Violence and Victimization in Adults with Mental Illness

患有精神疾病的成年人的暴力和受害情况

• 批准号: 8237197
• 负责人: Richard Van Dorn
• 金额: $ 17.32万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-18 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8237197
• 关键词: Address; Adult; Advance Directives; Alcohol consumption; Alcohol or Other Drugs use; Antipsychotic Agents; Caring; Clinical; Clinical Treatment; Clinical effectiveness; Collection; Communities; Continuity of Patient Care; Data; Data Analyses; Detection; Development; Drug usage; Effectiveness; Evaluation; Event; Freedom; Frequencies; Funding; General Population; Goals; Growth; Health Benefit; Healthcare; Incidence; Intervention; Intervention Trial; Investigation; Knowledge; Literature; Longitudinal Studies; Measurement; Measures; Mediating; Mediation; Mental disorders; Meta-Analysis; Methodology; Metric; Modeling; National Institute of Mental Health; Outcome; Outpatients; Persons; Pharmaceutical Preparations; Phase; Population; Prevalence; Prevalence Study; Preventive Intervention; Process; Psyche structure; Public Health; Public Policy; Published Comment; Quality of life; Recording of previous events; Reliance; Reporting; Research; Research Project Grants; Resistance; Risk; Risk Factors; Safety; Sampling; Schizophrenia; Sex Characteristics; Stigmata; Subgroup; Sum; Symptoms; Testing; Theoretical model; Time; Treatment Effectiveness; Treatment outcome; Validation; Victimization; Violence; Vulnerable Populations; Work; base; clinical practice; clinically relevant; cost; design; experience; high risk; improved; innovation; medication compliance; member; perpetrators; predictive modeling; racial difference; response; severe mental illness; social; social stigma; theories; therapy development; violence prevention

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.

描述（由申请人提供）：与普通公众相比，精神病患者实施暴力和成为暴力受害者的风险更高。暴力受害或经历暴力受害的风险增加，是一个重大的公共卫生问题。除了由此造成的身体伤害外，暴力事件对肇事者和受害者都是毁灭性的，并使公众付出高昂代价。这些事件加速了个人自由的丧失，需要昂贵的干预措施，使耻辱永久化，并破坏了护理的连续性。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有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应用程序将采用最先进的战略，综合数据分析（IDA），结合联合收割机的原始数据，从五个研究（包括三个由NIMH资助），使用相同的措施的暴力和受害，并允许开发一个共同的度量所有独立变量。我们的主要分析方法将依赖于潜在增长曲线模型来研究精神疾病，暴力和受害之间的纵向关联。本报告提议的项目将扩大与成年精神病患者之间的暴力和受害有关的临床、经验和理论文献。结果有可能产生显着的公共卫生效益，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，我们将提交一项治疗有效性RCT（R01），通过收集原始数据来解决该次要数据分析项目的设计局限性。然而，我们也预计会发现一个治疗耐药亚组（假设5），需要进行额外的治疗开发和验证工作。因此，我们还计划提交一项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、高需求人群的病前疾病和动态风险及保护因素的治疗。总之，通过利用创新的统计，方法和理论方法，拟议的项目是迈向精神保健新时代的重要一步，以改善患有SMI的成年人及其居住社区的生活质量。 公共卫生关系：该项目的成果，我们建议联合收割机原始数据从五个独立的研究，以评估流行率，前因，后果和治疗结果的暴力和受害的成年人与重度精神障碍，将有重要的影响，改善检测，临床实践和公共政策，以帮助减少或防止暴力在这一弱势群体。暴力和受害是重大的公共卫生问题，因为与一般人口相比，精神病患者中暴力和受害的发生率都要高得多。二级数据分析是一种流行且具有成本效益的方法，可以扩展现有数据的产量并开发新知识。这一应用是一个重要的独立贡献，有可能改善公共卫生和安全，并促进我们对精神疾病，暴力和受害的临床和理论理解。我们将通过对临床相关理论模型的持续评估和完善来实现这些目标，使用多步骤的理论治疗研究过程。