Victimisation in adults with severe mental illness: prevalence and risk factors

Domestic difficulties faced by women with a severe mental disorder: A qualitative study

When the family is considered as a system, individuals with a severe mental disorder can be affected by all the processes and conditions in the family. Women with a severe mental disorder are also affected by many factors such as their place in the family and society, gender roles and gender inequality. In the study, the authors aimed to determine domestic difficulties faced by women diagnosed with a severe mental disorder who were followed in a Community Mental Health Center in a province in the west of Türkiye. The study was a descriptive qualitative research design. Women who were diagnosed with a severe mental disorder, who were followed by the for mentioned Community Mental Health Center and who met the inclusion criteria were included in the study. The data collected using the one-on-one interview method were analyzed with the content analysis method. After the analysis of the data, the following four main themes related to the difficulties experienced in the family by women with a severe mental disorder identified: domestic violence, being both a sick person and a caregiver, stigma and coping strategies. It was concluded that women individuals with a diagnosis of a severe mental disorder experienced not only mental disorder-related difficulties but also difficulties of being a woman in the society brought about by their gender roles.

Prevalence and risk of sexual violence victimization among mental health service users: a systematic review and meta-analyses

PURPOSE

People with mental disorders are more likely to experience sexual violence than the general population, but little is known about the prevalence of sexual violence in people who use psychiatric services. This paper aims to estimate the prevalence and odds of sexual violence victimisation within mental health services by gender and mental health setting (i.e. inpatient, outpatient and mixed settings).

METHODS

This study is a systematic review and meta-analysis (PROSPERO registration number: CRD4201810019). Three databases (Medline, Embase, PsychINFO) were searched and citation tracking, and reference screening of included studies was conducted. Studies were included if the prevalence and/or risk of sexual violence in psychiatric service users were reported or calculable across the past year or adult lifetime. The methodological quality of included studies was assessed. A random effects meta-analyses was conducted to estimate odds ratios and pooled prevalence estimates of sexual violence in different mental health settings.

RESULTS

Twenty-six studies were included encompassing 197,194 participants. The meta-analyses revealed high pooled prevalence estimates and increased odds of sexual violence victimisation in male and female psychiatric service users compared to non-psychiatric service users.

CONCLUSIONS

Mental health practitioners should be trained to respond effectively to disclosures of sexual violence, particularly from these vulnerable groups. Future sexual violence interventions should consider mental health as a treatment outcome.

Victimisation in the life of persons with severe mental illness in Uganda: a pluralistic qualitative study

INTRODUCTION

Victimisation of persons with severe mental illness is recognised as an urgent global concern, with literature pointing to higher rates of violent victimisation of persons with severe mental illness than those of the general population. Yet, for low income countries, there is a huge gap in the literature on the risk, character and victims' in-depth experiences of victimisation of persons with severe mental illness. We explore the lived experiences and meanings of victimisation of persons with severe mental illness in Uganda, and discuss their implications for care of the mentally ill.

METHODS

A pluralistic qualitative study was undertaken to explore victimisation among patients with severe mental illness. Patients who had suffered victimisation were purposively sampled from Butabika National Referral Mental Clinic and Masaka Regional Referral Hospital, following confirmation of symptom remission. In-depth interviews were held with 18 participants, comprising 13 females and 5 males from low to moderate socioeconomic status. Interpretative phenomenological analysis and thematic content analysis were conducted.

RESULTS

Victimisation was exhibited in three main forms: (a) psychological, expressed in attitudes towards mentally ill family members as valueless and dispensable, and stigmatisation, (b) physical, as manifested in beatings, indoor confinement and tethering mostly by family members and (c) sexual victimisation, particularly rape. Also observed were victim's various responses that pointed to the negative impact of victimisation, including a heightened risk of suicide, social withdrawal, a sense of hatefulness and a predisposition to more victimisation.

CONCLUSION

The family environment plays a predominant role in perpetrating victimisation of the mentally ill in some sub-Saharan African contexts such as Uganda. We propose a holistic framework for mental health interventions, incorporating biomedical but notably also social determinants of mental health, and targeted at improving familial relationships, social support and a sense of belongingness both within the family and the broader community.

A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study

BACKGROUND

Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice.

OBJECTIVE

This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE.

METHODS

This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through "think-aloud" testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used.

RESULTS

Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals' priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users' inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy.

CONCLUSIONS

The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.

Absolute and relative risk of violent victimisation and perpetration following onset of mental illness: a Danish register-based study

Background

Previous research has suggested that people with severe mental illness are at elevated risk of both violence perpetration and violent victimisation, with risk of the latter being perhaps greater than the former. However, few studies have examined risk across both outcomes.

Methods

Using a total population approach, the absolute and relative risks of victimisation and perpetration were estimated for young men and women across the full psychiatric diagnostic spectrum. Information on mental disorder status was extracted from national registers and information on violent victimisation and perpetration outcomes from police records. The follow-up was from age 15 to a maximum of 31 years, with most of the person-time at risk pertaining to cohort members aged in their early twenties. Both absolute risk (at 1 and 5 years from onset of illness) and relative risk were estimated.

Findings

Both types of violent outcome occurred more frequently amongst those with mental illness than the general population. However, whether risk of one was greater than the other depended on a range of factors, including sex and diagnosis. Men with a mental disorder had higher absolute risks of both outcomes than women [victimisation: Cin (5 year) = 7.15 (6.88-7.42) versus Cin (5 year) = 4.79 (4.61-4.99); perpetration: Cin (5 year) = 8.17 (7.90-8.46) versus Cin (5 year) = 1.86 (1.75-1.98)], as was the case with persons in the general population without a recorded mental illness diagnosis. Women with mental illness had higher absolute risk of victimisation than perpetration, which was also true for men and women without mental illness. However, the opposite was true for men with mental illness. Men and women with diagnoses of personality disorders, substance use disorders, and schizophrenia-spectrum disorders were at highest risk of victimisation and perpetration.

