title: Mental disorder and violence: is there a relationship beyond substance use?
abstract: OBJECTIVE
  A general consensus exists that severe mental illness (SMI) increases violence risk. However, a recent report claimed that SMI "alone was not statistically related to future violence in bivariate or multivariate analyses." We reanalyze the data used to make this claim with a focus on causal relationships between SMI and violence, rather than the statistical prediction of violence.
  
  
  METHODS
  Data are from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a two-wave study (N = 34,653: Wave 1: 2001-2003; Wave 2: 2004-2005). Indicators of mental disorder in the year prior to Wave 1 were used to examine violence between Waves 1 and 2.
  
  
  RESULTS
  Those with SMI, irrespective of substance abuse status, were significantly more likely to be violent than those with no mental or substance use disorders. This finding held in both bivariate and multivariable models. Those with comorbid mental and substance use disorders had the highest risk of violence. Historical and current conditions were also associated with violence, including childhood abuse and neglect, household antisocial behavior, binge drinking and stressful life events.
  
  
  CONCLUSIONS
  These results, in contrast to a recently published report, show that the NESARC data are consistent with the consensus view on mental disorder and violence: there is a statistically significant, yet modest relationship between SMI (within 12 months) and violence, and a stronger relationship between SMI with substance use disorder and violence. These results also highlight the importance of premorbid conditions, and other contemporaneous clinical factors, in violent behavior.
authors.affiliation: University of South Florida, Tampa, FL, USA. rvandorn@fmhi.usf.edu
authors.forename: Richard
authors.initials: R
authors.lastname: Van Dorn
authors.forename: Jan
authors.initials: J
authors.lastname: Volavka
authors.forename: Norman
authors.initials: N
authors.lastname: Johnson
mesh_terms: D016208:Databases, Factual; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000503:physiopathology*; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications*; D014481:United States; D014754:Violence / Q000523:psychology*