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The criminal careers of incident cases of schizophrenia

Published online by Cambridge University Press:  09 July 2009

S. C. Wessely*
Affiliation:
Departments of Psychological Medicine and Forensic Psychiatry, Institute of Psychiatry; and Department of Epidemiology, London School of Hygiene and Tropical Medicine, London
D. Castle
Affiliation:
Departments of Psychological Medicine and Forensic Psychiatry, Institute of Psychiatry; and Department of Epidemiology, London School of Hygiene and Tropical Medicine, London
A. J. Douglas
Affiliation:
Departments of Psychological Medicine and Forensic Psychiatry, Institute of Psychiatry; and Department of Epidemiology, London School of Hygiene and Tropical Medicine, London
P. J. Taylor
Affiliation:
Departments of Psychological Medicine and Forensic Psychiatry, Institute of Psychiatry; and Department of Epidemiology, London School of Hygiene and Tropical Medicine, London
*
1 Address for correspondence: Dr S. C. Wessely, Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF

Synopsis

We present a population-based, longitudinal study of all incident cases (N = 538) of schizophrenia in the London Borough of Camberwell between 1964 and 1984. Cases were selected from the Camberwell Cumulative Psychiatric Case Register. Case-notes were obtained, and further classified using a computerized operational check list for rating psychotic illness. Cases are not restricted to hospital discharges, as in previous studies, and account is taken of time at liberty to offend. In order to test the hypothesis that schizophrenia makes an independent contribution to criminality over other mental disorders, controls were chosen to be representative of non-schizophrenic mental disorders matched for age, sex and period.

The rate of conviction is increased in women with schizophrenia compared to other mental disorders for most offence categories (rate ratio = 3·3). In men overall rates do not differ (rate ratio = 1·03), although there is an interaction between gender, schizophrenia and ethnicity, with young black men with schizophrenia being most at risk. The rate ratio for violent offences in men with schizophrenia is 3·8, confirming recent studies from Sweden. Subjects with schizophrenia were more likely to acquire any criminal record than those with other mental disorders. The rate of lifetime conviction was greater in those with schizophrenia than either a sample of working-class boys from the same area followed by Farrington & West, or National data.

The risk of first conviction is increased by schizophrenia, unemployment, ethnic group, substance abuse and low social class, and decreased by being employed, married, female and older age of onset. Adjustment using survival analysis showed that schizophrenia made a small independent contribution to the risk of acquiring a criminal record (hazard ratio = 1·4), but gender, substance abuse, ethnicity and age of onset were more substantial. Previous criminality was the strongest independent association of post-illness conviction, with schizophrenia only a trend. Although subjects with schizophrenia were more likely to acquire a criminal record, criminal careers began later and were shorter than those of the controls. The risk of criminality increased throughout the study period, but suggestions of a specific increase in those with schizophrenia as a result of changes in community care were not confirmed. These results confirm that women with schizophrenia are at increased risk of acquiring a criminal record, but the effect in men is for violent convictions only. The strongest associations of criminal conviction remain those recognized in non-schizophrenic subjects.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1994

