Victimization and Perpetration of Family Violence Among Persons with Serious Mental Illness

 

Background and Purpose: Persons with serious mental illness (SMI) are known to be at a considerably increased risk of being a victim and perpetrator of violence.  Despite approximately half of such violence occurring within families, few studies have examined family violence involving persons with SMI.  Additionally, while there is a wealth of indirect evidence indicating that mutual violence may play a considerable role in the victimization and perpetration of violence among persons with SMI, research studies have failed to examine the role of bidirectional violence in these phenomena.  After reviewing the available literature, it was proposed that victimization and perpetration of family violence among persons with SMI is associated with factors in three domains: 1) Persons with SMI, 2) Relatives, and 3) Interactions between persons with SMI and relatives.  The objective of the present investigation is to determine the extent to which proposed factors are associated with the occurrence of victimization and perpetration of family violence among persons with SMI.

Methods: A cross-sectional survey design was used.  Between December 29, 2015 and April 1, 2017, 523 persons with SMI completed a survey.   Respondents provided information regarding themselves, a reference relative (the relative with whom they spend the most time), and the interactions they and reference relatives have with each other. Using the MacArthur Community Violence Instrument, violence committed in the past 6 months by reference relatives towards persons with SMI, and vice versa, were measured.  Separate multivariate logistic regression models were estimated examining the association of proposed factors with the occurrence of victimization and perpetration of violence.    

Results: Thirteen percent (n = 67) of persons with SMI reported their reference relative committed violence towards them and 12% (n = 64) reported committing violence towards reference relatives.  Victimization and perpetration of violence co-occurred at statistically significant levels.  While controlling for significant covariates, the following factors were significantly associated with victimization of persons with SMI by reference relatives: Persons with SMI—income, use of mental health medications; Relatives—age, employment status; Interactions—psychological abuse by relatives, violence by persons with SMI. The following factors were significantly associated with perpetration of violence by persons with SMI towards reference relatives: Persons with SMI—history of ever committing serious violence; Relatives—age, relationship type; Interactions—psychological abuse by persons with SMI and relatives, violence by relatives, use of limit-setting practices. 

Conclusions and Implications: Practitioners and policy makers should be aware of the risk of victimization and perpetration of family violence among persons with SMI. Mutually engaged in conflict appears to play a considerable role in these phenomena.  As such, practitioners may better serve clients by assessing conflict in their familial relationships and intervening when appropriate.  Assessment and intervention is particularly apt when multiple risk factors are present.  While more research is needed, interventions aimed at decreasing psychological abuse may help de-escalate conflict and prevent physical violence.  Addressing medication adherence and the use of limit-setting practices in treatment may also decrease the risk of victimization and perpetration of violence.