Violence and Victimization in Adults with Mental Illness

描述（由申请人提供）：与普通公众相比，患有精神疾病的人实施暴力和成为暴力受害者的风险更高。实施或遭受暴力侵害的风险增加是一个重大的公共卫生问题。除了造成人身伤害外，暴力事件对肇事者和受害者都是毁灭性的，对公众来说代价高昂。这些事件加速了个人自由的丧失；需要昂贵的干预措施；延续耻辱;扰乱护理的连续性。虽然暴力和受害是相互关联的，但这两个事件也与其他因素交织在一起，包括精神病症状、物质使用和药物依从性。然而，很少有研究评论与预防和干预相关的动态风险和保护因素，或这些结果的独特和共同的原因和后果。拟议的R01申请将采用一种最先进的策略，即综合数据分析（IDA），将来自五项研究（包括NIMH资助的三项研究）的原始数据结合起来，这些研究使用相同的暴力和受害措施，并允许为所有独立变量开发一个共同的度量标准。我们的主要分析方法将依靠潜在增长曲线模型来检验精神疾病、暴力和受害之间的纵向关联。本文提出的项目将扩大与成年精神疾病患者的暴力和受害有关的临床、经验和理论文献。结果有可能产生重大的公共卫生效益，并有助于有意义的临床发展。在短期内，在我们的假设得到支持之前，我们将通过收集原始数据提交一份治疗效果RCT (R01)，以解决该二次数据分析项目的设计局限性。然而，我们也期望确定一个治疗耐药亚组（假设5），这将需要额外的治疗开发和验证工作。因此，我们还计划提交一份R34（随后是一项更大规模的RCT），以开发、实施和评估针对这一高风险、高需求群体的发病前状况、动态风险和保护因素的治疗方法。总而言之，通过采用创新的统计、方法和理论方法，拟议的项目是迈向精神卫生保健新时代的重要一步，旨在改善重度精神障碍成年人及其所在社区的生活质量。

DESCRIPTION (provided by applicant): Persons with mental illness are at increased risk of perpetrating and being the victims of violence compared to members of the general public. This increased risk for perpetrating or experiencing violent victimization is a substantial public health concern. Aside from the resultant physical harm, violent events are ruinous to its perpetrators and victims and costly to the public. These events precipitate the loss of personal liberty; necessitate expensive interventions; perpetuate stigma; and disrupt continuity of care. While violence and victimization are related to each other, both events are also intertwined with other factors, including psychotic symptoms, substance use, and medication adherence. Still, few studies comment on dynamic risk and protective factors relevant to prevention and intervention, or the unique and shared causes and consequences of these outcomes. The proposed R01 application will employ a state-of-the-art strategy, integrated data analysis (IDA), to combine raw data from five studies (including three funded by NIMH) that used the same measures of violence and victimization, and allow for the development a common metric for all independent variables. Our main analytic approach will rely on latent growth curve modeling to examine longitudinal associations between mental illness, violence, and victimization. The project proposed herein will expand the clinical, empirical and theoretical literature relating to violence and victimization among adults with mental illness. Outcomes have the potential to yield significant public health benefits and to contribute to meaningful clinical developments. In the short-term, pending support of our hypotheses, we will submit a treatment effectiveness RCT (R01) addressing the design limitations of this secondary data analysis project through collection of original data. However, we also anticipate identifying a treatment resistant subgroup (Hypothesis 5), for whom additional treatment development and validation work would be needed. As such, we also plan to submit an R34 (followed by a larger scale RCT) to develop, implement and evaluate treatment(s) that target premorbid conditions and dynamic risk and protective factors in this high risk, high need group. In sum, by utilizing innovative statistical, methodological and theoretical approaches, the proposed project is an important step towards ushering in a new era of mental healthcare to improve quality of life for adults with SMI and the communities in which they reside. PUBLIC HEALTH RELEVANCE: Outcomes from this project, in which we propose to combine raw data from five independent studies to assess the prevalence, antecedents, consequences and treatment outcomes for violence and victimization among adults with SMI, will have important implications for improving detection, clinical practice and public policy to help reduce or prevent violence in this vulnerable population. Violence and victimization represent significant public health concerns as the prevalence of each is significantly higher in persons with mental illness compared to rates found in the general population. Secondary data analysis is a popular and cost-efficient way to extend the yield of existing data and develop new knowledge. This application is an important stand-alone contribution with the potential to improve public health and safety, and to advance our clinical and theoretical understanding of mental illness, violence and victimization. We will accomplish these goals through ongoing evaluation and refinement of a clinically-relevant theoretical model, using a multi-step theory-to-treatment research process.