The public perception
that mental disorder is strongly associated with violence drives both
legal policy (e.g., civil commitment) and social practice (e.g., stigma)
toward people with mental disorders. This study describes and characterizes
the prevalence of community violence in a sample of people recently
discharged from acute psychiatric facilities at three sites. Prevalence
rates for violence are presented that derive from three sources -- self-report,
reports of collateral informants, and official agency records. The violence
is described in terms of the type of act committed, its target, and
its location. Prevalence rates are examined for change over time by
segmenting a 1-year follow-up into 5 10-week periods. At one site, comparative
violence rates were obtained by the same research interviewers applying
the same instruments both to recently discharged patients and to other
persons living in the same neighborhoods.
1,136 male and
female civil patients between 18 and 40 years old were enrolled in a
study that monitored violence to others every 10 weeks during their
first year after discharge. Patient self-reports were augmented by reports
from collaterals and by police and hospital records. The comparison
group consisted of 519 people living in the neighborhoods in which the
patients resided after hospital discharge. They were interviewed once
about violence in the past 10 weeks.
sampled from acute inpatient facilities at 3 sites: Western Psychiatric
Institute and Clinic (Pittsburgh, PA) (a university-based specialty
hospital); Western Missouri Mental Health Center (Kansas City, MO) (a
public mental health center); Worcester State Hospital (a state psychiatric
hospital) and the University of Massachusetts Medical Center (Worcester,
MA) (a university-based general hospital). Selection criteria were:
(1) civil admissions, (2) between the ages of 18 and 40, (3) English-speaking,
(4) White, or African American ethnicity (or Hispanic in Worcester only),
and (5) a chart diagnosis of schizophrenia, schizophreniform, schizoaffective,
depression, dysthymia, mania, brief reactive psychosis, delusional disorder,
alcohol or drug abuse or dependence, or a personality disorder. Eligible
patients were sampled according to age, gender, and race to maintain
a consistent distribution of these characteristics across sites. The
mean time between hospital admission and approach by the research interviewer
to obtain informed consent was 4.5 days. Eligible subjects were excluded
if they had been hospitalized for 21 days or more prior to being approached.
Data collection began in mid-1992 and ended in late 1995.
Hospital data collection
was conducted in 2 parts: (1) an interview by the research interviewer
to obtain data on demographic and historical factors; and (2) an interview
by a research clinician (Ph.D. or MA/MSW) to confirm the chart diagnosis
using the DSM-III-R Checklist (or to confirm a personality disorder
using the Structured Interview for DSM-III-R Personality when no eligible
Axis I diagnosis was present). Checklist diagnoses corresponded to a
chart diagnosis in 85.7% of the cases. Discrepant diagnoses were resolved
by a consultant psychiatrist at each site. Patients remaining in the
hospital for more than 145 days were dropped from the study (n=3).
were abstracted from patients' charts. A full discussion of all measures
can be found elsewhere. To obtain information on sample bias, similar
chart information was collected for a random sample of patients (n =
approximately 1,000 at each site) who were eligible for the study but
Patients were recontacted
in the community by the research interviewers and interviewed 5 times
(every 10 weeks) over 1 year from the date of discharge. Patient interviews
were in person (89%) or by telephone (11%). A collateral informant was
also interviewed (in person: 45%; by telephone: 55%) on the same schedule.
During each follow-up, a patient was asked to nominate as a collateral
the person who was most familiar with his or her behavior in the community.
If the nominee did not have at least weekly contact with the subject,
the interviewer suggested a more appropriate person based on a review
of the subject's social network data. Collaterals were most often family
members (47.1%), but were also friends (23.9%), professionals (13.9%),
significant others (12.4%), or others (e.g., co-workers; 2.7%). Patients
and collaterals were paid for their participation. Arrest and re-hospitalization
records were also obtained.
Subjects and collaterals
were asked whether the subject had engaged in several categories of
aggressive behavior in the past 10 weeks. If a positive response was
given, the subject or collateral was asked to list the number of times
the behavior occurred. Detailed information was obtained about each
act, including the target and location.
analyses, acts were divided into 2 categories of seriousness: Violence
(battery that resulted in physical injury; sexual assaults; assaultive
acts that involved the use of a weapon; or threats made with a weapon
in hand) and other aggressive acts (battery that did not result
in physical injury). Acts reported by any information source were reviewed
by two independent coders to obtain a single reconciled report of violence.
Only the most serious act for each incident was coded. A hierarchy of
coding rules is available from the authors.
of Pittsburgh's Center for Social and Urban Research identified a community
sample in Pittsburgh such that the distribution of the census tracts
in which that sample resided was the same as the distribution of the
census tracts in which the patients resided during the year following
discharge. In addition to living in a specified census tract, the community
respondent had to have lived at the current address for at least 2 months,
be between the ages of 18 and 40, and be of either white or African-American
Sample frames were
constructed by compiling lists of all addresses within the census tract.
In order to incorporate no-phone households, 1990 U.S. Census data were
used to provide an estimate of the number of such households per census
tract (3.4% of the total) and that proportion of interviews were obtained
by soliciting respondents in public places.
The subjects in
the community sample were interviewed only once. They and their collaterals
were questioned about the subjects' behavior in the past 10 weeks. Official
arrest records were also obtained.
Funding for this
study was provided by the John D. and Catherine T. MacArthur Foundation's
Research Network on Mental Health and the Law with a supplemental grant
from the National Institute of Mental Health (grant # R01 49696) to
interview the collateral informants.
Data are provided
as both SPSS data (.sav) files and SPSS portable (.por) files, allowing
for data to be used with a wide variety of statistical software packages.
There are six separate sub-sets of data for this study (see below).
Each sub-set corresponds to a distinct phase in the data collection
process. For those wishing to download the entire data set, we have
also provided an additional file that contains all six sub-sets as one
file (MacAlldata_SPSS.exe / MacAlldata_POR.exe).
is provided through a series of code books. Each of the six code books
correspond to a data file. Additionally, throughout the code books,
there are references made to code sheets. These code sheets were used
to code and/or interpret particular variables. These code sheets can
be found in the "Code Sheets" folder. Data sub-sets and their corresponding
code books are as follows:
Baseline Interview Coding (baseline_SPSS.exe
- Clinical Interview
/ Tracking Variables Manual
- Research / Baseline
Calculated Variables Manual
Follow-up Interview Coding Manual (follsubj_SPSS.exe /
Follow-up Interview Coding Manual (follcoll_SPSS.exe /
Sample -- Subject Interview Manual (commsubj_SPSS.exe
Sample -- Collateral Interview Manual (commcoll_SPSS.exe
Violence Coding Manual (violence_SPSS.exe / violence_POR.exe)
- MacArthur Code
sheets (These files are all of the code
sheets that were used in the study. The following is a list of each
code sheet in the set.)
Codes (MAC REL CODES)
Codes (MAC JOB CODES)
categories for violence probe question (MAC PROBE QUES)
- Street Drug
Codes (MAC DRUG CODES)
Codes (MAC MED CODES)
- Crime Classification
Codes (MAC CRIME CLASS)
- Global Assessment
of Functioning (GAF)