Short-term effects of psychiatric symptoms and interpersonal stressors on criminal violence

A case-crossover study
  • Ulrika Haggård-Grann
  • Johan Hallqvist
  • Niklas Långström
  • Jette Möller



The aim of the study was to analyse the triggering or acute risk effect of psychiatric symptoms and interpersonal stressors on criminal violence.


One hundred and thirty three violent offenders were recruited from a forensic psychiatric evaluation (FPE) unit and a national prison evaluation unit in Sweden during 2002–2003, and were interviewed about trigger exposures. A case-crossover design was used eliminating long-term within individual confounding.


Suicidal ideation or parasuicide within 24 h before the violent event conferred a ninefold risk increase. In contrast, violent ideation did not trigger criminal violence. Hallucinations yielded a fourfold risk increase, whereas paranoid thoughts were associated with a small and statistically non-significant risk increase. Acute conflicts with others and being denied psychiatric care within 24 h before violence also increased the risk of acting violently.


Some tested psychiatric symptoms and stressors triggered criminal violence, whereas others did not. The case-crossover design may be particularly useful for the study of triggers of violence.

Key words

violence mental disorders risk factors life events trigger case-crossover  



We acknowledge financial support from the Vårdal, the Söderström-Königska, and the Bror Gadelius’ Memorial Foundations and the National Board of Forensic Medicine


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Copyright information

© Steinkopff Verlag Darmstadt 2006

Authors and Affiliations

  • Ulrika Haggård-Grann
    • 1
  • Johan Hallqvist
    • 2
  • Niklas Långström
    • 1
  • Jette Möller
    • 2
  1. 1.Dept. of Clinical Neuroscience Centre for Violence PreventionKarolinska InstitutetStockholmSweden
  2. 2.Dept. of Public Health Sciences Division of Social MedicineKarolinska InstitutetStockholmSweden

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