Epidemiological Study on Factors Associated with Severe Violent Offending

Substance use disorders (SUDs), antisocial personality disorder (APD), borderline personality disorder, conduct disorder, and major mental disorders (MMDs) are associated with violent crime in the general population. Comorbid SUD has been observed to increase the risk of violent crime in MMD, but the role of coexisting personality disorders (PDs) in severe violence of persons with MMD has remained unclear. Study I assessed the prevalence of lifetime psychiatric disorders with the Structured Clinical Interview for DSM-IV Disorders, using both personal interviews and lifetime objective data, in a nationally representative sample of men with MMD and homicidal behaviour (N=90). Three diagnostic categories were identified: 47% of the offenders had triple disorder (MMD+APD+SUD), 27% had dual disorder (MMD+SUD), and 26% had pure MMD. The category (MMD+APD, no SUD) was absent. Study II (N=58) indicated that the homicidal behaviour of offenders with triple disorder was more often associated with arguments/fights with non-relatives when intoxicated; whereas persons with pure MMD more often killed relatives as a result of delusions. APD is a risk factor for severe violence in MMD, and always seems to be linked with co-existing SUD among homicide offenders with MMD. Prevention of severe violence among persons with MMD necessitates effective treatments for triple disorder. Dual disorder without APD may be a different syndrome than triple disorder, and may not increase the risk of severe violence in MMD. It has been problematic to estimate the need for preventive interventions in respect of the environmental risks that may result in violent and chronic offending among high-risk children, because no data on quantitative risk ratios have been available. In studies III and IV, the criminal and prison files of the children (G1) and parents (G3) of homicide recidivists (HR), extracted from the prison files of the 1584 homicide offenders convicted in Finland during the years 1981–1993, were compared with data from matched controls. Among the parents (G3) the risk was increased up to 24-fold for violent crimes (p=0.01), and 17-fold for any criminality (p=0.0008). Among the children (G1), the OR for committing any crime was 5.0 (95% CI=1.323.1) but the risk for violent offending was not significantly increased (OR=3.1, 95% CI=0.337.6). The prevalence of index persons convicted of any crime (versus controls) was 13.2% (vs. 2.9%) in G1 and 36.4% (vs. 3.2%) in G3. Only 4.4% (vs. 1.5%) of G1 index parents, as compared to 18.2% (vs. 0.9%) of G3, had convictions for violent crimes. The disparity between index and control groups increased across generations both in the proportion of violent offenders (p=0.0023) and in the proportion of all criminal offenders (p=0.0019). The results indicated for the first time that it is possible to estimate the OR of later violent offending and criminality among groups of children on the basis of parental violent crime (homicide recidivism). The study also revealed the first evidence of inter-generational transmission of violent crime from violent parents to their offspring. National Library of Medicine Classification: WM 190, WM 203, WM 270, WM 600 Medical Subject Headings: Adolescent; Adult; Antisocial Personality Disorder/diagnosis; Antisocial Personality Disorder/epidemiology; Antisocial Personality Disorder/psychology; Child; Child of Impaired Parents; Crime/prevention and control; Crime/psychology; Dangerous Behavior; Diagnosis, Dual (Psychiatry); Finland/epidemiology; Homicide/psychology; Intergenerational Relations; Mental Disorders/complications; Mental Disorders/psychology; Parents/psychology; Prevalence; Psychiatric Status Rating Scales; Risk Factors; Schizophrenia; Substance-Related Disorders/epidemiology; Substance-Related Disorders/psychology; Time Factors; Violence/prevention and control; Violence/psychology Putkonen, Anu. Mielenterveyshäiriöt ja väkivaltarikollisuus väkivaltarikollisuuteen liittyvistä tekijöistä. Epidemiologinen tutkimus vakavaan Kuopion yliopiston julkaisuja D. Lääketiede 422. 2007. 89 s. ISBN 978-951-27-0942-7 ISBN 978-951-27-0759-1 (PDF) ISSN 1235-0303