Arboleda-Flórez J, Holley H, Crisanti A
Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
Soc Psychiatry Psychiatr Epidemiol. 1998 Dec;33 Suppl 1:S38-46. doi: 10.1007/s001270050208.
The stigma associated with mental illness is a major concern for patients, families, and providers of health services. One reason for the stigmatization of the mentally ill is the public perception that they are violent and dangerous. Although, traditionally, mental health advocates have argued against this public belief, a recent body of research evidence suggests that patients who suffer from serious mental conditions are more prone to violent behaviour than persons who are not mentally ill. It is a point of contention, however, whether the relationship between mental illness and violence is only one of association, or one of causality; that mental illness causes violence. A proven causal association between mental illness and violence will have major consequences for the mentally ill and major implications for caregivers, communities, and legislators. This paper outlines the key methodological barriers precluding casual inferences at this time. The authors suggest that a casual inference about mental illness and violence may yet be hasty. Because a premature statement advocating a causal relationship between mental illness and violence could increase stigma and have devastating effects on the mentally ill the authors urge researchers to consider the damage that may be produced as a result of poorly substantiated causal inferences.
与精神疾病相关的污名化是患者、家庭和医疗服务提供者主要关注的问题。对精神疾病患者污名化的一个原因是公众认为他们具有暴力倾向且很危险。尽管传统上，心理健康倡导者一直反对这种公众观念，但最近一系列研究证据表明，患有严重精神疾病的患者比没有精神疾病的人更容易出现暴力行为。然而，精神疾病与暴力之间的关系究竟只是一种关联，还是一种因果关系（即精神疾病导致暴力），这是一个有争议的问题。精神疾病与暴力之间已被证实的因果关联将对精神疾病患者产生重大影响，并对护理人员、社区和立法者具有重大意义。本文概述了目前妨碍进行因果推断的关键方法障碍。作者们认为，此时对精神疾病与暴力之间进行因果推断可能为时过早。由于过早主张精神疾病与暴力之间存在因果关系的说法可能会增加污名化，并对精神疾病患者产生毁灭性影响，因此作者们敦促研究人员考虑因缺乏充分依据的因果推断可能产生的危害。
