Persons with mental illness are at increased risk of perpetrating and being the victims of violence compared to members of the general public. This increased risk for perpetrating or experiencing violent victimization is a substantial public health concern. Aside from the resultant physical harm, violent events are ruinous to its perpetrators and victims and costly to the public. These events precipitate the loss of personal liberty;necessitate expensive interventions;perpetuate stigma;and disrupt continuity of care. While violence and victimization are related to each other, both events are also intertwined with other factors, including psychotic symptoms, substance use, and medication adherence. Still, few studies comment on dynamic risk and protective factors relevant to prevention and intervention, or the unique and shared causes and consequences of these outcomes. The proposed R01 application will employ a state-of-the-art strategy, integrated data analysis (IDA), to combine raw data from five studies (including three funded by NIMH) that used the same measures of violence and victimization, and allow for the development a common metric for all independent variables. Our main analytic approach will rely on latent growth curve modeling to examine longitudinal associations between mental illness, violence, and victimization. The project proposed herein will expand the clinical, empirical and theoretical literature relating to violence and victimization among adults with mental illness. Outcomes have the potential to yield significant public health benefits and to contribute to meaningful clinical developments. In the short-term, pending support of our hypotheses, we will submit a treatment effectiveness RCT (R01) addressing the design limitations of this secondary data analysis project through collection of original data. However, we also anticipate identifying a treatment resistant subgroup (Hypothesis 5), for whom additional treatment development and validation work would be needed. As such, we also plan to submit an R34 (followed by a larger scale RCT) to develop, implement and evaluate treatment(s) that target premorbid conditions and dynamic risk and protective factors in this high risk, high need group. In sum, by utilizing innovative statistical, methodological and theoretical approaches, the proposed project is an important step towards ushering in a new era of mental healthcare to improve quality of life for adults with SMI and the communities in which they reside.
Outcomes from this project, in which we propose to combine raw data from five independent studies to assess the prevalence, antecedents, consequences and treatment outcomes for violence and victimization among adults with SMI, will have important implications for improving detection, clinical practice and public policy to help reduce or prevent violence in this vulnerable population. Violence and victimization represent significant public health concerns as the prevalence of each is significantly higher in persons with mental illness compared to rates found in the general population. Secondary data analysis is a popular and cost-efficient way to extend the yield of existing data and develop new knowledge. This application is an important stand-alone contribution with the potential to improve public health and safety, and to advance our clinical and theoretical understanding of mental illness, violence and victimization. We will accomplish these goals through ongoing evaluation and refinement of a clinically-relevant theoretical model, using a multi-step theory-to-treatment research process.
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