title: Caregiver reports of patient-initiated violence in psychosis.
abstract: OBJECTIVE
  Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes.
  
  
  METHODS
  Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence.
  
  
  RESULTS
  One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence.
  
  
  CONCLUSIONS
  Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.
authors.affiliation: Lecturer in Clinical Psychology, Institute of Psychiatry, King's College London, London, England.
authors.forename: Juliana
authors.initials: J
authors.lastname: Onwumere
authors.affiliation: Clinical Psychologist, Institute of Psychiatry, King's College London, London, England.
authors.forename: Sarah
authors.initials: S
authors.lastname: Grice
authors.affiliation: Professor of Clinical Psychology, Institute of Psychiatry, King's College London, London, England; Professor of Clinical Psychology, Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust, Institute of Psychiatry, King's College London, London, England.
authors.forename: Philippa
authors.initials: P
authors.lastname: Garety
authors.affiliation: Emeritus Professor of Social and Community Psychiatry, Mental Health Science Unit, University College London, London, England.
authors.forename: Paul
authors.initials: P
authors.lastname: Bebbington
authors.affiliation: Professor of Biomedical Statistics, Centre for Biostatistics, University of Manchester, Manchester, England.
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Professor of Clinical Psychology, Department of Psychiatry, University of Oxford, Oxford, England.
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
authors.affiliation: Professor of Social Psychiatry, Department of Psychiatry, University of East Anglia, Norfolk, England.
authors.forename: David
authors.initials: D
authors.lastname: Fowler
authors.affiliation: Professor of Clinical Psychology, Institute of Psychiatry, King's College London, London, England; Professor of Clinical Psychology, Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust, Institute of Psychiatry, King's College London, London, England.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kuipers
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000374:Aggression / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D017281:Cost of Illness; D004739:England; D019260:Expressed Emotion; D005195:Family Relations; D005196:Family Therapy; D005260:Female; D006791:Hostility; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D012008:Recurrence; D012307:Risk Factors; D012649:Self Concept; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D014754:Violence / Q000517:prevention & control* / Q000523:psychology*