Interpretation

Strategies developed to prevent violent victimisation and violence perpetration may need to be tailored for young adults with mental disorders. There may also be a benefit in taking a sex-specific approach to prevention in this group.

Funding

This study was supported by an Australian National Health and Medical Research Council Investigator Grant awarded to the first author.

The Extent and Nature of Autistic People's Violence Experiences During Adulthood: A Cross-sectional Study of Victimisation

This study investigated the extent and nature of violence experiences reported by autistic adults. Autistic (n = 118) and non-autistic (n = 110) adults completed a questionnaire about their experiences of sexual harassment, stalking and harassment, sexual violence and physical violence since the age of 15. Autistic adults reported higher rates of all violence types, multiple forms of violence and repeated instances of the same type of violence. Typical gender differences in the patterns of violence (more physical violence reported by men and more sexual violence reported by women) were apparent in the non-autistic but not the autistic group. Findings add to the limited research in this area and highlight the need to identify risk and protective factors. Policy and practice implications are also discussed.

Victimization in schizophrenia and its relation to violence

BACKGROUND

People with schizophrenia are frequently victims of violence. Previous attempts to examine the reasons for this have mostly used cross-sectional designs that limit the ability to distinguish, among the correlates they identify, potential causes of victimization from its consequences.

METHOD

We studied patients with schizophrenia participating in the NIMH-funded Clinical Antipsychotic Treatment for Intervention Effectiveness (CATIE) trial. The dependent variable was self-reported victimization during the 18-month CATIE follow-up. Independent variables were assessed at study entry and included demographics, childhood experiences, recent victimization and violent behavior, social circumstances, and mental health symptoms. Bivariate and multivariate analyses examined correlates of victimization and, among those victimized, the correlates of also acting violently oneself.

RESULTS

Of 1179 participants, 206 (17.5 %) reported one or more incidents where they were victimized over the 18-months. Over a third had been hit with a fist or an object. Most perpetrators were family or acquaintances. Controlling for other variables, victimization was associated with having been recently victimized at baseline as well as with sexual abuse in childhood, frequent interactions with close friends and depressive, but not schizophrenia, symptoms. Victimized participants who reported acting violently themselves (113; 55%) were more likely to report violent behavior at baseline and frequent interactions with close friends.

CONCLUSIONS

Victimization in schizophrenia is often associated with aggressive behavior by the victim and is more often related to social involvement, past trauma, substance use and depression than to schizophrenia symptoms. Treatments that encourage socialization may incur an unintended risk of victimization.

Relationship between Vitamin Intake and Resilience Based on Sex in Middle-Aged and Older Japanese Adults: Results of the Shika Study

Epidemiological studies reported that resilience, generally regarded as the ability to manage stress in the face of adversity, correlates with mental health in middle-aged and older adults. Currently, there is limited information on eating habits that affect resilience. Therefore, this cross-sectional study investigated the relationship between vitamin intake and resilience based on sex in community-dwelling middle-aged and older individuals in Shika town, Ishikawa Prefecture, Japan. A total of 221 participants (106 men and 115 women) aged 40 years or older were included in the analysis. We assessed vitamin intake and resilience using a brief-type self-administered diet history questionnaire (BDHQ) and the resilience scale (RS), respectively. A two-way analysis of covariance (ANCOVA) revealed that higher intakes of β-carotene and vitamin K were associated with higher RS in women, but not in men. Furthermore, a multiple logistic regression analysis stratified by sex showed that β-carotene and vitamin K were significant independent variables for RS only in women. The present study suggests that higher intakes of β-carotene and vitamin K were associated with higher resilience among middle-aged and older women. The results obtained demonstrate that β-carotene and vitamin K intakes may enhance resilience by strengthening stress tolerance.

Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards

PURPOSE

Estimate the effect of nursing, shift, and patient characteristics on patients' aggression.

DESIGN AND METHODS

Follow-up study on a closed psychiatric ward was performed to estimate the effect of nursing team characteristics and patient characteristics on the incidence of aggression.

FINDINGS

The incidence of aggression (n = 802 in sample) was lower in teams with >75% male nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive.

PRACTICE IMPLICATIONS

These findings could stimulate support for nurses to prevent aggression.

Deinstitutionalization from the perspective of community-dwelling adults with a severe mental illness in Amsterdam: a cohort study protocol

Background

People with a severe mental illness (SMI) increasingly receive ambulatory forms of care and support. The trend of deinstitutionalization accelerated in the Netherlands from 2008 and onwards without sufficient understanding of its consequences. The study protocol herein focuses on deinstitutionalization from the perspective of adults with an SMI living within the community in Amsterdam and aims at delivering better insight into, amongst others, their recovery, quality of life, societal participation and needs for care and support.

Methods

A cohort design will be used. A representative sample of community-dwelling adults with an SMI, including those in care (n = 650) and not in care (n = 150), will be followed over time. During a two-year time period, participants will be interviewed twice using a wide-ranging set of validated instruments. Interview data will be matched with administrative data about the care process, as retrieved from their patient files. Primary outcomes are changes over time in recovery, societal participation and quality of life, controlled for the occurrence of adverse life-events during follow-up. Additionally, prevalence estimates of and associations between social functioning, safety and discrimination, substance use and health indicators will be investigated.

Discussion

The study protocol aims at delivering a comprehensive insight into the needs of community-dwelling adults with an SMI based on which ambulatory care and support can best be provided to optimally promote their social recovery and well-being.

