Tuesday, April 3, 2018

Risk of Victimization Is High in Patients With Psychosis, Meta-Analysis Finds

A meta-analysis in Schizophrenia Bulletin found that rates of victimization were between 4 and 6 times higher among individuals with psychosis than in the general community.

“Every year approximately 1 in 5 individuals with a psychotic disorder becomes victimized,” wrote Bertine de Vries, Ph.D., and colleagues at the University of Groningen, the Netherlands. “Clinical factors such as hallucinations, delusions, manic symptoms, and a personality disorder may increase target attractiveness.”

The researchers searched the literature for studies reporting victimization rates among individuals with a diagnosis in the psychosis spectrum according to DSM-5, DSM-IV, DSM-III-R, or ICD criteria. Four categories of victimization were distinguished: violent victimization, sexual victimization, nonviolent victimization, and victimization not otherwise specified (studies that did not differentiate between victimization types or gave total score based on more than one type).

A total of 27 studies were included in the meta-analysis. When victimization was examined over a short period (less than 3 years) approximately 1 in 5 patients reported violent, nonviolent, sexual, or victimization not otherwise specified. When victimization was examined during their entire adulthood, 2 out of 3 people were found to have been a victim of violent victimization, and 39% reported nonviolent victimization. The median prevalence rate of sexual victimization among individuals with psychosis over their entire adulthood was 27%.

Clinical risk factors for victimization included delusions and hallucinations, the presence of a personality disorder, and/or manic symptoms. The meta-analysis also revealed that both drug and alcohol misuse and abuse are associated with victimization.

“The offender may see someone with many symptoms as an easy target, or they may provoke anger or aggression more easily in potential offenders,” de Vries and colleagues wrote. “People whose social functioning is impaired face additional risks because they may not be able to develop a social network that protects them and because they may have difficulty [detecting] social threats in time.”

The authors concluded, “More prospective research is needed to capture the causal trajectories of victimization and investigate mediating or moderating factors that protect or increase the victimization risk.”

For more information, see the Psychiatric News article “Schizophrenia and Violence Risk: Media Distort the Picture” and the Psychiatric Services article “Violence to Others, Violent Self-Victimization, and Violent Victimization by Others Among Persons With a Mental Illness.”

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