Factors Correlated with Violence Committed By Persons with Psychiatric Disorders Against a Relative

Background and Purpose:While most persons with psychiatric disorders (PD) such as schizophrenia, bipolar, and major depressive disorder do not engage in violence, epidemiological studies indicate that said persons are at an increased risk of committing violence, with half of all such violence being committed against relatives.  Despite the high prevalence rate of family violence committed by persons with PD, little research has been conducted in this area.  After reviewing the literature regarding family violence committed by this population and proximal fields, the present study sought to answer the following question: To what extent are proposed perpetrator, victim, and interaction factors associated with the occurrence of family violence committed by persons with PD?

Methods:A cross-sectional survey design was used.  Between July 2014 and February 2015, 573 adults, living in at least 42 states in the U.S., with an adult relative with PD completed an online survey.  Respondents were recruited through advertisements made with a myriad of non-profit organizations across America including food banks, disability rights organizations, departments of aging, and mental health advocacy/support organizations.  Respondents provided information regarding themselves, their relative with PD, and the interactions they and their relative with PD have with each other.  By adapting the MacArthur Community Violence Instrument, violence committed by the relative with PD towards respondents in the past 6 months was assessed.  With the use of multivariate logistic regression, factors associated with the occurrence of violence were explored. 

Results:Twenty two percent of respondents (n = 124) reported that their relative with PD had committed at least one act of violence against them in the past 6 months.  While controlling for other significant covariates, the following factors were found to be significantly associated with the occurrence of violence: Perpetrator factors—recent psychiatric hospitalization,  non-attendance of mental health treatment, and use of illegal drugs; Victim factors—below median level of income, being a non-parental family member, and having a mental health diagnosis; Interaction factors—serving as a representative payee for the relative with PD or unofficially managing their income, co-residence and exercising high levels of limit setting and financial coercion towards the relative with PD.  Respondents who provided high levels of caregiving for their relative with PD were at an increased risk of experiencing violence, however, the majority of this relationship was mediated through limit setting practices. 

Conclusion: Social work practitioners and policy makers should be aware of the risk of family violence.  Social workers may better serve clients with PD by inquiring about the risk/occurrence of family violence and conflict and intervening to prevent violence—especially when clients and family members endorse several risk factors.  While more research is needed, risk of violence appears strongly impacted by the presence of money management, limit setting practices, and the use of financial coercion.  As such, risk of violence may be ameliorated by social workers providing services to clients and their relatives regarding strategies for managing money and setting limits that do not result in conflict.