Experiencing discrimination mediates the relationship between victimization and social withdrawal in patients suffering from a severe mental illness: A cross-sectional study

Psychiatric patients are often victims of crime and discrimination and are often socially withdrawn. This has negative consequences for their health and recovery. We examined whether such discrimination mediates the association between victimization and social withdrawal, and whether these associations differ between men and women. We also determined the prevalence of social withdrawal and the discrimination experienced by patients suffering from a severe mental illness. This study is embedded in the Victimization in Psychiatric Patients study. Information on discrimination, social withdrawal and victimization was obtained using structured self-report questionnaires (N = 949). We reported the 12-month prevalence of these phenomena and used path analysis to estimate the direct path between personal and property victimization and social withdrawal, and the indirect path through the discrimination experienced. The impact of gender was assessed by testing interaction terms. Social withdrawal was reported by 20.6% (95%CI 18.1-23.2) of participants, and being discriminated against in the past 12 months by 75.3% (95%CI: 72.6-78.0%). While crime victimization had no direct effects on social withdrawal, personal crime victimization (B = 0.47; 95%CI 0.25-0.72; p < 0.001) and property crime victimization (B = 0.65; 95%CI 0.42-0.93; p < 0.001) had significant indirect effects on social withdrawal, which were mediated by the discrimination experienced. In men we found a direct negative effect of property crime on social withdrawal (B = -0.68; 95%CI: -1.21to -0.11, p = 0.014). We conclude that personal and property victimization, for both men and women, was associated with higher levels of social withdrawal, and this was fully mediated by the discrimination experienced.

Addressing victimization to enable societal participation in flexible assertive community treatment: A process evaluation of the implementation of a new intervention

BACKGROUND

Individuals with severe mental illness experience more victimization and discrimination than other persons in the community. Effective rehabilitation and recovery-oriented care interventions aimed at addressing this issue are lacking. We therefore developed a victimization-informed intervention (accompanied by a training module for professionals) called the Victoria intervention. The purpose of the present study was to understand the trial effects by examining the implementation process and the factors that influenced it.

MATERIALS AND METHODS

A process evaluation was conducted using a mixed-methods design. During the professionals' intervision sessions, we used observations to understand the learning processes (n = 25). Subsequently, we studied the use of the intervention in practice through structured questionnaires (n = 215) and semi-structured interviews (n = 34) with clients and professionals. We used descriptive and inferential statistics for the quantitative data and the framework method for the analyses of the qualitative data.

RESULTS

The observations showed that the trainings were well received. The professionals shared the urgency of paying attention to victimization and discrimination and its harmful effects on participation. They also found the intervention steps to be logical and the intervention protocol easy to use. Nevertheless, they mentioned in the interviews that they had experienced difficulties initiating a conversation about victimization, and if they started one, they did not always follow the steps of the intervention as intended. Few clients said that victimization was placed on the agenda, though those who had discussed victimization with their caregivers expressed their appreciation in the interviews; they felt acknowledged and supported.

DISCUSSION

The findings indicate that the intervention was considered helpful in raising awareness and the acknowledgment of victimization. However, professionals remain reluctant to talk about the subject, and the results show they need more practical training in this regard. This process evaluation has an important added value in that it helps us to understand the results of the effect evaluation of the intervention. The findings will facilitate the development and implementation of interventions that address clients' victimization experiences in community mental healthcare settings and subsequently enable their participation in society.

Development of an Intervention Aimed at Increasing Awareness and Acknowledgement of Victimisation and Its Consequences Among People with Severe Mental Illness

Individuals with severe mental illness have a significant risk of (anticipated) discrimination and (criminal) victimisation, which is not structurally and systematically addressed by mental health practitioners. The aim of this study was to develop and pilot an intervention which supports professionals to address victimisation and its consequences, in order to reinforce safe social participation and improve recovery. Following the rehabilitation and positive risk management literature, in addition to current practice, intervention components were developed in two focus groups and four subsequent expert meetings. The intervention was piloted in two outpatient teams before being finalised. The Victoria intervention includes positive risk management, focusing on clients' narratives and strengths, and awareness of unsafe (home) environments: it comprises four steps: exploring issues with social participation, analysing victimisation experiences, clarifying the context of these experiences, and determining future steps, including victimisation-sensitive rehabilitation planning and optional trauma treatment. Future research should further test this intervention.

Victimisation of individuals with serious mental illness living in sheltered housing: differential impact of risk factors related to clinical and demographic characteristics

BACKGROUND

Sheltered housing is associated with quality-of-life improvements for individuals with serious mental illness (SMI). However, there are equivocal findings around safety outcomes related to this type of living condition.

AIMS

We aimed to investigate raw differences in prevalence and incidence of crime victimisation in sheltered housing compared with living alone or with family; and to identify groups at high risk for victimisation, using demographic and clinical factors. We do so by reporting estimated victimisation incidents for each risk group.

METHOD

A large, community-based, cross-sectional survey of 956 people with SMI completed the Dutch Crime and Victimisation Survey. Data was collected on victimisation prevalence and number of incidents in the past year.

RESULTS

Victimisation prevalence was highest among residents in sheltered housing (50.8%) compared with persons living alone (43%) or with family (37.8%). We found that sheltered housing was associated with increased raw victimisation incidence (incidence rate ratio: 2.80, 95% CI 2.36-3.34 compared with living with family; 1.87, 95% CI 1.59-2.20 compared with living alone). Incidence was especially high for some high-risk groups, including men, people with comorbid post-traumatic stress disorder and those with high levels of education. However, women reported less victimisation in sheltered housing than living alone or with family, if they also reported drug or alcohol use.

CONCLUSIONS

The high prevalence and incidence of victimisation among residents in sheltered housing highlights the need for more awareness and surveillance of victimisation in this population group, to better facilitate a recovery-enabling environment for residents with SMI.

