Beyond Mental Illness: Targeting Stronger and More Direct Pathways to Violence

The association between violence and serious mental illness (SMI)-schizophrenia, other psychotic disorder, bipolar disorder, or major depressive disorder-was examined and guided by the I-3 model to frame analysis of the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2, enrolling N = 34,653 participants representative of the U. S. population. SMI was related to subsequent violent behavior but in multivariable analysis had the weakest link to severe violence. Risk factors postulated to increase dispositional impellance (anger, perceived threats), situational impellance (recent divorce/separation, financial crisis, victimization), and disinhibition (alcohol/drug abuse) fully mediated the relationship between SMI and violence. Clinical research, interventions, and policies on violence should use conceptual models and consider SMI not in isolation but relative to other risk factors. Violence prevention targeting only psychiatric diagnosis is likely to have limited impact given lack of a strong or direct connection found between SMI and violent behavior.