[Violence towards people with severe mental disorders: a review of the literature and of related concepts].
BACKGROUND
People with severe mental disorders tend to be seen as authors rather than as victims of violence, while mental illness is associated with violence and danger. French policy focuses on individuals with mental illness as authors of violence, to the detriment of evidence-based public health regarding such individuals when they are victims.


METHODS
This article reviews knowledge concerning violence towards people with severe psychiatric disorders, clarifies what is meant by violence and raises the question of the need for local and national studies. The first part compares definitions and operationalisation of main variables, sampling, methods and results of studies published since 1990 on violence towards adults with severe psychiatric disorders. The second part draws on qualitative studies to clarify conceptual problems that arose in the review.


RESULTS
Rates of victimisation for individuals with severe psychiatric disorders are shown to be high and far greater than those for the general population, despite the heterogeneity of studies in terms of sample characteristics, measures, methods and analyses. Certain types of factors - clinical, treatment, contextual - raise the probability of becoming a victim, as does the fact of having already been the author or the victim of a misdemeanour or crime. However, the cross-sectional designs used in these studies and the frequency of traumatic antecedents among psychiatric patients make it difficult to know whether violence precedes mental illness or vice-versa.


CONCLUSIONS
The relationship between life conditions and victimisation among people with severe psychiatric disorders points to areas in which public health can already intervene. But geographical variation in results may require more local and national studies. The relationship between author and victim and between violence, discrimination and stigma requires more research.
Lovell
A M
AM
CESAMES (Centre de recherche « Psychotropes, santé mentale, société »), Inserm U611, CNRS UMR 8136, université Paris-Descartes, 75270 Paris cedex 06, France.
Cook
J
J
Inserm U750, CNRS, Cermes, UMR 8169, France.
Velpry
L
L
CESAMES (Centre de recherche « Psychotropes, santé mentale, société »), Inserm U611, CNRS UMR 8136, université Paris-Descartes, 75270 Paris cedex 06, France.
D019548:Crime Victims; D006801:Humans; D028642:Persons with Psychiatric Disorders; D012307:Risk Factors; D014754:Violence