Criminal victimization of people with epilepsy: Sixteen criminal judgments in Japan between 1990 and 2019

Criminal behavior by people with epilepsy (PWE) has often been discussed. However, there are limited studies on criminal victimization of PWE-in particular, how such victimizations occur. We identified criminal cases involving victims with epilepsy using databases containing criminal judgments and found 16 such cases between 1990 and 2019. Seven were homicide cases, including four filicide cases. In the four filicide cases, all the perpetrators had the intention of homicide-suicide; all the victims had intellectual disabilities or cerebral palsy; two of these victims had acted violently toward the family; and two mothers who perpetrated the crime against the victims had depression. It seemed that the comorbidities and problem behaviors of the victims were more strongly related to serious crimes by family caregivers than the epilepsy itself. To prevent victimization caused by family caregivers, reducing their stress levels is important. Defendants sometimes argued against objective evidence of a crime, claiming that epileptic seizure of PWE caused or was related to the death of victims. Legal and medical professionals involved in determining the manner of death need careful evaluation when sudden deaths of PWE occur.

Women with Schizophrenia over the Life Span: Health Promotion, Treatment and Outcomes

Women with schizophrenia show sex-specific health needs that differ according to stage of life. The aim of this narrative review is to resolve important questions concerning the treatment of women with schizophrenia at different periods of their life—paying special attention to reproductive and post-reproductive stages. Review results suggest that menstrual cycle-dependent treatments may be a useful option for many women and that recommendations re contraceptive options need always to be part of care provision. The pregnancy and the postpartum periods—while constituting vulnerable time periods for the mother—require special attention to antipsychotic effects on the fetus and neonate. Menopause and aging are further vulnerable times, with extra challenges posed by associated health risks. Pregnancy complications, neurodevelopmental difficulties of offspring, cancer risk and cognitive defects are indirect results of the interplay of hormones and antipsychotic treatment of women over the course of the lifespan. The literature recommends that health promotion strategies need to be directed at lifestyle modifications, prevention of medical comorbidities and increased psychosocial support. Careful monitoring of pharmacological treatment has been shown to be critical during periods of hormonal transition. Not only does treatment of women with schizophrenia often need to be different than that of their male peers, but it also needs to vary over the course of life.

The association between neighbourhood characteristics and physical victimisation in men and women with mental disorders

BACKGROUND

How neighbourhood characteristics affect the physical safety of people with mental illness is unclear.

AIMS

To examine neighbourhood effects on physical victimisation towards people using mental health services.

METHOD

We developed and evaluated a machine-learning-derived free-text-based natural language processing (NLP) algorithm to ascertain clinical text referring to physical victimisation. This was applied to records on all patients attending National Health Service mental health services in Southeast London. Sociodemographic and clinical data, and diagnostic information on use of acute hospital care (from Hospital Episode Statistics, linked to Clinical Record Interactive Search), were collected in this group, defined as 'cases' and concurrently sampled controls. Multilevel logistic regression models estimated associations (odds ratios, ORs) between neighbourhood-level fragmentation, crime, income deprivation, and population density and physical victimisation.

RESULTS

Based on a human-rated gold standard, the NLP algorithm had a positive predictive value of 0.92 and sensitivity of 0.98 for (clinically recorded) physical victimisation. A 1 s.d. increase in neighbourhood crime was accompanied by a 7% increase in odds of physical victimisation in women and an 13% increase in men (adjusted OR (aOR) for women: 1.07, 95% CI 1.01-1.14, aOR for men: 1.13, 95% CI 1.06-1.21, P for gender interaction, 0.218). Although small, adjusted associations for neighbourhood fragmentation appeared greater in magnitude for women (aOR = 1.05, 95% CI 1.01-1.11) than men, where this association was not statistically significant (aOR = 1.00, 95% CI 0.95-1.04, P for gender interaction, 0.096). Neighbourhood income deprivation was associated with victimisation in men and women with similar magnitudes of association.

CONCLUSIONS

Neighbourhood factors influencing safety, as well as individual characteristics including gender, may be relevant to understanding pathways to physical victimisation towards people with mental illness.

Frequency and correlates of violence against patients with schizophrenia living in rural China

BACKGROUND

Violence against patients with schizophrenia is very common, however it is rarely studied in China, especially in primary health care institutions of rural areas. Therefore, we investigated the frequency of violence against patients with community-living schizophrenia in rural China and examined its associated factors and impact on quality of life (QoL) and social function.

METHOD

A survey was conducted among 487 patients with schizophrenia living in rural communities. Data about violent victimization experiences in the past 6 months, demographic information, and clinical characteristics were collected by questionnaires.

RESULTS

We found that 92 (18.9%) of 487 subjects experienced at least one type of violent event in the past 6 months. Logistic regression analysis suggested that a history of conducting dangerous behaviors(OR = 1.702, P = 0.02, 95%CI: 1.05-2.73), higher Brief Psychiatric Rating Scale (anxiety domain) score (OR = 1.15, P = 0.02, 95%CI: 1.01-1.304) and lower hospitalization rates (OR = 0.89, P = 0.04, 95%CI: 0.81-0.99) were significantly associated with violent victimization in patients with schizophrenia. Analysis of covariance showed the victims of violence tended to have worse social function in patients with schizophrenia living in rural communities of China (P = 0.04).

CONCLUSIONS

Individuals with schizophrenia living in rural China had a high risk of being exposed to violence and violent victimization of patients with schizophrenia had adverse consequences for social function. More attention is needed for those patients experiencing violent events, because they are simultaneously possible to conduct dangerous behaviors.

"Please tell me what happened": A descriptive study on prevalence, disclosure and characteristics of victimization in people with a psychotic disorder

Introduction

Although people with a psychotic disorder are approximately four to six times more often victimized than the general population, victimization is not routinely assessed in mental healthcare. This study investigates prevalence, context and risk factors of victimization in patients with a psychotic disorder in the Northern, relatively rural region of the Netherlands. Moreover, disclosure rates and awareness of psychiatrists are examined.

Method

Information on personal crime (threats, assaults and sexual violence), property and other forms of crime, the context of victimization and disclosure was routinely assessed in 353 patients with a psychotic disorder who received care at a mental health facility. In addition, involved psychiatrists reported on last year’s victimization incidents in their patients.

