International Study of Schizophrenia and Violence

A new meta-analysis identifies target for improved care in patients with schizophrenia.

Daniel Whiting, BM, BCh, Department of Psychiatry, University of Oxford, and colleagues reviewed the risk of perpetrating interpersonal violence in patients with schizophrenia spectrum disorders compared to the general population.1

The investigators identified 24 studies of violence perpetration outcomes in 15 countries involving 51,309 individuals with schizophrenia spectrum disorders from multiple databases; the studies were conducted between January 1970 and March 2021, and included case-control and cohort studies that allowed risks of interpersonal violence perpetration and/or violent criminality in individuals with schizophrenia spectrum disorders. Violence outcomes were obtained via official records, self-reports and/or collateral-reports, or medical file review. The analysis included any physical assault, robbery, sexual offenses, illegal threats or intimidation, and arson.

Whiting et al found an increase in the risk of violence perpetration in men with schizophrenia and other psychoses (pooled OR, 4.5; 95% CI, 3.6-5.6) with substantial heterogeneity (I2 = 66%; 95% CI, 31-83) as well as an elevated risk of violence perpetration in women (pooled OR, 10.2; 95% CI, 7.1-14.6), with substantial heterogeneity (I2 = 66%; 95% CI, 31-83). They further found the absolute risks of violence perpetration in register-based studies were less than 1 in 20 for women with schizophrenia spectrum disorder, compared to less than 1 in 4 in men over a 35-year period.

“Violence perpetration outcomes in individuals with schizophrenia spectrum disorders contribute to morbidity and mortality at a population level, disrupt care, and lead to stigma,” Whiting and colleagues wrote. “Violence perpetration outcomes may be an important target for prevention and to reduce stigma in people with schizophrenia spectrum disorders.”


1. Whiting D, Gulati G, Geddes JR, Fazel S. Association of schizophrenia spectrum disorders and violence perpetration in adults and adolescents from 15 countries: a systematic review and meta-analysis. JAMA Psychiatry. 2022;79(2):120-132.

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