Link B G, Stueve A, Phelan J
Epidemiology of Mental Disorders, New York, NY 10032, USA.
Soc Psychiatry Psychiatr Epidemiol. 1998 Dec;33 Suppl 1:S55-60. doi: 10.1007/s001270050210.
Evidence for an association between mental illness and violence has grown in recent years, leading many to ask why such an association exists. One hypothesis links elevated rates of violence among people with mental illness to a small set of psychotic symptoms--so called threat/control-override (TCO) symptoms. Several studies have supported this hypothesis, but none has examined which of the components, threat or control-override--if either--predominates in explaining violence. To explore this issue we used data from a two-stage epidemiological study (n = 2741) conducted in Israel. Data on TCO symptoms were collected using two methods--fixed-format self-report questions from the first stage and psychiatrists' ratings based on interviews using the Schedule for Affective Disorders and Schizophrenia (SADS) from the second. Results show that both a measure of threat and a measure of control-override are independently associated with violent behaviors. Results also show that neither method--neither fixed-format questions nor psychiatrist rating--predominates in explaining violence. In sum, these results indicate that both the threat and the control-override components of the TCO concept are useful in predicting violent behaviors and that a better measurement of the TCO concept is achieved using a multimethod approach.
近年来，关于精神疾病与暴力行为之间存在关联的证据越来越多，这使得许多人不禁要问为何会存在这样的关联。一种假说将患有精神疾病者的暴力行为发生率升高与一小部分精神病性症状联系起来，即所谓的威胁/控制主导（TCO）症状。多项研究支持了这一假说，但尚无研究探讨在解释暴力行为时，威胁或控制主导这两个组成部分（若有其一占主导的话）中哪一个起主要作用。为探究这一问题，我们使用了以色列一项两阶段流行病学研究（n = 2741）的数据。关于TCO症状的数据通过两种方法收集——第一阶段采用固定格式的自我报告问题，第二阶段采用基于使用情感障碍和精神分裂症量表（SADS）进行访谈的精神科医生评分。结果显示，威胁指标和控制主导指标均与暴力行为独立相关。结果还显示，在解释暴力行为方面，两种方法（固定格式问题和精神科医生评分）均不起主要作用。总之，这些结果表明，TCO概念中的威胁和控制主导两个组成部分在预测暴力行为方面均有用，并且使用多方法途径能更好地衡量TCO概念。
