Experiences of violence among people with mental disorders in the context of social, biographical and institutional factors. A mixed-method study

与普通人群相比，患有严重精神障碍的人成为受害者的风险要高得多。暴力经历不仅会造成身体伤害，还会对心理健康和康复进程产生负面影响。在心理健康环境中，服务使用者的暴力经历(包括暴力行为)往往没有得到心理健康专业人员的充分重视。在德国，缺乏关于严重精神疾病患者中的暴力行为的实证研究。在一项包括标准化方法和顺序解释设计的混合方法研究中，我们将致力于调查严重精神障碍患者中暴力事件的发生率，全面了解社会、传记和机构背景因素，并确定在精神健康环境中解决暴力经历的障碍。我们的研究包括以下内容：(1)在住院和门诊精神卫生环境中接受治疗的严重精神障碍患者的代表性样本(n=500)中，我们将调查在精神卫生环境中受害和暴力行为、在暴力方面的污名化和自我污名化以及披露暴力经历的障碍的发生率。数据将从5家在固定日期进行强制护理的精神病院的样本中获得。为了与一般人群进行比较，我们使用了具有代表性的在线样本(n=1000)。(2)在此基础上，我们对严重精神障碍患者(n=40)进行了定性访谈，这些人报告了超出界限的暴力经历。使用传记-叙事访谈，我们关注社会、传记和规范的背景。(3)采用定性和定量相结合的研究方法，考察心理卫生从业人员应对心理卫生服务对象暴力体验的经验和策略。在全球范围内，针对严重精神障碍患者的暴力是一个紧迫的问题。通过我们的研究，我们将大大有助于全面了解受害情况，研究结果将为制定旨在预防和减少受害行为的干预措施提供背景。在全球范围内，对严重精神障碍患者的暴力行为是一个紧迫的问题。为了制定预防和减少受害的干预措施，重要的是系统地评估精神卫生服务使用者的暴力经历，了解对暴力经历的主观观点，并纳入社会、传记和体制因素。

People with severe mental disorders are at significantly higher risk for being victimised compared to the general population. Experiences of violence not only causes physical injuries but has negative effects on mental health and recovery processes. In mental health settings, services users’ violence experiences (including violent acts) are often not sufficiently addressed by mental health professionals. In Germany, there is a lack of empirical studies on violence among people with severe mental illness. In a mixed-method study including standardised methods and a sequential explanatory design, we will aim at the investigation of prevalences of violent incidents among people with severe mental disorders, a comprehensive understanding of the social, biographical and institutional context factors, and the identification of barriers for addressing experiences of violence within mental health settings. Our study includes the following: (1) In a representative sample (n=500) of people with severe mental disorders, treated in in-patient and out-patient mental health settings, we will investigate the prevalence of victimization and violent behavior, stigmatization and self-stigmatization with regard to violence, and barriers for disclosure of violence experiences within mental health settings. Data will be obtained from samples at 5 psychiatric hospitals with mandatory care on a fixed day. For comparisons with the general population, we use a representative online sample (n=1000). (2) Based on this, we conduct qualitative interviews with a sub-sample of persons with severe mental disorders (n=40) who reported violence experiences beyond a cut-off. Using biographic-narrative interviews we focus on the social, biographical, and normative context. (3) In addition, we use qualitative and quantitative measures to investigate mental health professionals’ experiences and strategies to deal with mental health clients’ experiences of violence. Wordwide, violence against people with severe mental disorders is a pressing problem. With our study, we will significantly contribute to a comprehensive understanding of victimisation and the study findings provide the background for the development of interventions aiming at the prevention and reduction of victimization.Wordwide, violence against people with severe mental disorders is a pressing problem. In order to develop interventions to prevent and reduce victimisation, it is important to systematically assess mental health service users’ experiences of violence, to understand the subjective perspectives on experiences of violence and to include social, biographical and institutional factors.