背景:尽管只有少数患有严重精神障碍(SMD)的患者可以在社区中实施暴力行为,暴力行为加剧了对SMD患者的污名。了解暴力行为的亚型可能有助于预防SMD患者的暴力行为,但它很少被研究。
方法:这项纵向研究在基线时调查了社区中1914例SMD患者,随访期为2021年2月至2021年8月。巴拉特冲动量表第11版,巴斯-佩里侵略问卷,冲动/预谋攻击量表,在基线时使用人格诊断问卷和麦克阿瑟社区暴力工具。使用改良的公开攻击量表评估随访期间暴力行为的发生(结果)。Cox回归模型用于计算具有95%置信区间(CI)的风险比(HR)。潜在类别分析用于表征在随访中从事暴力行为的SMD患者的亚型。
结果:我们发现7.2%的SMD患者在社区6个月内出现暴力行为。年龄较小(OR=0.98,95%CI=0.96-1.00,p=0.016)和无经济来源(OR=1.60,95%CI=1.10-2.33,p=0.014)是暴力行为的危险因素。从事暴力行为的SMD患者可以分为三种亚型:一类以暴力和冲动性病史为特征,另一类以高水平的攻击性和运动冲动为特征,最后一类以认知冲动为特征。
结论:社会人口统计学因素是SMD患者暴力行为的危险因素,这可以消除对这个群体的歧视。冲动性在识别从事暴力行为的SMD患者的三种亚型中起着至关重要的作用。这些发现可能有助于为在社区实施暴力行为的SMD患者制定个性化暴力风险管理计划。
BACKGROUND: Although only a few patients with severe mental disorders (SMD) can commit violent behaviour in the community, violent behaviour aggravates the stigma towards patients with SMD. Understanding the subtypes of violent behaviour may be beneficial for preventing violent behaviour among patients with SMD, but it has rarely been studied.
METHODS: This longitudinal study investigated 1914 patients with SMD in the community at baseline, and the follow-up period ranged from February 2021 to August 2021. The Barratt Impulsiveness Scale Version-11, the Buss-Perry
Aggression Questionnaire, the Impulsive/Premeditated
Aggression Scale, the Personality Diagnostic Questionnaire and the MacArthur Community Violence Instrument were used at baseline. The Modified Overt
Aggression Scale was used to assess the occurrence of violent behaviour (outcome) during the follow-up period. Cox regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Latent class analysis was used to characterise the subtypes of patients with SMD who engaged in violent behaviour at follow-up.
RESULTS: We found that 7.2% of patients with SMD presented violent behaviour within six months in the community. Younger age (OR = 0.98, 95% CI = 0.96-1.00, p = 0.016) and no economic source (OR = 1.60, 95% CI = 1.10-2.33, p = 0.014) were risk factors for violent behaviour. Patients with SMD who engaged in violent behaviour could be classified into three subtypes: one class characterised by a history of violence and impulsivity, another class characterised by high levels of
aggression and motor impulsivity, and the last class characterised by median cognitive impulsivity.
CONCLUSIONS: Socio-demographic factors were risk factors for violent behaviour among patients with SMD, which could eliminate the discrimination toward this group. Impulsivity played a vital role in identifying the three subtypes of patients with SMD who engaged in violent behaviour. These findings may be helpful for the development of a personalised violence risk management plan for patients with SMD who commit violent behaviour in the community.