May 24, 2018
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Vulnerability to crime higher in people with mental illness

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Results from a national cohort study of more than 2 million people in Denmark showed that onset of mental illness was associated with heightened risk for exposure to violent and nonviolent crimes across multiple diagnostic categories.

“Research to date has focused more on the association between mental illness and an elevated risk of crime perpetration than on the heightened vulnerability to being subjected to nonviolent or violent crime,” Kimberlie Dean, PhD, of the School of Psychiatry, University of New South Wales, Australia, and colleagues wrote in JAMA Psychiatry. “Robust evidence is lacking to inform the development of preventive strategies, including initiatives aimed at improving the experience of persons with mental illness who report being subjected to crime and subsequently seek justice.”

In this longitudinal national cohort study, researchers examined the incidence of being subjected to all types of criminal offenses and violent crimes separately after onset of mental illness across the full spectrum of psychiatric diagnoses compared with those without mental illness in a Danish cohort of more than 2 million people born between 1965 and 1998 who were followed for over 10 years. Using register data, the investigators estimated incidence rate ratios for first subjection to crime event reported to police after onset of mental disorder. Adjustment was made for several sociodemographic factors.

Both men and women with any recorded mental disorder showed higher rates of being subjected to crime than those without, even after adjustment for sociodemographic factors (IRR = 1.68; 95% CI, 1.65-1.71 for men and IRR = 1.71; 95% CI, 1.68-1.73 for women) and after further adjustment for own criminal offending (IRR = 1.49; 95% CI, 1.46-1.51 and IRR = 1.64; 95% CI, 1.61-1.66). Analysis revealed associations between individual categories of mental disorders and the incidence of subjection to crime across psychiatric diagnostic spectrum for both sexes, with the strongest associations seen for substance use disorders and personality disorders.

The magnitude of the link between subjection to violent crime and mental disorders was considerably greater among women, after adjustment for sociodemographic factors and own criminal offending (IRR = 2.72; 95% CI, 2.65-2.79 for women vs. IRR = 1.76; 95% CI, 1.72-1.8 for men). These associations were also found across the psychiatric diagnostic spectrum, with the strongest link seen for in those with substance use disorders and personality disorders.

“At a policy level, our findings have the potential to contribute to efforts to remedy public misconceptions about mental illness, often fueled by selective and pejorative media reporting, with the ultimate aim of reducing stigma,” Dean and colleagues concluded. “Our results highlight the need for further research to determine more fully why some people with mental illnesses are especially vulnerable to being subjected to crime (eg, those with substance use and personality disorders) and to develop effective interventions to reduce the elevated risk.”

Jeffrey Swanson
Jeffrey W. Swanson

These findings raise questions about the nature of the link between mental illness and subjection to crime, Jeffrey W. Swanson, PhD, and Charles M. Belden, PhD, from department of psychiatry and behavioral sciences, social and community psychiatry, Duke University School of Medicine, wrote in an accompanying comment.

“We still do not understand much about the relative contribution of psychopathology vs. other interrelated variables that may partially explain the association between mental illness and being a target for crime — factors such as adverse childhood experiences, social disadvantage, economic deprivation, residential instability and varying exposure to ambient crime,” they wrote. “Further research and intervention development are indeed necessary.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.

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