Results

One third of the patients reported victimization in the previous year. More than half of the crimes were committed by someone acquainted and took place in the victim’s own home or a place familiar to the victim. Younger age, having a comorbid disorder, drug use and perpetration of a crime were all positively associated with victimization. Approximately half of the reported personal crimes were disclosed to a health care professional but only in 16% of the cases the involved psychiatrist report to know about the incident.

Conclusion

This study confirms that people with a history of psychosis have an increased risk of becoming the victim of a crime. Although our results suggest that in fifty percent of cases the patients did share the information with professionals, a substantial proportion of incidents appear to go still unnoticed.

Who Are the Victims of NGRI Acquittees? A Study of Belgian Internees

BACKGROUND

The limited literature on victim characteristics of offenders found not guilty by reason of insanity (NGRI) shows that most victims are adults who are known to the offender. It is currently unclear whether victims are mainly male or female or whether there are differences in the type of victims according to the offenders' psychiatric disorder.

METHOD

Victim characteristics were retrospectively collected from 362 NGRI acquittees, and the influence of psychiatric diagnoses on victim profiles was examined.

RESULTS

Victims were mainly adult acquaintances and were equally likely to be male or female. Family members and caregivers were the most frequent type of acquaintance victims. Further analyses suggest that these victim characteristics are similar for perpetrators with different psychiatric diagnoses.

CONCLUSION

Victimization of strangers and minors was unlikely in NGRI offenders.

Rates and profile of victimization in a sample of Egyptian patients with major mental illness

BACKGROUND

Patients with major mental illness have an increased risk of victimization. Nevertheless, this topic was not thoroughly studied in Egyptian patients with major mental illness.

OBJECTIVES

The objectives of this study are to investigate the rates of victimization and understand its profile, psycho-demographic and clinical correlates among a sample of Egyptian patients with major mental illness.

PARTICIPANTS AND METHODS

A total of 300 patients (100 patients with schizophrenia, 100 with bipolar and 100 with major depression) were recruited from the inpatient wards and outpatient clinics at Ain Shams University. They were subjected to a demographic questionnaire, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI) and a Victimization Questionnaire (VQ).

RESULTS

In our study population, 130 (43.3%) of patients were victimized, of them 52 (40%) were diagnosed with major depressive disorder, 48 (36.9%) with bipolar disorder and 30 (23.1%) with schizophrenia. Victimization was more in female, married, unemployed individuals and those living in rural areas. Patients exposed to domestic violence or abuse during childhood had higher rates of victimization. All victimized patients were subjected to emotional victimization, 64.6% were physically victimized and 53.8% were subjected to miscellaneous types of victimization. Patients were victimized mainly by acquaintance followed by family members. The majority of patients did not report their victimization and considered it as a personal issue or not important enough to be reported.

CONCLUSION

Patients with major mental illness are susceptible to significant victimization. Clinicians should explore possible history of abuse or victimization in their patients, empower and support the victimized ones.

Psychiatric symptoms and risk of victimisation: a population-based study from Southeast London

AimsAlthough violence is a vital public health problem, no prospective studies have tested for subsequent vulnerability to violence, as a victim or witness, in members of the general population with a range of psychiatric symptoms, or evaluated the importance of higher symptom burden on this vulnerability.

METHODS

We used successive waves of a household survey of Southeast London, taken 2 years apart, to test if association exists between psychiatric symptoms (symptoms of psychosis, common mental disorders, post-traumatic stress disorder and personality disorder) and later victimisation, in the form of either witnessing violence or being physically victimised, in weighted logistic regression models. Statistical adjustment was made for prior violence exposure, sociodemographic confounders, substance/alcohol use and violence perpetration. Sensitivity analyses were stratified by violence perpetration, sex and history of mental health service use.

RESULTS

After adjustments, psychiatric symptoms were prospectively associated with reporting any subsequent victimisation (odds ratio (OR) 1.88, 95% confidence interval (CI) 1.25-2.83), a two times greater odds of reporting witnessed violence (OR 2.24, 95% CI 1.33-3.76) and reporting physical victimisation (OR 1.76, 95% CI 1.01-3.06). One more symptom endorsed was accompanied by 47% greater odds of subsequent victimisation (OR 1.47, 95% CI 1.16-1.86). In stratified analyses, statistical associations remained evident in non-perpetrators, and among those without a history of using mental health services, and were similar in magnitude in both men and women.

CONCLUSIONS

Psychiatric symptoms increase liability to victimisation compared with those without psychiatric symptoms, independently of a prior history of violence exposure and irrespective of whether they themselves are perpetrators of violence. Clinicians should be mindful of the impact of psychiatric symptoms on vulnerability to victimisation, including among those with common psychiatric symptoms and among those who are not considered at risk of perpetrating violence.

Self-wise, Other-wise, Streetwise (SOS) training, an intervention to prevent victimization in dual-diagnosis patients: results from a randomized clinical trial

BACKGROUND AND AIMS

Patients with co-occurring substance use and other mental disorders are vulnerable to crime victimization, yet no evidence-based preventive interventions exist. Our aim was to test the efficacy of a new intervention, Self-wise, Other-wise, Streetwise training (SOS training), to prevent victimization in these dual-diagnosis patients as an add-on to care as usual.

DESIGN

Multi-site single-blind parallel randomized controlled trial.

SETTING

Three sites within one psychiatric service in Amsterdam, the Netherlands.

PARTICIPANTS

Adult in-patients and out-patients with dual diagnosis (n = 250), who were predominantly male (70.4%), aged on average 42.1 years, and diagnosed with 3.7 DSM-IV disorders.

INTERVENTION AND COMPARATOR

Care as usual, consisting of pharmacotherapy combined with individual psychotherapy, group psychotherapy and/or supportive counselling (n = 125) was compared with care as usual plus SOS training: a 6-week, 12-session manualized group training focused on enhancing emotion regulation skills, conflict resolution skills and street skills (n = 125).

