Population-based studies on violent crime and background factors may provide an understanding of the relationships between susceptibility factors and crime. We aimed to determine the distribution of violent crime convictions in the Swedish population 1973-2004 and to identify criminal, academic, parental, and psychiatric risk factors for persistence in violent crime.
The nationwide multi-generation register was used with many other linked nationwide registers to select participants. All individuals born in 1958-1980 (2,393,765 individuals) were included. Persistent violent offenders (those with a lifetime history of three or more violent crime convictions) were compared with individuals having one or two such convictions, and to matched non-offenders. Independent variables were gender, age of first conviction for a violent crime, nonviolent crime convictions, and diagnoses for major mental disorders, personality disorders, and substance use disorders.
A total of 93,642 individuals (3.9%) had at least one violent conviction. The distribution of convictions was highly skewed; 24,342 persistent violent offenders (1.0% of the total population) accounted for 63.2% of all convictions. Persistence in violence was associated with male sex (OR 2.5), personality disorder (OR 2.3), violent crime conviction before age 19 (OR 2.0), drug-related offenses (OR 1.9), nonviolent criminality (OR 1.9), substance use disorder (OR 1.9), and major mental disorder (OR 1.3).
The majority of violent crimes are perpetrated by a small number of persistent violent offenders, typically males, characterized by early onset of violent criminality, substance abuse, personality disorders, and nonviolent criminality.
Estimates of lifetime risk of suicide in mental disorders were based on selected samples with incomplete follow-up.
To estimate, in a national cohort, the absolute risk of suicide within 36 years after the first psychiatric contact.
Prospective study of incident cases followed up for as long as 36 years. Median follow-up was 18 years.
Individual data drawn from Danish longitudinal registers.
A total of 176,347 persons born from January 1, 1955, through December 31, 1991, were followed up from their first contact with secondary mental health services after 15 years of age until death, emigration, disappearance, or the end of 2006. For each participant, 5 matched control individuals were included.
Absolute risk of suicide in percentage of individuals up to 36 years after the first contact.
Among men, the absolute risk of suicide (95% confidence interval [CI]) was highest for bipolar disorder, (7.77%; 6.01%-10.05%), followed by unipolar affective disorder (6.67%; 5.72%-7.78%) and schizophrenia (6.55%; 5.85%-7.34%). Among women, the highest risk was found among women with schizophrenia (4.91%; 95% CI, 4.03%-5.98%), followed by bipolar disorder (4.78%; 3.48%-6.56%). In the nonpsychiatric population, the risk was 0.72% (95% CI, 0.61%-0.86%) for men and 0.26% (0.20%-0.35%) for women. Comorbid substance abuse and comorbid unipolar affective disorder significantly increased the risk. The co-occurrence of deliberate self-harm increased the risk approximately 2-fold. Men with bipolar disorder and deliberate self-harm had the highest risk (17.08%; 95% CI, 11.19%-26.07%).
This is the first analysis of the absolute risk of suicide in a total national cohort of individuals followed up from the first psychiatric contact, and it represents, to our knowledge, the hitherto largest sample with the longest and most complete follow-up. Our estimates are lower than those most often cited, but they are still substantial and indicate the continuous need for prevention of suicide among people with mental disorders.
We examined mid-adolescent psychosocial problems as risk factors for subsequent depression up to adulthood proper, and differences in these for episodic and persistent depression.
In a 16-year follow-up of an urban Finnish community cohort (547 males and 714 females) from age 16 years risk factors for subsequent depression (S-BDI) were studied. Data were collected with a classroom questionnaire at 16 years and a postal questionnaire at 22 and 32 years. Differences in predictors for episodic depression (only at age of 22 or 32 y) and persistent depression (both at 22 and 32 y) were studied using logistic and multinomial regression analyses.
Mid-adolescent depressive symptoms predicted persistent and female sex episodic depression. Low self-esteem, dissatisfaction with academic achievement, problems with the law, having no dating experiences, and parental divorce all predicted both episodic and persistent depression.
We had two assessment points in adulthood, but no information about depression between these.
The associations between mid-adolescent psychosocial problems and subsequent depression extended up to adulthood proper, somewhat differently for episodic and persistent depression. Preventive efforts should be focused towards young people at risk.
Predictors for repetition of suicide attempts were evaluated among 92 adolescent suicide attempters 9 years after an index suicide attempt (90% females). Five were dead, two by suicide. Thirty-one (42%) of 73 had repeated a suicide attempt. In multiple Cox regression analysis, four factors had an independent predictive effect: comorbid disorders, hopelessness, having ever received treatment for mental or behavior problems, and having a father exerting control without affection. Prediction on an individual level was difficult. Since almost half repeated a suicidal act, the best strategy is to evaluate all adolescent suicide attempters thoroughly and provide treatment as needed.
