VIOLENCE AND SEVERE MENTAL DISORDER IN CLINICAL AND COMMUNITY POPULATIONS - THE EFFECTS OF PSYCHOTIC SYMPTOMS, COMORBIDITY, AND LACK OF TREATMENT

This paper examines links between violent behavior, type and severity of psychopathology, substance abuse comorbidity, and community mental health treatment, using matched data from two surveys: the National In stitute of Mental Health Epidemiologic Catchment Area project and the Triangle Mental Health Survey (a North Carolina study of adults with s evere and persistent mental illness), Multivariate logistic regression analysis was used to model the risk of violent acts attributable to t hree domains of independent variables: sociodemographic characteristic s, clinical diagnoses and symptomatology, and mental health services u tilization, Findings include: (1) Symptom severity was significantly g reater in the clinically-selected sample than in the community survey of respondents with comparable diagnoses who self-reported using menta l health services; (2) Violence risk was related to psychoticism/agita tion in a curvilinear form; (3) In a multivariable model, violence was significantly associated with substance abuse comorbidity, particular psychotic symptoms (perceived threat and loss of internal cognitive c ontrols), and absence of recent contact with a community mental health provider; (4) The relationship between lack of treatment and higher o dds of violence was less pronounced among respondents with substance a buse comorbidity; (5) When clinical and services-use variables were ta ken into account, sociodemographic predictors were not significantly r elated to violence.