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References

Allen, H. (1987). Justice Unbalanced: Gender, Psychiatry and Judicial Decisions. ‘Official Statistics on Psychiatric Disposals’. Open University Press: Milton Keynes.Google Scholar
American Psychiatric Association. (1987). Diagnostic and Statistical Manual for the Classification of Psychiatric Diseases (3rd edn, revised)! APA: Washington, DC.Google Scholar
Bebbington, P., Hurry, J., Tennant, C., Sturt, E. & Wing, J. (1981). Epidemiology of mental disorders in Camberwell. Psychological Medicine 11, 561579.CrossRefGoogle ScholarPubMed
Bernadt, M. & Murray, R. (1986). Psychiatric disorder, drinking and alcoholism. British Journal of Psychiatry 148, 393400.CrossRefGoogle ScholarPubMed
Braithwaite, J. (1981). The myth of social class and criminality reconsidered. American Sociological Review 46, 3657.CrossRefGoogle Scholar
Brown, C. (1984). Black and White Britain: The Third PSI Survey. Heinemann: London.Google Scholar
Castle, D. & Murray, R. (1991). The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine 21, 565575.CrossRefGoogle ScholarPubMed
Castle, D., Wessely, S., Der, G. & Murray, R. (1991). The incidence of schizophrenia in Camberwell; 1964–1984. British Journal of Psychiatry 159, 790794.Google Scholar
Castle, D., Wessely, S. & Murray, R. (1993 a). Sex and schizophrenia: effects of diagnostic stringency and associations with Premorbid variables. British Journal of Psychiatry 162, 658664.CrossRefGoogle ScholarPubMed
Castle, D., Scott, K., Wessely, S. & Murray, R. (1993 b). Does social deprivation during gestation and early life predispose to schizophrenia? Social Psychiatry and Psychiatric Epidemiology 28, 14.CrossRefGoogle Scholar
Castle, D., Phelan, M., Wessely, S. & Murray, R. (1994). Which schizophrenics are not admitted at first psychiatric contact? An analysis of 484 patients. British Journal of Psychiatry (in the press).CrossRefGoogle Scholar
Cohen, C. (1980). Crime among mental patients – a critical analysis. Psychiatric Quarterly 52, 100107.CrossRefGoogle ScholarPubMed
Coid, B., Lewis, S. & Reveley, A. (1993). A twin study of psychosis and criminality. British Journal of Psychiatry 162, 8792.CrossRefGoogle ScholarPubMed
Coid, J. (1983). The epidemiology of abnormal homicide and homicide followed by suicide. Psychological Medicine 13, 855860.CrossRefGoogle Scholar
Coleman, M., Hermon, C. & Douglas, A. (1989). Person-Years (PYRS): A Fortran Program for Cohort Study Analysis. IARC Internal Report No 89/006: Lyon.Google Scholar
Commission for Racial Equality (1992). Cautions v. Prosecutions; Ethnic Monitoring of Juveniles by Seven Police Forces. Commission for Racial Equality: London.Google Scholar
Crow, I. (1987). Black people and criminal justice in the UK. Howard Journal of Criminal Justice 26, 303314.Google Scholar
Durbin, J., Pasewark, R. & Albers, D. (1977). Criminality and mental illness: a study of arrest rates in a rural state. American Journal of Psychiatry 143, 8083.Google Scholar
Eaton, W. (1985). Epidemiology of schizophrenia. Epidemiologic Reviews 7, 105126.CrossRefGoogle ScholarPubMed
Edwards, S. (1984). Women on Trial. Manchester University Press: Manchester.Google Scholar
Farrell, M. & David, A. (1988). Do psychiatric registrars take a proper drinking history? British Medical Journal 296, 395396.CrossRefGoogle Scholar
Farrington, D. (1981). The prevalence of convictions. British Journal of Criminology 21, 173175.Google Scholar
Farrington, D. (1990 a). Age, period, cohort and offending. In Policy and Theory in Criminal Justice (ed. Gottfriedson, D. and Clarke, R.), pp. 5175. Cambridge Studies in Criminology No. 52. Avebury: Aldershot.Google Scholar
Farrington, D. (1990 b). Childhood aggression and adult violence; early precursors and later life outcomes. In The Development of Childhood Aggression (ed. Pepler, D. and Rubin, K.), pp. 529. Erlbaum: Hillsdale, New Jersey.Google Scholar
Farrington, D. (1993). The psychological milieu of the offender. In Forensic Psychiatry: Clinical, Ethical and Legal Issues (ed. Gunn, J. and Taylor, P.), pp. 252285. Heinemann: London.Google Scholar
Farrington, D. & West, D. (1990). The Cambridge Study in Delinquent Development: a long-term follow-up of 411 London males. In Kriminalität: Persönlichkeit, Lebensgeschichte und Verhalten, pp. 115138. Springer Verlag: Berlin.Google Scholar
Gibbens, T., Soothill, K. & Pope, R. (1977). Medical Remands in the Criminal Court. Oxford University Press: Oxford.Google Scholar
Gibbens, T. & Robertson, G. (1983). A survey of the criminal careers of hospital order patients. British Journal of Psychiatry 143, 362369.CrossRefGoogle ScholarPubMed
Hafner, H. & Boker, W. (1973, transl. Marshall, Helen, 1982). Crimes of Violence by Mentally Abnormal Offenders: A Psychiatric and Epidemiological Study. Cambridge University Press: Cambridge.Google Scholar
Harrison, G., Owens, D., Holton, A., Neilson, D. & Boot, D. (1988). A prospective study of severe mental illness in Afro-Caribbean patients. Psychological Medicine 18, 643647.CrossRefGoogle ScholarPubMed
