title: Threats to kill: a follow-up study.
abstract: BACKGROUND
  Mental health clinicians are frequently asked to assess the risks presented by patients making threats to kill, but there are almost no data to guide such an evaluation.
  
  
  METHODS
  This data linkage study examined serious violence following making threats to kill and the potential role of mental disorder. A total of 613 individuals convicted of threats to kill had their prior contact with public mental health services established at the time of the index offence. The group's subsequent criminal convictions were established 10 years later using the police database. Death from suicidal or homicidal violence was also established.
  
  
  RESULTS
  Within 10 years, 44% of threateners were convicted of further violent offending, including 19 (3%) homicides. Those with histories of psychiatric contact (40%) had a higher rate (58%) of subsequent violence. The highest risks were in substance misusers, mentally disordered, young, and those without prior criminal convictions. Homicidal violence was most frequent among threateners with a schizophrenic illness. Sixteen threateners (2.6%) killed themselves, and three were murdered.
  
  
  CONCLUSIONS
  In contrast to the claims in the literature that threats are not predictive of subsequent violence, this study revealed high rates of assault and even homicide following threats to kill. The mentally disordered were over-represented among threat offenders and among those at high risk of subsequent violence. The mentally disordered threateners at highest risk of violence were young, substance abusing, but not necessarily with prior convictions. Those who threaten others were also found to be at greater risk of killing themselves or being killed.
authors.affiliation: Victorian Institute of Forensic Mental Health, Victoria, Australia.
authors.forename: L J
authors.initials: LJ
authors.lastname: Warren
authors.forename: P E
authors.initials: PE
authors.lastname: Mullen
authors.forename: S D M
authors.initials: SD
authors.lastname: Thomas
authors.forename: J R P
authors.initials: JR
authors.lastname: Ogloff
authors.forename: P M
authors.initials: PM
authors.lastname: Burgess
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003617:Dangerous Behavior; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006708:Homicide / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D012008:Recurrence; D018570:Risk Assessment / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology; D012565:Schizophrenic Psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D014739:Victoria; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data