@article{ref1,
title="Violence and severe mental illness: the effects of substance abuse and nonadherence to medication",
journal="American journal of psychiatry",
year="1998",
author="Swartz, M. S. and Swanson, Jeffrey W. and Hiday, V. A. and Borum, Randy and Wagner, H. R. and Burns, B. J.",
volume="155",
number="2",
pages="226-231",
abstract="OBJECTIVE: Violent behavior among individuals with severe mental illness has become an important focus in community-based care. This study examines the joint effect of substance abuse and medication noncompliance on the greater risk of serious violence among persons with severe mental illness. METHOD: Involuntarily admitted inpatients with severe mental illness who were awaiting a period of outpatient commitment were enrolled in a longitudinal outcome study. At baseline, 331 subjects underwent an extensive face-to-face interview. Complementary data were gathered by a review of hospital records and a telephone interview with a family member or other informant. These data included subjects' sociodemographic characteristics, illness history, clinical status, medication adherence, substance abuse, insight into illness, and violent behavior during the 4 months that preceded hospitalization. Associations between serious violent acts and a range of individual characteristics and problems were analyzed by using multivariable logistic regression. RESULTS: The combination of medication noncompliance and alcohol or substance abuse problems was significantly associated with serious violent acts in the community, after sociodemographic and clinical characteristics were controlled. CONCLUSIONS: Alcohol or other drug abuse problems combined with poor adherence to medication may signal a higher risk of violent behavior among persons with severe mental illness. Reduction of such risk may require carefully targeted community interventions, including integrated mental health and substance abuse treatment.<p /><p>Language: en</p>",
language="en",
issn="0002-953X",
doi="",
url="http://dx.doi.org/"
}