The present study examines the association of adverse childhood experiences (ACEs) to suicidal behavior and mortality in 508 Finnish adolescents (aged 12-17 years) who required acute psychiatric hospitalization between April 2001 and March 2006. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) and the European Addiction Severity Index (EuropASI) were used to obtain information about ACEs, adolescents' suicidal behavior and psychiatric diagnoses. The cases of death were obtained from Statistics Finland. The results of our study indicated that, among girls, exposure to sexual abuse statistically significantly increased the risk of non-suicidal self-injury (NSSI) (OR, 1.8; 95 % CI, 1.0-3.2) and suicide attempts (OR, 2.3; 95 % CI, 1.0-4.5). The cumulative number of ACEs was also associated with an increased risk of NSSI (OR, 1.2; 95 % CI, 1.0- 1.4) and suicide attempts (OR, 1.2; 95 % CI, 1.0-1.4) in girls. Among all deceased adolescents, ACEs were most notable among those who had died due to accidents and injuries. Gender differences in the types of ACEs were noted and discussed.
Department of Psychology and Research Unit on Children's Psychosocial Maladjustment (GRIP), Université de Montréal, Montréal, QC, Canada. veronique.dupere@umontreal.ca
Because youth gangs tend to cluster in disadvantaged neighborhoods, adolescents living in such neighborhoods are more likely to encounter opportunities to join youth gangs. However, in the face of these opportunities, not all adolescents respond in the same manner. Those with preexisting psychopathic tendencies might be especially likely to join. In this study, we tested whether a combination of individual propensity and facilitating neighborhood conditions amplifies the probabilities of youth gang affiliation. A subset of 3,522 adolescents was selected from a nationally representative, prospective sample of Canadian youth. Psychopathic tendencies (i.e., a combination of high hyperactivity, low anxiety, and low prosociality as compared to national norms) were assessed through parent reports, while neighborhood characteristics (i.e., concentrated economic disadvantage and residential instability) were derived from the 2001 Census of Canada. Our results indicated that neighborhood residential instability, but not neighborhood concentrated economic disadvantage, interacted with individual propensity to predict youth gang membership. Adolescents with preexisting psychopathic tendencies appeared especially vulnerable mainly if they were raised in residentially unstable neighborhoods.
Age of onset of psychiatric disorders was determined from a random sample of 3,258 household residents who were administered the DIS by trained lay interviewers. Onset was determined by the subject's recall of the age of the first symptom in those who met lifetime criteria for a diagnosis (DSM III without exclusions). The peak age of risk for most disorders was from the teens to 30 years, however a number of schizophrenics showed first symptoms before age 10. Few cases of any disorder had an onset in old age. The ages of onset are generally lower than those usually given from series of treated or hospitalized cases.
Many studies report associations between alcohol problems, mental disorder, mental health and suicidal behaviour. Still, more knowledge is needed about possible differential characteristics of these factors in risk groups. This naturalistic and retrospective study included former patients who received emergency treatment in child and adolescent outpatient clinics for their mental health problems. One hundred patients were personally interviewed 5-9 years after treatment referral about alcohol problems and mental disorders. Also, they completed questionnaires about 11 indicators of mental health. At the follow-up, those who had attempted suicide during the follow-up period had more alcohol problems and mental disorders than the non-attempters. However, no association was found between suicide attempt in the follow-up period and the mental health indicators. Among the attempters, a high psychological burden as indicated by mental health disorders and poor mental health were associated with suicide re-attempt (lifetime) and an intention to die.
This article raises questions about some of the perverse effects of the reasoning behind correlations between sex and health in our socio-cultural context. Such a reasoning strongly denounces the psychosocial problems of women, but tends to forget the vulnerability of men which is nonetheless clearly evident in official statistics on suicide, dependence on alcohol and other drugs, violence and itinerancy.
Although the issue of medication nonadherence among children and youth appears to be high, there is a paucity of research examining associated factors related to medication nonadherence among youth with mental health difficulties. Using logistic regression, this exploratory study sought to examine specific factors associated with medication nonadherence among youth with mental health needs in Ontario, Canada. Data on 3681 youth between the ages of 12-18 years old were obtained from the Resident Assessment Instrument for Mental Health (RAI-MH). Medication nonadherence was observed among 24.6% of the study population. Multivariate results showed that youth who experienced side effects of psychotropic medication were more than 3 times more likely to have failed to adhere to their medication. Other significant factors contributing to medication nonadherence include age, having multiple psychiatric admissions, limited insight into mental health, and having a disturbed/dysfunctional relationship with immediate family members. Tobacco use, cannabis use, depressive symptoms, and positive symptoms were also associated with medication nonadherence. Our data highlights some of the factors associated with medication nonadherence among youth with mental health needs. Physicians, clinicians and mental health care providers need to consider these factors, particularly when planning for discharge.
