Recent victimization increases risk for violence in justice-involved persons with mental illness. This is the bottom line of a recently published article in Law and Human Behavior. Below is a summary of the research and findings as well as a translation of this research into practice.
Featured Article | Law and Human Behavior | 2014, Vol. 38, No. 2, 119-125
Recent Victimization Increases Risk for Violence in Justice-Involved Persons With Mental Illness
AuthorsNaomi Sadeh, University of California, San Francisco Renée L. Binder, University of California, San Francisco Dale E. McNiel, University of California, San Francisco
A large body of research has examined relationships between distal experiences of victimization and the likelihood of engaging in violence later in life. Less is known about the influence of recent violent victimization on risk for violence perpetration. To our knowledge, this is the first study to examine prospectively whether recent victimization in adulthood increases the risk of future violence. Specifically, the present study assessed the incremental validity of recent violent victimization in the prediction of future violence in a sample of justice-involved adults with serious mental illness. The study examined (a) whether recent experiences of violent victimization (i.e., within 6 months of the baseline assessment) predicted a greater likelihood of perpetrating violence in the next year, and (b) whether inclusion of recent victimization enhanced the predictive validity of a model of violence risk in a sample of justice-involved adults with severe mental illness (N = 167). Hierarchical logistic regression analyses indicated that exposure to recent violent victimization at the baseline assessment predicted a greater likelihood of engaging in violent behavior during the year follow-up period. Additionally, recent exposure to violence at the baseline assessment continued to explain a significant amount of variance in a model of future violence perpetration above the variance accounted for by well-established violence risk factors. Taken together, the findings suggest that recent victimization is important to consider in understanding and evaluating risk of violence by persons with mental disorders who are involved in the criminal justice system.
recent victimization, violence, mental illness, criminal justice system
Summary of the Research
“The purpose of the present study was to assess the incremental validity of violent victimization in the prediction of violence risk by assessing (a) whether recent experiences of violent victimization (i.e., within 6 months of the baseline assessment) predicted a greater likelihood of perpetrating violence in the next year, and (b) whether inclusion of recent victimization enhanced the predictive validity of a model of short-term violence risk that included other well-established risk factors. Risk factors that have been found consistently in previous research to be significant predictors of violence were included in the analysis of incremental validity, including demographic characteristics (i.e., age, gender), distal experiences of victimization (i.e., a history of childhood physical abuse), personality traits (i.e., anger, impulsivity), mental health symptoms (i.e., 30-day drug and alcohol use, psychiatric symptoms in the last month), and a recent history of violent behavior” (p. 120).
The study employed a prospective research design wherein participants were interviewed at baseline and then again at 6 and 12 months. Individuals were eligible to participate in the study if they were at least 18 years, spoke English, were diagnosed with a mental illness (primary diagnosis of mental retardation or developmental disability excluded), and were incarcerated for fewer than 60 days at the time of initial interview. Baseline and follow-up data (6 and 12-month combined) were obtained for 167 participants, 75% of whom were male, ranging in age from 19 to 63 with an average age of 38.3 (SD = 10.5).
Mood disorders (54%), schizophrenia (37%), and anxiety disorders (8%) were the most common diagnoses; a co-occurring diagnosis of substance use disorder was present for 89.2% of the sample.
Baseline and follow-up structured interviews were conducted to evaluate a number of traits and characteristics including: recent violent victimization (3-item modified version of the Conflict Tactics Scale), childhood physical abuse (Sub-scale of the Parent-Child Conflict Tactics Scale), trait anger (4-item version of the Behavior Subscale of the Novaco Anger Scale), impulsivity (10-item Motor Impulsiveness subscale of the Barratt Impulsiveness Scale Version-10), psychiatric symptoms (Colorado Symptom Index), 30-day alcohol and substance use, and recent history of violence. At follow-up, participants were also asked about the violence perpetration since the baseline interview (using a modified version of the Physical Assault Scale from the Revised Conflict Tactics Scale).
Results indicated that victimization experiences in the 6 months prior to baseline assessment predicted violence during the follow-up period. That is, “of individuals who reported engaging in violence during the year follow-up period, a higher proportion endorsed a recent history of violent victimization (85%) than did not (15%)” (p. 122).
Results also indicated that “recent violent victimization increased the likelihood of perpetrating violence during the year follow-up period when assessed in a model with other well-established predictors of violence” (p. 123). That is, recent violent victimization remains a significant predictor of future violence above and beyond other significant predictors in the model (frequency of physical abuse in childhood, trait anger, recent history of violence perpetration).
Translating Research into Practice
“The main finding of the study is that recent violent victimization is an important risk factor to consider when assessing risk for violence among justice-involved persons with serious mental illness. Specifically, violent victimization in the 6 months prior to the baseline assessment predicted a greater likelihood of perpetrating violence during the year follow-up period above the variance accounted for by other well-established risk factors for violence. This finding suggests that recent violent victimization adds incremental validity to models of future violence in samples of criminal-justice-involved persons with mental illness, a group that is especially vulnerable to exposure to victimization and is at elevated risk of perpetrating violence” (p. 123).
“Underscoring its relevance as a risk factor, recent victimization was an all-too-common experience in the study sample. Slightly over half of individuals endorsed a recent history of violent victimization, which replicates other research that finds higher rates of victimization among individuals with serious mental illness than those in the general population. Although a high percentage of the individuals who perpetrated violence during the follow-up period also reported a history of recent victimization, it is important to note than only 30% of individuals victimized in the 6 months prior to the baseline assessment perpetrated violence during the follow-up period. Thus, the majority of individuals with mental illness who experienced recent victimization did not later report perpetrating violence toward others. The present findings do suggest, however, that exposure to victimization increases the risk that persons with serious mental illness will engage in future violent behavior” (p. 123).
Other Interesting Tidbits for Researchers and Clinicians
“The present study cannot speak to potential causal relationships between victimization and violence, and more research is needed to further understanding of the processes by which victimization may increase violence risk. One possibility is that experiences of violent victimization create periods of increased stress and vulnerability that worsen mental health symptoms (e.g., substance abuse, posttraumatic stress symptoms) and activate preexisting tendencies toward violent behavior (e.g., personality traits). However, additional prospective research is needed to further unpack these relationships. It may be fruitful to examine potential moderators and mediators of the victimization-violence relationship to identify dynamic intervening variables (e.g., impulsiveness, anger, substance use, posttraumatic stress symptoms, antisocial attitudes) that may be amenable to treatment interventions” (p. 123).
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