THE CRIMINAL CAREERS OF INCIDENT CASES OF SCHIZOPHRENIA

We present a population-based, longitudinal study of all incident case s (N = 538) of schizophrenia in the London Borough of Camberwell betwe en 1964 and 1984. Cases were selected from the Camberwell Cumulative P sychiatric Case Register, Case-notes were obtained, and further classi fied using a computerized operational check list for rating psychotic illness. Cases are not restricted to hospital discharges, as in previo us studies, and account is taken of time at liberty to offend. In orde r to test the hypothesis that schizophrenia makes an independent contr ibution to criminality over other mental disorders, controls were chos en to be representative of nonschizophrenic mental disorders matched f or age, sex and period. The rate of conviction is increased in women w ith schizophrenia compared to other mental disorders for most offence categories (rate ratio = 3.3). In men overall rates do not differ (rat e ratio = 1.03), although there is an interaction between gender, schi zophrenia and ethnicity, with young black men with schizophrenia being most at risk. The rate ratio for violent offences in men with schizop hrenia is 3.8, confirming recent studies from Sweden, Subjects with sc hizophrenia were more likely to acquire any criminal record than those with other mental disorders. The rate of lifetime conviction was grea ter in those with schizophrenia than either a sample of working-class boys from the same area followed by Farrington & West, or National dat a. The risk of first conviction is increased by schizophrenia, unemplo yment, ethnic group, substance abuse and low social class, and decreas ed by being employed, married, female and older age of onset. Adjustme nt using survival analysis showed that schizophrenia made a small inde pendent contribution to the risk of acquiring a criminal record (hazar d ratio = 1.4), but gender, substance abuse, ethnicity and age of onse t were more substantial. Previous criminality was the strongest indepe ndent association of post-illness conviction, with schizophrenia only a trend. Although subjects with schizophrenia were more likely to acqu ire a criminal record, criminal careers began later and were shorter t han those of the controls. The risk of criminality increased throughou t the study period, but suggestions of a specific increase in those wi th schizophrenia as a result of changes in community care were not con firmed. These results confirm that women with schizophrenia are at inc reased risk of acquiring a criminal record, but the effect in men is f or violent convictions only. The strongest associations of criminal co nviction remain those recognized in non-schizophrenic subjects.