Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies

Background

Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.

Method

We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.

Findings

There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.

Conclusion

Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.

The influence of sex, temperament, risk-taking and mental health on the emergence of gambling: a longitudinal study of young people

There are a host of complex and interlinked psychological, social and biological factors involved in the development of problem gambling (PG). While existing research, which is predominantly cross-sectional, shows that emerging adulthood is a critical period for PG, the early risk factors for PG are currently unknown. Here, we recruited a sample of 156 early adolescents with no history of PG (mean age 12.6 years) and longitudinally followed them up into late adolescence (mean age 18.9 years) to investigate the role of sex, risk-taking behaviour and changes in temperament and psychiatric symptoms in the evolution of risky gambling behaviour. There were sex-independent effects of temperament and risk-taking behaviour, with greater developmental increases in temperamental frustration (i.e. negative affectivity), greater developmental decreases in temperamental attention (i.e. effortful control) and greater involvement in risky behaviours, such as alcohol use, predicting greater likelihood of being in the risky gambling group. In addition, there were sex-dependent effects whereby higher levels of baseline aggression in females and lower levels of the same in males were more predictive of risky gambling. These findings highlight how sex-dependent and independent factors across the early- to mid-adolescent period influence the occurrence of gambling later in life.

Dynamic risk and sexual offending: the conundrum of assessment

The potential to reduce sexual victimisation, promote community safety, and decrease incarceration costs has resulted in considerable progress in terms of how we understand and predict sexual recidivism. And yet, the past decade has seen a degree of fragmentation emerge as research attention has shifted away from relative risk prediction (with its focus on static risk factors) to the identification of factors capable of reducing risk through intervention (i.e. dynamic risk). Although static and dynamic risk are often treated as orthogonal constructs [Beech, A. R., & Craig, L. A. (2012). The current status of static and dynamic factors in sexual offender risk assessment. Journal of Aggression, Conflict and Peace Research, 4(4), 169–185. doi:10.1108/17596591211270671], there are arguments to support a claim that the two are in fact functionally related [see Ward, T. (2015). Dynamic risk factors: Scientific kinds or predictive constructs. Psychology, Crime & Law (in this issue); Ward, T., & Beech, A. R. (2015). Dynamic risk factors: A theoretical dead-end? Psychology, Crime & Law, 21(2), 100–113. doi:10.1080/1068316X.2014.917854]. This discussion clearly affects how we assess dynamic risk. This review considered several commonly used methods of assessment and the evidence offered for their predictive accuracy. Of note were differences in the predictive accuracy of single psychometric measures versus composite scores of dynamic risk domains and the conventions used for establishing effect sizes for risk assessment tools.

Venting anger in cyberspace: self-entitlement versus self-preservation in #roadrage tweets

The increase in the popularity of social media and access to portable smart-technology means more drivers are using forums to vent their frustrations about driving. A content analysis was performed on 80,923 twitter posts relating to road rage collected over a 13-month period. The aim was to understand what sources of anger drivers report on social media. Approximately two thirds of the analysed tweets related directly to anger over another driver perceived as a perpetrator of inappropriate behaviour. Judgements of the improper speed of other drivers were the most common tweets. However, a general attitude also emerged where other drivers were seen as "idiots," "unskilled," and "should not be driving." Such a downward comparison is likely to predispose drivers to unjustly blame other drivers for frustrating situations that may be out of their control. Twitter appears to be a social media forum commonly used to vent anger by drivers. Posts ranged from text message, a photo of the offending vehicle or of the driver, or a 6-s video filmed while driving. The sample of tweeted angry comments indicated that many drivers used smart technology to express their anger. However, the motivation behind this action may vary and may be to express anger, report the incident, or to warn the public. The findings highlight the need for further research to understand the prevalence and danger of anger-provoked distraction with smart technology.

Sex steroid profiles and pair-maintenance behavior of captive wild-caught zebra finches (taeniopygia guttata)

Here, we studied the life-long monogamous zebra finch, to examine the relationship between circulating sex steroid profiles and pair-maintenance behavior in pairs of wild-caught zebra finches (paired in the laboratory for >1 month). We used liquid chromatography-tandem mass spectrometry to examine a total of eight androgens and progestins [pregnenolone, progesterone, dehydroepiandrosterone (DHEA), androstenediol, pregnan-3,17-diol-20-one, androsterone, androstanediol, and testosterone]. In the plasma, only pregnenolone, progesterone, DHEA, and testosterone were above the limit of quantification. Sex steroid profiles were similar between males and females, with only circulating progesterone levels significantly different between the sexes (female > male). Circulating pregnenolone levels were high in both sexes, suggesting that pregnenolone might serve as a circulating prohormone for local steroid synthesis in zebra finches. Furthermore, circulating testosterone levels were extremely low in both sexes. Additionally, we found no correlations between circulating steroid levels and pair-maintenance behavior. Taken together, our data raise several interesting questions about the neuroendocrinology of zebra finches.

Intimate partner violence perpetrator subtypes and their developmental origins: implications for prevention and intervention

Intimate partner violence (IPV) is a major issue for many Australian families and yet progress towards the development of effective prevention and behaviour change programs has been relatively slow. In this paper, it is proposed that the tendency to treat perpetrators as a homogenous group has hampered progress, and that treatment outcomes can be improved by tailoring treatment responses to a small set of personal and offence-related characteristics. It explores the developmental origins and trajectories of these presentations and identifies some new directions for further research in this area.

Sexual selection predicts brain structure in dragon lizards

Phenotypic traits such as ornaments and armaments are generally shaped by sexual selection, which often favours larger and more elaborate males compared to females. But can sexual selection also influence the brain? Previous studies in vertebrates report contradictory results with no consistent pattern between variation in brain structure and the strength of sexual selection. We hypothesize that sexual selection will act in a consistent way on two vertebrate brain regions that directly regulate sexual behaviour: the medial preoptic nucleus (MPON) and the ventromedial hypothalamic nucleus (VMN). The MPON regulates male reproductive behaviour whereas the VMN regulates female reproductive behaviour and is also involved in male aggression. To test our hypothesis, we used high-resolution magnetic resonance imaging combined with traditional histology of brains in 14 dragon lizard species of the genus Ctenophorus that vary in the strength of precopulatory sexual selection. Males belonging to species that experience greater sexual selection had a larger MPON and a smaller VMN. Conversely, females did not show any patterns of variation in these brain regions. As the volumes of both these regions also correlated with brain volume (BV) in our models, we tested whether they show the same pattern of evolution in response to changes in BV and found that the do. Therefore, we show that the primary brain nuclei underlying reproductive behaviour in vertebrates can evolve in a mosaic fashion, differently between males and females, likely in response to sexual selection, and that these same regions are simultaneously evolving in concert in relation to overall brain size.

Traumatic stress in parents of children with autism spectrum disorder.

A traumatic stress framework was identified as a valid way of conceptualising high levels of parenting stress in a subpopulation of parents raising a child with autism. An association between traumatic stress symptoms and child behaviours that posed a threat to child safety (e.g., elopement, aggression, self-injury) was found.