Risk of Exposure to Violence Among Adults with Mental Health Diagnoses at an Urban Hospital

Background: Previous research suggests that adults that have been diagnosed with a mental illness experience elevated rates of exposure to violence, but there is limited data on this association from high-crime and low-income urban areas, where such exposures may likewise be common among people without diagnoses. Additionally, prior studies have typically focused on direct victimization rather than on indirect exposure to community-level violence. Further, there is some evidence that rates of violence perpetration are higher among people with psychiatric diagnoses, but this appears to be primarily explained by confounding factors. The aims of this study were to assess the association between having a mental health diagnosis and exposure to direct- and community-level violence, as well as perpetration of violence, among adults receiving services at an urban hospital located in an area with exceptional high levels of violent crime.

Methods: Surveys were administered to patients in a family medicine department of a large urban hospital. Chi square analyses were used to determine whether adults with a self-reported diagnosis of a mental illness were at greater likelihood to experience exposure to community violence and personal victimization.

Results: Of the participants sampled, 43.2% had been diagnosed with a mental health issue in their lives, specifically, schizophrenia (4.5%), bipolar disorder (20.5%), major depressive disorder (18.2%), posttraumatic stress disorder (6.8%), obsessive compulsive disorder (43.2%), generalized anxiety disorder (9.1%), other anxiety disorder (11.4%), borderline personality disorder (2.3%), and other mental health condition (18.2%). In this sample, people who have been diagnosed with a mental illness are significantly more likely to know people in the community who have been: threatened with knives, guns, and other weapons; harmed by a weapon; hurt badly by another person; and sexually assaulted within the past 12 months than people who have not been diagnosed with a mental illness. Additionally, people who have been diagnosed with mental illnesses are more likely to be victimized than people who have not been diagnosed with a mental illness, including being more likely to report that physical assault victimization over the past year and more likely to have someone try to physically force sex against their will in their lifetimes. There were no significant associations between having been diagnosed with a mental illness and having exhibited violent behaviors toward others in the past 12 months.

Implications: The analyses confirmed that people who have been diagnosed with a mental illness are more likely to be victimized and exposed to community violence than people who have not been diagnosed with a mental illness, even in an urban setting with exceptionally high rates of violent crime. Conversely, mental illness diagnoses were not associated with perpetration of violence. This not only confirms a growing body of empirical literature on the direct and community-level risks faced by people with psychiatric diagnoses, and further dispels the myth that mentally ill people are more violent than the general population.