PURPOSE:
This
article describes epidemiologic evidence concerning risk of gun violence and
suicide linked to psychiatric disorders, in contrast to media-fueled public
perceptions of the dangerousness of mentally ill individuals, and evaluates
effectiveness of policies and laws designed to prevent firearms injury and
mortality associated with serious mental illnesses and substance use disorders.
METHODS:
Research
concerning public attitudes toward persons with mental illness is reviewed and
juxtaposed with evidence from benchmark epidemiologic and clinical studies of
violence and mental illness and of the accuracy of psychiatrists' risk
assessments. Selected policies and laws designed to reduce gun violence in
relation to mental illness are critically evaluated; evidence-based policy
recommendations are presented.
RESULTS:
Media
accounts of mass shootings by disturbed individuals galvanize public attention
and reinforce popular belief that mental illness often results in violence.
Epidemiologic studies show that the large majority of people with serious
mental illnesses are never violent. However, mental illness is strongly
associated with increased risk of suicide, which accounts for over half of US
firearms-related fatalities.
CONCLUSIONS:
Policymaking
at the interface of gun violence prevention and mental illness should be based
on epidemiologic data concerning risk to improve the effectiveness,
feasibility, and fairness of policy initiatives.
Below: Average prevalence of minor to serious violence among persons with serious mental illness by setting of study: meta-analysis
Below: Violence risk varies among people with serious mental illness who are involuntarily committed: characteristics of violent behavior in 4 months before involuntary hospital admission (Duke Mental Health Study; n = 331).
Below: Accumulation of MH records in National Instant Check System
Below: Mean monthly predicted probabilities of first violent crime for persons with serious mental illness with and without a gun-disqualifying mental health record, before and after NICS reporting began in Connecticut (n = 23,282). Note: analysis excludes persons with disqualifying criminal records.
By: Jeffrey W. Swanson, PhD,a,∗ E. Elizabeth McGinty, PhD, MS,b Seena Fazel, MBChB, MD, FRCPsych,c and Vickie M. Mays, PhD, MSPHd,e
aDepartment of Psychiatry and Behavioral
Sciences, Duke University School of Medicine, Durham, NC
bDepartment of Health Policy and
Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
cDepartment of Psychiatry, University of
Oxford, Oxford, England
dDepartment of Psychology, University of
California at Los Angeles, Los Angeles, CA
eDepartment of Health Policy and
Management, University of California at Los Angeles, Los Angeles, CA
∗Corresponding author.
Department of Psychiatry and Behavioral Sciences, Duke University School of
Medicine, DUMC Box 3071, Durham, NC.Email: ude.ekud@nosnaws.yerffej
Ann Epidemiol. 2015 May; 25(5): 366–376.
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