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Clinical Trial
. 2019 Apr 16;14(4):e0214924.
doi: 10.1371/journal.pone.0214924. eCollection 2019.

Violence risk and mental disorders (VIORMED-2): A prospective multicenter study in Italy

Stefano Barlati  1   2 , Alberto Stefana  1 , Francesco Bartoli  3 , Giorgio Bianconi  4 , Viola Bulgari  5 , Valentina Candini  5 , Giuseppe Carrà  3 , Cesare Cavalera  5   6 , Massimo Clerici  3   7 , Marta Cricelli  8 , Maria Teresa Ferla  8 , Clarissa Ferrari  9 , Laura Iozzino  5 , Ambra Macis  9 , Antonio Vita  1   2 , Giovanni de Girolamo  5 ; VIORMED-2 Group
Affiliations
Clinical Trial

Violence risk and mental disorders (VIORMED-2): A prospective multicenter study in Italy

Stefano Barlati et al. PLoS One. .

Abstract

Background: The management of mentally ill offenders in the community is one of the great challenges imposed on community psychiatry.

Aim: The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders.

Method: This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients' profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment.

Results: The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls.

Conclusions: Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Longitudinal evaluation of MOAS Total and subscales scores during follow-up in cases and controls.
Trend estimated through Smoothing Spline functions with corresponding 95% confidence bands.
Fig 2
Fig 2. Longitudinal evaluation of MOAS Total score during the 1-year follow-up in three different clinical groups.
Trend estimated through Smoothing Spline functions with corresponding 95% confidence bands.
See this image and copyright information in PMC

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