MEASUREMENTS

Victimization was assessed with the Safety Monitor, the Dutch equivalent of the International Crime Victims Survey, in a face-to-face assessment. The primary outcome measure was treatment response (yes/no), with 'yes' defined as reporting at least a 50% reduction in the number of past-year victimization incidents at the 14-month follow-up compared with baseline. Analyses were performed according to the intention-to-treat principle.

FINDINGS

The proportion of participants achieving treatment response for total victimization was 54.0% in the control group and 67.6% in the experimental group, a significant difference [odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.02-3.11, P = 0.042]. Treatment response for violent victimization was achieved by 68.7% of the control group and 79.3% of the experimental group (OR = 1.75, 95% CI = 0.91-3.34, P = 0.092). With a Bayes factor of 2.26, this result was inconclusive.

CONCLUSIONS

Among dual-diagnosis patients, care as usual plus Self-wise, Other-wise, Streetwise training was more effective in preventing victimization than care as usual alone.

Dying Too Soon: Excess Mortality in Severe Mental Illness

Aims: We aimed to identify baseline predictors of mortality in patients with a severe mental illness (SMI) over a 6-year period and to describe mortality rates as standardised mortality ratios (SMRs). We hypothesised that cardiovascular diseases, older age, cigarette smoking, more severe psychiatric symptoms and more severe psychotropic side effects, and alcohol or drug use were independent risk factors for mortality. Method: Medical examinations were conducted at baseline in a cohort of 322 SMI patients. SMRs were estimated after 6 years and an evaluation was made of the impact of a wide range of variables on survival time. Results: Almost 11% of the SMI patients had died at the end of the study period. All-cause SMRs were 4.51 (95% CI 3.07-5.95) for all SMI patients (4.89, 95% CI 2.97-6.80 for men, and 3.94, 95% CI 1.78-6.10 for women). Natural causes accounted for 86% of excess mortality and unnatural causes for 14%. Cardiovascular disease was a major contributor to this excess mortality. Multivariate Cox regression analyses showed that premature death was associated with a longer history of tobacco use (HR: 1.03, 95% CI 1.02-1.03) and more severe symptoms of disorganisation (HR: 2.36, 95% CI 2.21-2.52). Conclusions: The high SMR and the incidence of cardiovascular disease-related death in SMI patients in our study justify concern. This study underscores the urgent need for interventions to reduce excess mortality in patients with SMI.

Profiling of victimization, perpetration, and participation: A latent class analysis among people with severe mental illness

BACKGROUND

Persons with severe mental illness are more prone to victimization and experience more difficulties regarding societal participation than other community members. These experiences vary greatly among individuals. Community mental health care should offer more individualized support by addressing these differences in experience. Therefore, this study aimed to identify subgroups of outpatients with severe mental illness based on their experiences of social participation and victimization.

METHODS

Data from patients with severe mental illness from eight outpatient teams in the Netherlands were used to perform latent class analysis. From the total caseload, 395 patients agreed to participate. Classes were based on: i) criminal victimization incidents, ii) criminal perpetration incidents (Dutch Safety Monitor), iii) experienced discrimination (DISC-12), and iv) social functioning (Social Functioning Scale). Also, to investigate differences between the classes, socio-demographic, clinical, and person-related variables were examined.

RESULTS

Three classes were identified. The Victimized and Perpetrating class (34.4%) had the highest prevalence of discrimination, victimization, and perpetration, and intermediate scores on social functioning subscales. This class also experienced the most problems in other domains, such as psychosocial functioning and quality of life. The Discriminated and Avoiding class (36.4%) had moderate scores for discrimination, victimization and perpetration, and the lowest scores for social functioning and social support. The General Difficulties class (28.8%) had the lowest prevalence of discrimination, victimization, and perpetration, and the highest scores on social functioning.

DISCUSSION

These distinct classes offer new insights to mental health professionals in outpatient teams in in their aim to positively influence the patient's social context during rehabilitation; this includes addressing the role of victimization, and indicates the relevance of distinctive approaches and the support needed for each class. Professionals may need to focus more on the impact of difficulties in their patients' social context to adequately support them in the rehabilitation process.

Prevalence and predictors of violent victimization in remitted patients with recurrent depression

BACKGROUND

Depressed patients are at increased risk to fall victim to a violent crime compared to the general population. It remains unknown whether their increased risk persists after remission. This study compared victimization rates of remitted patients with both a random general population sample and a group of currently depressed patients. Furthermore, this study aimed to identify predictors of future violent victimization.

METHODS

In this longitudinal study conducted in the Netherlands, 12-month prevalence rates of sexual assaults, physical assaults, and threats were assessed with the Safety Monitor in 140 currently remitted patients with recurrent depression, and compared to those of a weighted general population sample (N = 9.175) and a weighted sample of currently depressed outpatients (N = 102) using Chi-square tests. Logistic regression analyses were performed to identify baseline predictors of future victimization.

RESULTS

The prevalence of violent victimization did not differ between remitted patients and the general population (12.1 vs. 11.7%). Remitted patients were significantly less likely to have been victimized over the past 12 months than currently depressed patients (12.1 vs. 35.5%). In remitted patients, living alone and low sense of mastery at baseline predicted future violent victimization. However, when combined in a multiple model, only living alone was independently associated with violent victimization (χ² = 16.725, df = 2, p < .001, R² = 0.221).

LIMITATIONS

Our comparison of victimization rates across samples was cross-sectional.

CONCLUSIONS

Since the increased risk of victimization appears to be specific for the acute depressive state, preventive interventions should target victimization in currently depressed patients.

TRIAL REGISTRATION

Netherlands Trial Register (NTR): 2599.

