title: Leading indicators of community-based violent events among adults with mental illness.
abstract: BACKGROUND
  The public health, public safety and clinical implications of violent events among adults with mental illness are significant; however, the causes and consequences of violence and victimization among adults with mental illness are complex and not well understood, which limits the effectiveness of clinical interventions and risk management strategies. This study examined interrelationships between violence, victimization, psychiatric symptoms, substance use, homelessness and in-patient treatment over time.
  
  
  METHODS
  Available data were integrated from four longitudinal studies of adults with mental illness. Assessments took place at baseline, and at 1, 3, 6, 9, 12, 15, 18, 24, 30 and 36 months, depending on the parent studies' protocol. Data were analysed with the autoregressive cross-lag model.
  
  
  RESULTS
  Violence and victimization were leading indicators of each other and affective symptoms were a leading indicator of both. Drug and alcohol use were leading indicators of violence and victimization, respectively. All psychiatric symptom clusters - affective, positive, negative, disorganized cognitive processing - increased the likelihood of experiencing at least one subsequent symptom cluster. Sensitivity analyses identified few group-based differences in the magnitude of effects in this heterogeneous sample.
  
  
  CONCLUSIONS
  Violent events demonstrated unique and shared indicators and consequences over time. Findings indicate mechanisms for reducing violent events, including trauma-informed therapy, targeting internalizing and externalizing affective symptoms with cognitive-behavioral and psychopharmacological interventions, and integrating substance use and psychiatric care. Finally, mental illness and violence and victimization research should move beyond demonstrating concomitant relationships and instead focus on lagged effects with improved spatio-temporal contiguity.
authors.affiliation: Behavioral and Urban Health Program, RTI International,Research Triangle Park, NC,USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Van Dorn
authors.affiliation: Department of Psychology,Arizona State University,Tempe, AZ,USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Grimm
authors.affiliation: Department of Psychology,North Carolina State University,Raleigh, NC,USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Desmarais
authors.affiliation: Behavioral and Urban Health Program, RTI International,Research Triangle Park, NC,USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Tueller
authors.affiliation: Behavioral and Urban Health Program, RTI International,Research Triangle Park, NC,USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Johnson
authors.affiliation: Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham, NC,USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Swartz
mesh_terms: D000328:Adult; D019548:Crime Victims / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D014754:Violence / Q000706:statistics & numerical data*
keywords: Autoregressive cross-lag; longitudinal studies; mental illness; victimization; violence.