title: Violence and violent victimization in people with severe mental illness in a rural low-income country setting: a comparative cross-sectional community study.
abstract: BACKGROUND
  Violence perpetrated by and against people with severe mental illness (SMI) is important but rarely investigated in low- and middle income countries.
  
  
  OBJECTIVE
  To compare the prevalence of perpetrated violence and violent victimization, and associated factors, in people with and without SMI in rural Ethiopia.
  
  
  METHODS
  A random sub-sample of people with a standardized, clinician diagnosis of SMI (n=201) was recruited from an existing population-based study and compared to a group of unaffected individuals from the same neighborhood (n=200). The lifetime and 12-month prevalence of violence and violent victimization was measured using an adapted version of the McArthur Violence Interview.
  
  
  RESULTS
  Lifetime and 12-month prevalence of perpetrated violence in people with SMI (28.4% and 17.4%, respectively) was significantly higher than in the non-mentally ill comparison group (15.0% and 8.5%, respectively). Male gender, being literate and violent victimization were associated independently with violence in both groups. In people with SMI, violence was associated additionally with being unmarried, exposure to stressful life events and non-response to medication. The prevalence of violent victimization was also significantly higher in people with SMI than those without SMI (60.7% vs. 41.5%). In people with SMI, violent victimization was associated with unemployment, non-adherence to treatment and being a perpetrator of violence.
  
  
  CONCLUSIONS
  Our finding of high levels of violence and violent victimization in people with SMI underscores the need to improve access to mental health services in this setting, as well as the urgent need to raise awareness about victimization of people with SMI.
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia. Electronic address: r_tessera@yahoo.com.
authors.forename: Ruth
authors.initials: R
authors.lastname: Tsigebrhan
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia. Electronic address: shibreteshome@yahoo.com.
authors.forename: Teshome
authors.initials: T
authors.lastname: Shibre
authors.affiliation: Addis Ababa University, Aklilu-Lemma Institute of Pathobiology, Addis Ababa, Ethiopia. Electronic address: gtmedhin@yahoo.com.
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia; King's College London, Institute of Psychiatry, Department of Psychological Medicine, London, UK. Electronic address: abe.wassie@kcl.ac.uk.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, Addis Ababa, Ethiopia; King's College London, Institute of Psychiatry, Centre for Global Mental Health, London, UK. Electronic address: charlotte.hanlon@kcl.ac.uk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D015331:Cohort Studies; D019548:Crime Victims / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D012111:Residence Characteristics; D012424:Rural Population; D057566:Self Report; D014754:Violence / Q000523:psychology*
keywords: Bipolar disorder; HCR-20; SMI; Schizophrenia; Severe mental illness; Sub-Saharan Africa; Violence; Violent victimization; severe mental illness; the historical/clinical/risk management 20-item (HCR-20) scale