Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 4, pp 549–558

Violence and crime among male inpatients with severe mental illness: attempting to explain ethnic differences

  • Matt Bruce
  • Deborah Cobb
  • Holly Clisby
  • David Ndegwa
  • Sheilagh Hodgins
Original Paper



Studies report that in the UK, among men with severe mental illness (SMI), those of black Caribbean ethnicity display increased risk of aggressive behaviour, criminal convictions, and schizophrenia. The study aimed to compare aggressive behaviour and criminal convictions among men with SMI of white British, black Caribbean and black African ethnicity, and to explore factors associated with differences across ethnicities.


Sample 1 included 1,104 male inpatients with SMI. Sample 2 included a representative sub-sample of 165 who completed interviews, and authorized access to medical and criminal files. Ethnicity was self-ascribed.


Staff-rated violence prior to admission, self-reported aggressive behaviour, and convictions for non-violent and violent crimes differed among men with SMI of different ethnicities. Relative to men with SMI of white British ethnicity, those of black African ethnicity showed decreased risk of aggressive behaviour, and those of black Caribbean ethnicity showed elevated risk of convictions for non-violent, and marginally, for violent crimes. Relative to men with SMI of black African ethnicity, those of black Caribbean ethnicity showed elevated risk of aggressive behaviour and criminal convictions. Proportionately more of the men of both black African and black Caribbean ethnicity, than those of white British ethnicity, presented schizophrenia spectrum disorders. Multivariate analyses failed to identify factors that would explain differences in aggressive behaviour, and criminal convictions across ethnic groups.


Differences in four different measures of aggressive and antisocial behaviour among men with SMI of different ethnicities were observed but factors associated with these differences were not found.


Ethnicity Violence Criminal convictions Schizophrenia Antisocial personality disorder 