Common transdiagnostic cognitive deficits among people with psychiatric disorders exposed to childhood maltreatment: a meta-analysis

INTRODUCTION

Previous meta-analyses have shown a moderate negative impact of maltreatment on the neuropsychological functioning of people with or without psychiatric disorders compared to healthy groups. The objectives of the present meta-analysis were to (1) investigate the impact of maltreatment on neuropsychological functioning of people with psychiatric disorders and to (2) evaluate the moderating effect of age, at the time of the cognitive assessment, on neuropsychological functioning.

METHODS

Seventeen studies published between 1970 and July 2017 were included.

RESULTS

The results showed a negative impact of maltreatment with a small effect size (g = -0.25) on the neuropsychological performances in the group with psychiatric disorders with a history of exposure to childhood maltreatment compared to the group with psychiatric disorders without a history of exposure to childhood maltreatment. Cognitive domains that are significantly affected by maltreatment are: working memory (g = -0.56), verbal episodic memory (g = -0.39), intelligence (g = -0.27) and processing speed (g = -0.21). The impact of childhood maltreatment on the cognitive profile is greater in adults than young people.

CONCLUSIONS

Clinicians should consider these common cognitive deficits using a transdiagnostic approach in cognitive interventions.

Prevention of violent revictimization in depressed patients with an add-on internet-based emotion regulation training (iERT): study protocol for a multicenter randomized controlled trial

BACKGROUND

Psychiatric patients are at high risk of becoming victim of a violent crime compared to the general population. Although most research has focused on patients with severe mental illness, depressed patients have been demonstrated to be prone to victimization as well. Victimization is associated with more severe symptomatology, decreased quality of life, and high risk of revictimization. Hence, there is a strong need for interventions that focus on preventing violent revictimization. Since emotion dysregulation is associated with both victimization and depression, we developed an internet-based Emotion Regulation Training (iERT) to reduce revictimization in depressed patients. This study aims to evaluate the clinical and cost-effectiveness of iERT added to Treatment As Usual (TAU) in reducing incidents of violent revictimization among depressed patients with a recent history of victimization. Furthermore, this study aims to examine secondary clinical outcomes, and moderators and mediators that may be associated with treatment outcomes.

METHODS

In a multicenter randomized controlled trial with parallel group design, patients with a major depressive disorder and a history of violent victimization over the past three years (N = 200) will be allocated to either TAU + iERT (N = 100) or TAU only (N = 100), based on computer-generated stratified block randomization. Assessments will take place at baseline, 8 weeks, 14 weeks, and 6 months after start of treatment, and 12, 24, and 36 months after baseline. The primary outcome measure is the total number of violent victimization incidents at 12 months after baseline, measured with the Safety Monitor: an adequate self-report questionnaire that assesses victimization over the preceding 12 months. Secondary outcome measures and mediators include emotion dysregulation and depressive symptomatology. An economic evaluation with the societal perspective will be performed alongside the trial.

DISCUSSION

This study is the first to examine the effectiveness of an intervention aimed at reducing violent revictimization in depressed patients. If effective, iERT can be implemented in mental health care, and contribute to the well-being of depressed patients. Furthermore, the results will provide insight into underlying mechanisms of revictimization.

TRIAL REGISTRATION

The study is registered at the Netherlands Trial Register ( NTR5822 ). Date of registration: 4 April 2016.

Social inclusion and relationship satisfaction of patients with a severe mental illness

BACKGROUND

Research suggests that patients with a severe mental illness (SMI) are among the most social excluded in society. However, comparisons of social network composition and relationship satisfaction between SMI patients and a control group are rare.

AIMS

Our aim was to compare differences in size, satisfaction and composition of the social network between patients with SMI and a control group. Potential sociodemographic and clinical risk factors in relation to social network size in SMI patients were explored.

METHODS

The sample consisted of a control group ( N = 949) and SMI patients ( N = 211) who were under treatment in Dutch mental health care institutions. In these groups, network size, relationship satisfaction, sociodemographic and clinical (patients only) characteristics were assessed.

RESULTS

Social network size was 2.5 times lower in SMI patients, which was also reflected in a lower relationship satisfaction. The composition of the social network of SMI patients differs from that of controls: patients' network seems to consist of a smaller part of friends. Different risk factors were associated with the impoverishment of the social network of family, friends and acquaintances of patients with SMI.

CONCLUSION

SMI patients have very small networks compared to controls. This may be a problem, given the ongoing emphasis on outpatient treatment of SMI patients and self-dependence. This outcome advocates for more attention to social isolation of SMI patients and involvement of family in the treatment and aftercare of SMI patients.

Gender differences in characteristics of physical and sexual victimization in patients with dual diagnosis: a cross-sectional study

BACKGROUND

Patients with substance use disorders and co-occurring mental health disorders are vulnerable to violent victimization. However, no evidence-based interventions are available to reduce patients' vulnerability. An exploration of the characteristics of physical and sexual violence can provide valuable information to support the development of interventions for these patients. This study aimed to examine gender differences in characteristics of violent victimization in patients with dual diagnosis.

METHODS

In this cross-sectional survey study recent incidents of physical and sexual assault were examined with the Safety Monitor in 243 patients with dual diagnosis. Chi-square tests were used to examine gender differences in the prevalence of physical and sexual victimization. Fisher's exact tests and Fisher-Freeman-Halton exact tests were used to determine whether there were significant differences between victimized men and women with regard to perpetrators, locations, reporting to the police and speaking about the assault with others.

RESULTS

There was no significant difference in the prevalence of physical violence in men (35%) and women (47%) with dual diagnosis. There was a significant association between gender of the victim and type of perpetrator (P < .001). Men were most often physically abused by a stranger or an acquaintance, whereas women were most frequently abused by an (ex)partner. Sexual violence was more prevalent in women (29%) compared to men (4%) (P < .001). Patients with dual diagnosis were unlikely to report incidents of physical abuse and sexual assault to the police and to speak about it with caregivers.

CONCLUSIONS

Characteristics of physical violence are different for men and women with dual diagnosis. Women with dual diagnosis are more often victims of sexual violence compared to men. Interventions aimed at reducing patients' vulnerability for victimization should take gender differences into account.

