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Violence in women with psychosis in the community: prospective study

Department of Forensic Mental Health Science, Institute of Psychiatry, London

ELIZABETH WALSH, MD

Division of Psychological Medicine, Institute of Psychiatry, London

PAUL MORAN, MD

Department of Health Services Research, Institute of Psychiatry, London

PETER TYRER, MD

Division of Neuroscience and Psychological Medicine, Imperial College, London

FRANCIS CREED, MD

School of Psychiatry and Behavioural Sciences, University of Manchester

SARAH BYFORD, MSc

Centre for the Economics of Mental Health, Institute of Psychiatry, London

TOM BURNS, MD

Department of Psychiatry, University of Oxford

ROBIN MURRAY, DSc

Division of Psychological Medicine, Institute of Psychiatry, London

TOM FAHY, MD

Department of Forensic Mental Health Science, Institute of Psychiatry, London, UK

Correspondence: Dr Kimberlie Dean, PO 23, Department of Forensic Mental Health Science, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: +44 (0)20 7848 0771; fax +44 (0)20 7701 9044; e-mail: k.dean{at}iop.kcl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgement. P.T. is Editor of the British Journal of Psychiatry but had no partinthe evaluation of this paper for publication.

Background Little is known about the determinants of violence in women with psychosis.

Aims To identify predictors of violence in a community sample of women with chronic psychosis.

Method The 2-year prevalence of physical assault was estimated for a sample of 304 women with psychosis. Baseline socio-demographic and clinical factors were used to identify predictors of assault.

Results The 2-year prevalence of assault in the sample was 17%. Assaultive behaviour was associated with previous violence (OR=5.87,95% CI 2.42–14.25), non-violentconvictions (OR=2.63,95% CI 1.17–5.93), victimisation (OR=2.46, 95% CI1.02–5.93), African–Caribbean ethnicity (OR=2.24,95% CI1.02–4.77), cluster B personality disorder (OR=2.66, 95% CI1.11–6.38) and high levels of unmet need (OR=1.17,95% CI1.01–1.35). An interaction between African–Caribbean ethnicity and cluster B personality disorder was identified in relation to violent outcome. Violent women were found to be more costly to services.

Conclusions Nearly a fifth of community-dwelling women with chronic psychosis committed assault over a period of 2 years. Six independent risk factors were found to predict violence.

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