  1. 1.
    Afuwape SA, Johnson S, Craig TJK, Miles H, Leese M, Mohan R, Thornicroft G (2006) Ethnic difference among a community cohort of individuals with dual diagnosis in South London. J Mental Health 15(5):551–567CrossRefGoogle Scholar
  2. 2.
    Babor TF, Dolinsky ZS, Meyer RE, Hesselbrock M, Hofmann M, Tennen H (1992) Types of alcoholics: concurrent and predictive validity of some common classification schemes. Br J Addict 87(10):1415–1431PubMedCrossRefGoogle Scholar
  3. 3.
    Berman AH, Bergman H, Palmstierna T, Schlyter F (2003) DUDIT: the drug use disorders identification test manual.
  4. 4.
    Bhugra D, Bhui K (1998) Transcultural psychiatry: do problems persist in the second generation? Hosp Med 59(2):126–129PubMedGoogle Scholar
  5. 5.
    Brennan PA, Mednick SA, Hodgins S (2000) Major mental disorders and criminal violence in a Danish birth cohort. Arch Gen Psychiatry 57(5):494–500. doi:10.1001/archpsyc.57.5.494 PubMedCrossRefGoogle Scholar
  6. 6.
    Bruce M, Gwaspari M, Cobb D, Ndegwa D (2012) Ethnic differences in reported unmet needs among male inpatients with severe mental illness. J Psychiatr Ment Health Nurs 19(9):830–838. doi:10.1111/j.1365-2850.2011.01859.x PubMedCrossRefGoogle Scholar
  7. 7.
    Cantor-Graae E, Zolkowska K, McNeil TF (2005) Increased risk of psychotic disorder among immigrants in Malmo: a 3-year first-contact study. Psychol Med 35(8):1155–1163PubMedCrossRefGoogle Scholar
  8. 8.
    Coid JW, Kirkbride JB, Barker D, Cowden F, Stamps R, Yang M, Jones PB (2008) Raised incidence rates of all psychoses among migrant groups: findings from the East London first episode psychosis study. Arch Gen Psychiatry 65(11):1250–1258. doi:10.1001/archpsyc.65.11.1250 PubMedCrossRefGoogle Scholar
  9. 9.
    De Brito SA, Hodgins S (2009) Antisocial personality disorder. In: McMurran M, Howard R (eds) Personality, personality disorder, and violence: an evidence based approach. Wiley-Blackwell Publishing, Chichester, pp 133–153Google Scholar
  10. 10.
    Dean K, Walsh E, Morgan C, Demjaha A, Dazzan P, Morgan K, Murray RM (2007) Aggressive behaviour at first contact with services: findings from the AESOP First Episode Psychosis Study. Psychol Med 37(4):547–557PubMedCrossRefGoogle Scholar
  11. 11.
    DelBello MP, Lopez-Larson MP, Soutullo CA, Strakowski SM (2001) Effects of race on psychiatric diagnosis of hospitalized adolescents: a retrospective chart review. J Child Adolesc Psychopharmacol 11(1):95–103. doi:10.1089/104454601750143528 PubMedCrossRefGoogle Scholar
  12. 12.
    Fazel S, Gulati G, Linsell L, Geddes JR, Grann M (2009) Schizophrenia and violence: systematic review and meta-analysis. PLoS Med 6(8):e1000120. doi:10.1371/journal.pmed.1000120 PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Fearon P, Kirkbride JB, Morgan C, Dazzan P, Morgan K, Lloyd T, Murray RM (2006) Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychol Med 36(11):1541–1550. doi:10.1017/S0033291706008774 PubMedCrossRefGoogle Scholar
  14. 14.
    First MB, Spitze R, Gibbon M, Williams JBW (1996) Structured clinical interview for axes I and II DSM-IV disorders-patient edition. Biometrics Research Department, New York State Psychiatric Institute, New YorkGoogle Scholar
  15. 15.
    Fite PJ, Wynn P, Pardini DA (2009) Explaining discrepancies in arrest rates between Black and White male juveniles. J Consult Clin Psychol 77(5):916–927. doi:10.1037/a0016626 PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Harrison G, Owens D, Holton A, Neilson D, Boot D (1988) A prospective study of severe mental disorder in Afro-Caribbean patients. Psychol Med 18(3):643–657PubMedCrossRefGoogle Scholar
  17. 17.
    Hodgins S (1992) Mental disorder, intellectual deficiency, and crime. Evidence from a birth cohort. Arch Gen Psychiatry 49(6):476–483PubMedCrossRefGoogle Scholar
  18. 18.
    Hodgins S (2008) Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention. Philos Trans R Soc Lond B Biol Sci 363(1503):2505–2518. doi:10.1098/rstb.2008.0034 PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Hodgins S, Calem M, Shimel R, Williams A, Harleston D, Morgan C, Jones P (2011) Criminal offending and distinguishing features of offenders among persons experiencing a first episode of psychosis. Early Interv Psychiatry 5(1):15–23. doi:10.1111/j.1751-7893.2010.00256.x PubMedCrossRefGoogle Scholar
  20. 20.
    Hodgins S, Cree A, Alderton J, Mak T (2008) From conduct disorder to severe mental illness: associations with aggressive behaviour, crime and victimization. Psychol Med 38(07):975–987. doi:10.1017/S0033291707002164 PubMedCrossRefGoogle Scholar
  21. 21.
    Hodgins S, Mednick SA, Brennan PA, Schulsinger F, Engberg M (1996) Mental disorder and crime. Evidence from a Danish birth cohort. Arch Gen Psychiatry 53(6):489–496PubMedCrossRefGoogle Scholar
  22. 22.
    Hodgins S, Tiihonen J, Ross D (2005) The consequences of Conduct Disorder for males who develop schizophrenia: associations with criminality, aggressive behavior, substance use, and psychiatric services. Schizophr Res 78(2–3):323–335PubMedCrossRefGoogle Scholar
  23. 23.
    King M, Coker E, Leavey G, Hoare A, Johnson-Sabine E (1994) Incidence of psychotic illness in London: comparison of ethnic groups. BMJ 309(6962):1115–1119PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Large MM, Nielssen O (2011) Violence in first-episode psychosis: a systematic review and meta-analysis. Schizophr Res 125(2–3):209–220PubMedCrossRefGoogle Scholar
  25. 25.
    Meltzer H, Gatward R, Goodman RS, Ford T (2000). Mental health of children and adolescents in Great BritainGoogle Scholar
  26. 26.
    Modestin J, Wuermle O (2005) Criminality in men with major mental disorder with and without comorbid substance abuse. Psychiatry Clin Neurosci 59(1):25–29. doi:10.1111/j.1440-1819.2005.01327.x PubMedCrossRefGoogle Scholar
  27. 27.
    Moffitt TE, Caspi A (2001) Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females. Dev Psychopathol 13(2):355–375PubMedCrossRefGoogle Scholar
  28. 28.
    Moran P, Hodgins S (2004) The correlates of comorbid antisocial personality disorder in schizophrenia. Schizophr Bull 30(4):791–802PubMedCrossRefGoogle Scholar
  29. 29.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M (1993) Development of the ALCOHOL USE DISORDERS IDENTIFICATION TEST (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption–II. Addiction 88(6):791–804PubMedCrossRefGoogle Scholar
  30. 30.
    Sharpley M, Hutchinson G, McKenzie K, Murray RM (2001) Understanding the excess of psychosis among the African-Caribbean population in England. Review of current hypotheses. Br J Psychiatry Suppl 40:s60–s68PubMedCrossRefGoogle Scholar
  31. 31.
    Soyka M (2000) Substance misuse, psychiatric disorder and violent and disturbed behaviour. Br J Psychiatry 176:345–350PubMedCrossRefGoogle Scholar
  32. 32.
    Steadman HJ, Mulvey EP, Monahan J, Robbins PC, Appelbaum PS, Grisso T, Silver E (1998) Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighbourhoods. Arch Gen Psychiatry 55(5):393–401PubMedCrossRefGoogle Scholar
  33. 33.
    Stewart R, Soremekun M, Perera G, Broadbent M, Callard F, Denis M, Lovestone S (2009) The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry 9:51. doi:10.1186/1471-244X-9-51 PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Thornicroft G, Davies S, Leese M (1999) Health service research and forensic psychiatry: a black and white case. Int Rev Psychiatry 11(2–3):250–257CrossRefGoogle Scholar
  35. 35.
    Wallace C, Mullen P, Burgess P, Palmer S, Ruschena D, Browne C (1998) Serious criminal offending and mental disorder. Case linkage study. Br J Psychiatry 172:477–484PubMedCrossRefGoogle Scholar
  36. 36.
    Wessely S (1998) The Camberwell study of crime and schizophrenia. Soc Psychiatry Psychiatr Epidemiol 33(Suppl 1):S24–S28PubMedCrossRefGoogle Scholar
  37. 37.
    Wing JK, Beevor AS, Curtis RH, Park SB, Hadden S, Burns A (1998) Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry 172:11–18PubMedCrossRefGoogle Scholar

Copyright information

© European Union 2013

Authors and Affiliations

  • Matt Bruce
    • 1
    • 2
  • Deborah Cobb
    • 2
  • Holly Clisby
    • 2
  • David Ndegwa
    • 1
    • 2
  • Sheilagh Hodgins
    • 2
    • 3
  1. 1.South London and Maudsley Trust, Forensic ServicesLondonUK
  2. 2.Department of Forensic and Neurodevelopmental ScienceInstitute of Psychiatry, Kings College LondonLondonUK
  3. 3.Département de PsychiatrieUniversité de MontréalMontrealCanada

Personalised recommendations