Prevalence of Victimization in Patients With Dual Diagnosis

OBJECTIVE

The purpose of this study was to determine the prevalence of victimization in patients with co-occurring mental health and substance use disorders (dual diagnosis) and compare them to the general population.

METHODS

In this cross-sectional survey study conducted in the Netherlands, 9 different types of victimization (e.g., physical assault) were assessed with the Safety Monitor in patients with dual diagnosis (n = 243) and a sample of the general population (n = 10,865). Chi-square tests were used to compare patients with a weighted sample of the general population.

RESULTS

Compared to the general population, patients with dual diagnosis were more likely to have been a victim of violence (60% vs. 11%), property crime (58% vs. 30%), and vandalism (21% vs. 14%) in the year preceding the assessment. Threats, sexual assault, physical assault, robbery, bicycle theft, other theft, and vandalism were more prevalent in patients with dual diagnosis compared to the general population. Car theft was more prevalent in the general population. The risk of burglary did not differ significantly between groups.

CONCLUSIONS

Patients with dual diagnosis are highly prone to victimization. In patients with severe mental illness, victimization is associated with psychopathology, substance use, homelessness, and engagement in criminal activity. Future research is necessary to explore underlying mechanisms in patients with dual diagnosis and develop interventions to reduce their vulnerability for victimization.

The interplay of psychosis and victimisation across the life course: a prospective study in the general population

PURPOSE

Psychosis has been associated with adult victimisation. However, it remains unclear whether psychosis predicts incident adult victimisation, or whether adult victimisation predicts incident psychosis. Furthermore, a moderating effect of childhood victimisation on the association between psychosis and adult victimisation has not been investigated.

METHODS

The longitudinal association between baseline psychotic experiences and six-year incidence of adult victimisation was assessed in a prospective general population cohort of 6646 adults using logistic regression analysis. The association between baseline adult victimisation and six-year incidence of psychotic experiences was examined as well. Furthermore, the moderating effect of childhood victimisation on these bidirectional associations was analysed.

RESULTS

Psychotic experiences and childhood victimisation were both associated with an increased risk of incident adult victimisation. However, this was through competing pathways, as suggested by a negative interaction between psychotic experiences and childhood victimisation. Baseline adult victimisation and childhood victimisation both independently increased the risk of incident psychotic experiences, but there was no interaction between adult victimisation and childhood victimisation.

CONCLUSIONS

Psychosis and victimisation are interconnected throughout the life course. Childhood victimisation is connected to psychosis through two pathways: one direct and one indirect through adult victimisation. In individuals without childhood victimisation, psychosis and adult victimisation bidirectionally impact on each other.

BEATVIC, a body-oriented resilience training with elements of kickboxing for individuals with a psychotic disorder: study protocol of a multi-center RCT

BACKGROUND

Individuals with a psychotic disorder are at an increased risk of becoming victim of a crime or other forms of aggression. Research has revealed several possible risk factors (e.g. impaired social cognition, aggression regulation problems, assertiveness, self-stigma, self-esteem) for victimization in patients with a psychotic disorder. To address these risk factors and prevent victimization, we developed a body-oriented resilience training with elements of kickboxing: BEATVIC. The present study aims to evaluate the effectiveness of the intervention.

METHODS/DESIGN

Seven mental health institutions in the Netherlands will participate in this study. Participants will be randomly assigned to either the BEATVIC training or the control condition: social activation. Follow-ups are at 6, 18 and 30 months. Short term effects on risk factors for victimization will be examined, since these are direct targets of the intervention and are thought to be mediators of victimization, the primary outcome of the intervention. The effect on victimization will be investigated at follow-up. In a subgroup of patients, fMRI scans will be made before and after the intervention period in order to assess potential neural changes associated with the effects of the training.

DISCUSSION

This study is the first to examine the effectiveness of an intervention targeted at victimization in psychosis. Methodological issues of the study are addressed in the discussion of this paper.

TRIAL REGISTRATION

Current Controlled Trials: ISRCTN21423535 . Retrospectively registered 30-03-2016.

Self-wise, Other-wise, Streetwise (SOS) training: a novel intervention to reduce victimization in dual diagnosis psychiatric patients with substance use disorders: protocol for a randomized controlled trial

BACKGROUND

Psychiatric patients are more likely to be victims of crime than others in the community. Dual diagnosis patients with comorbid psychiatric and substance use disorders are especially prone to victimization. Victimization is associated with substance abuse, more severe symptomatology and homelessness. There is a strong need for interventions to reduce victimization in this population. We developed the Self-wise, Other-wise, Streetwise (SOS) training to reduce victimization in patients with dual diagnosis.

METHODS/DESIGN

This study is a randomized controlled trial using a parallel group design to determine the effectiveness of adding the SOS training to care as usual. Patients with dual diagnosis (N = 250) will be allocated to either care as usual plus SOS training (N = 125) or care as usual only (N = 125) using computer-generated stratified block randomization. To compare effectiveness participants will be interviewed at baseline and 2, 8 and 14 months follow-up. The primary outcome measure is treatment response (yes/no), defined as either no victimization at 14 months follow-up or at least a 50% reduction in incidents of victimization at 14 months follow-up compared to baseline assessment. Victimization is measured with the Safety Monitor, an adequate self-report instrument used by Statistics Netherlands to measure victimization on a large scale in the Netherlands. Outcome assessors are blind to treatment allocation. An economic evaluation will be performed alongside the randomized controlled trial and will take the societal perspective.

DISCUSSION

This study is the first randomized controlled trial to examine the effectiveness of an intervention that aims to reduce victimization in patients with dual diagnosis. If the intervention is effective it can be implemented in mental health care and contribute to the safety and well-being of patients.

TRIAL REGISTRATION

Dutch Trial Register (NTR): 4472, date of registration: 24-03-2014.