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Arch Gen Psychiatry. 2010 Sep;67(9):931-8. doi: 10.1001/archgenpsychiatry.2010.97.

Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review.

Author information

1
Department of Psychiatry, University of Oxford, Warneford Hospital, England. seena.fazel@psych.ox.ac.uk

Abstract

CONTEXT:

Although bipolar disorder is associated with various adverse health outcomes, the relationship with violent crime is uncertain.

OBJECTIVES:

To determine the risk of violent crime in bipolar disorder and to contextualize the findings with a systematic review.

DESIGN:

Longitudinal investigations using general population and unaffected sibling control individuals.

SETTING:

Population-based registers of hospital discharge diagnoses, sociodemographic information, and violent crime in Sweden from January 1, 1973, through December 31, 2004.

PARTICIPANTS:

Individuals with 2 or more discharge diagnoses of bipolar disorder (n = 3743), general population controls (n = 37 429), and unaffected full siblings of individuals with bipolar disorder (n = 4059).

MAIN OUTCOME MEASURE:

Violent crime (actions resulting in convictions for homicide, assault, robbery, arson, any sexual offense, illegal threats, or intimidation).

RESULTS:

During follow-up, 314 individuals with bipolar disorder (8.4%) committed violent crime compared with 1312 general population controls (3.5%) (adjusted odds ratio, 2.3; 95% confidence interval, 2.0-2.6). The risk was mostly confined to patients with substance abuse comorbidity (adjusted odds ratio, 6.4; 95% confidence interval, 5.1-8.1). The risk increase was minimal in patients without substance abuse comorbidity (adjusted odds ratio, 1.3; 95% confidence interval, 1.0-1.5), which was further attenuated when unaffected full siblings of individuals with bipolar disorder were used as controls (1.1; 0.7-1.6). We found no differences in rates of violent crime by clinical subgroups (manic vs depressive or psychotic vs nonpsychotic). The systematic review identified 8 previous studies (n = 6383), with high heterogeneity between studies. Odds ratio for violence risk ranged from 2 to 9.

CONCLUSION:

Although current guidelines for the management of individuals with bipolar disorder do not recommend routine risk assessment for violence, this assertion may need review in patients with comorbid substance abuse.

[Indexed for MEDLINE]

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