoms significantly raised the rate of violence in both the patient and the comparison groups, and a higher portion of patients than of others in their neighborhoods reported symptoms of substance abuse. Violence in both patient and comparison groups was most frequently targeted at family members and friends, and most often took place at home.
"Discharged mental patients" do not form a homogeneous group in relation to violence in the community. The prevalence of community violence by people discharged from acute psychiatric facilities varies considerably according to diagnosis and, particularly, co-occurring substance abuse diagnosis or symptoms.
公众认为精神障碍与暴力密切相关，这推动了针对精神障碍患者的法律政策（如民事收容）和社会实践（如污名化）。本研究描述并刻画了来自3个地点急性精神病设施出院患者样本中的社区暴力患病率。在其中一个地点，还对同一社区的其他居民组成的对照组进行了评估。
我们招募了1136名年龄在18至40岁之间的患有精神障碍的男性和女性患者，进行一项研究，在他们出院后的第一年里每10周监测一次对他人的暴力行为。患者的自我报告通过旁证信息提供者的报告以及警方和医院记录得到补充。对照组由519名居住在患者出院后所在社区的人组成。他们接受了一次关于过去10周内暴力行为的访谈。
没有物质滥用症状的患者的暴力患病率与居住在同一社区且也没有物质滥用症状的其他人的暴力患病率之间没有显著差异。物质滥用症状显著提高了患者组和对照组的暴力发生率，并且患者中报告有物质滥用症状的比例高于其所在社区的其他人。患者组和对照组的暴力行为最常针对家庭成员和朋友，且大多发生在家中。
就社区暴力而言，“出院精神患者”并非一个同质化群体。从急性精神病设施出院的人在社区中的暴力患病率因诊断情况，特别是同时存在的物质滥用诊断或症状而有很大差异。
