Bipolar Disorder and Violent Crime New Evidence From Population-Based Longitudinal Studies and Systematic Review
Bipolar Disorder and Violent Crime New Evidence From Population-Based Longitudinal Studies and Systematic Review
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DOI：
10.1001/archgenpsychiatry.2010.97
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发表时间：
2010-09-01
影响因子：
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通讯作者：
Langstrom, Niklas
中科院分区：
文献类型：
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作者：
Fazel, Seena;Lichtenstein, Paul;Langstrom, Niklas
内容：虽然双相情感障碍与各种不良的健康结果有关，但与暴力犯罪的关系尚不确定。目的：确定双相情感障碍中暴力犯罪的风险，并将研究结果与系统回顾联系起来。设计：使用普通人群和未受影响的同胞对照个体进行纵向调查。设置：从1973年1月1日到2004年12月31日，瑞典基于人口的出院诊断、社会人口信息和暴力犯罪登记。有2个或更多双相情感障碍出院诊断的个体（n=3743），一般人群对照（n= 37429）和双相情感障碍患者未受影响的同胞（n=4059）。主要结果测量：暴力犯罪（导致杀人、殴打、抢劫、纵火、任何性犯罪、非法威胁或恐吓的行为）。结果：在随访期间，314名双相情感障碍患者（8.4%）与1312名普通人群对照组（3.5%）相比犯下了暴力犯罪（调整后的比值比，2.3; 95%置信区间，2.0-2.6）。该风险主要局限于药物滥用合并症患者（校正比值比，6.4; 95%置信区间，5.1-8.1）。无药物滥用合并症的患者风险增加最小（校正比值比，1.3; 95%置信区间，1.0-1.5），当双相情感障碍患者未受影响的同胞作为对照时，风险增加进一步减弱（1.1; 0.7-1.6）。我们发现临床亚组（躁狂与抑郁或精神病与非精神病）的暴力犯罪率没有差异。系统性综述识别了8项既往研究（n=6383），研究间异质性较高。暴力风险的比值比范围为2 ~ 9。结论：虽然目前双相情感障碍患者的管理指南不推荐常规的暴力风险评估，但在共病药物滥用患者中，这种说法可能需要重新审查。
Context: Although bipolar disorder is associated with various adverse health outcomes, the relationship with violent crime is uncertain.Objectives: To determine the risk of violent crime in bipolar disorder and to contextualize the findings with a systematic review.Design: Longitudinal investigations using general population and unaffected sibling control individuals.Setting: Population-based registers of hospital discharge diagnoses, sociodemographic information, and violent crime in Sweden from January 1, 1973, through December 31, 2004.Participants: Individuals with 2 or more discharge diagnoses of bipolar disorder (n=3743), general population controls (n=37 429), and unaffected full siblings of individuals with bipolar disorder (n=4059).Main Outcome Measure: Violent crime (actions resulting in convictions for homicide, assault, robbery, arson, any sexual offense, illegal threats, or intimidation).Results: During follow-up, 314 individuals with bipolar disorder (8.4%) committed violent crime compared with 1312 general population controls (3.5%) (adjusted odds ratio, 2.3; 95% confidence interval, 2.0-2.6). The risk was mostly confined to patients with substance abuse comorbidity (adjusted odds ratio, 6.4; 95% confidence interval, 5.1-8.1). The risk increase was minimal in patients without substance abuse comorbidity (adjusted odds ratio, 1.3; 95% confidence interval, 1.0-1.5), which was further attenuated when unaffected full siblings of individuals with bipolar disorder were used as controls (1.1; 0.7-1.6). We found no differences in rates of violent crime by clinical subgroups (manic vs depressive or psychotic vs nonpsychotic). The systematic review identified 8 previous studies (n=6383), with high heterogeneity between studies. Odds ratio for violence risk ranged from 2 to 9.Conclusion: Although current guidelines for the management of individuals with bipolar disorder do not recommend routine risk assessment for violence, this assertion may need review in patients with comorbid substance abuse.