Hindelang, M. (1983). Race and involvement in crime. American Sociological Review 43, 93109.CrossRefGoogle Scholar
HMSO (1970). Classification of Occupations. HMSO: London.Google Scholar
Hodgins, S. (1992). Mental disorder, intellectual deficiency, and crime: evidence from a birth cohort, Archives of General Psychiatry 49, 476483.Google Scholar
Holcomb, W. & Ahr, P. (1988). Arrest rates among young adult psychiatric patients treated in inpatient and outpatient settings. Hospital Community Psychiatry 39, 5257.Google ScholarPubMed
Home Office Statistical Bulletin. (1989). Crime Statistics for the Metropolitan Police District by Ethnic Group. 1987: Victims, Suspects and Those Arrested. Home Office Statistical Department: London.Google Scholar
Institute of Psychiatry Training Committee (1973). Notes on Eliciting and Recording Clinical Information. Oxford University Press: Oxford.Google Scholar
Johnstone, E., Leary, J., Frith, C. & Owens, D. (1991). Disabilities and circumstances of schizophrenic patients – a follow-up study. VII. Police contact. British Journal of Psychiatry 159 (Suppl. 13), 3739.Google Scholar
Kalbfleisch, J. & Prentice, R. (1980). The Statistical Analysis of Failure Time Data. John Wiley: Chichester.Google Scholar
Lagos, J., Perlmutter, K. & Saexinger, H. (1977). Fear of the mentally ill: empirical support for the common man's response. American Journal of Psychiatry 134, 11341137.Google ScholarPubMed
Landau, S. (1981). Juveniles and the police. British Journal of Criminology 21, 2746.Google Scholar
Lewis, C. (1990). Crime and its classification. In Principles and Practice of Forensic Psychiatry (ed. Bluglass, R. and Bowden, P.), pp. 119128. Churchill Livingstone: Edinburgh.Google Scholar
Lewis, G., Croft-Jeffreys, C. & David, A. (1990). Are British psychiatrists racist? British Journal of Psychiatry 57, 410415.CrossRefGoogle Scholar
Lindqvist, P. & Allebeck, P. (1990 a). Schizophrenia and crime: a longitudinal follow-up of 644 schizophrenics in Stockholm. British Journal of Psychiatry 157, 345350.CrossRefGoogle ScholarPubMed
Lindqvist, P. & Allebeck, P. (1990 b). Schizophrenia and assaultive behaviour: the role of alcohol and drug abuse. Acta Psychiatrica Scandinavica 82, 191195.Google Scholar
Link, B., Andrews, H. & Cullen, F. (1992). The violent and illegal behaviour of mental patients reconsidered. American Sociological Review 57, 275292.Google Scholar
McGuffin, P., Farmer, A. & Harvey, I. (1991). A polydiagnostic application of operational criteria in studies of psychotic illness: development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764770.Google Scholar
Mackay, R. & Wight, R. (1984). Schizophrenia and anti-social (criminal) behaviour – some responses from sufferers and relatives. Medicine, Science and Law 24, 192198.Google Scholar
MacMillan, J. & Johnson, A. (1987). Contact with the police in early schizophrenia: its nature, frequency and relevance to the outcome of treatment. Medicine, Science and Law 27, 191200.Google Scholar
McNiel, D., Binder, R. & Greenfield, T. (1988). Predictors of violence in civilly committed acute psychiatric patients. American Journal of Psychiatry 145, 965970.Google ScholarPubMed
Maden, A. (1992). Psychiatric disorders in women serving a prison sentence. M.D. thesis, University of London.Google Scholar
Monahan, J. (1988). Risk assessment of violence among the mentally disordered: generating useful knowledge. International Journal of Law and Psychiatry 11, 249257.CrossRefGoogle ScholarPubMed
Monahan, J. (1992). Mental disorder and violent behaviour: perceptions and evidence. American Psychologist 47, 511521.Google Scholar
Monahan, J. & Steadman, H. (1983). Crime and mental illness: an epidemiological approach. In Crime and Justice, Volume 4 (ed. Morris, N. and Tonry, M.), pp. 145189. University of Chicago Press: Chicago.Google Scholar
Mulvey, E., Blumstein, A. & Cohen, J. (1986). Reframing the research question of mental patient criminality. International Journal of Law and Psychiatry 9, 5765.CrossRefGoogle ScholarPubMed
Payne, C., McCabe, S. & Walker, N. (1974). Predicting offender patients' reconvictions. British Journal of Psychiatry 125, 6064.Google Scholar
Pollak, O. (1950). The Criminality of Women. University of Pennsylvania Press: New York.Google Scholar
Rabkin, J. (1979). Criminal behaviour of discharged mental patients: a critical appraisal of the research. Psychological Bulletin 86, 127.Google Scholar
Rothman, K. (1986). Modern Epidemiology. Little, Brown & Co.: Boston.Google Scholar
Schanda, H., Foldes, P., Topitz, A., Fliedl, R. & Knecht, G. (1992). Premorbid adjustment of schizophrenic criminal offenders. Acta Psychiatrica Scandinavica 86, 121126.CrossRefGoogle ScholarPubMed
Schipkowensky, N. (1973). Epidemiological aspects of homicide. In World Biennial of Psychiatry and Psychotherapy, Volume 2 (ed. Arieti, S.), pp. 192215. Basic Books: New York.Google Scholar
Schneier, F. & Sins, S. (1987). A review of psychoactive substance use and abuse in schizophrenia. Journal of Nervous and Mental Disease 175, 641652.CrossRefGoogle ScholarPubMed
Shore, D., Filson, R., Johnston, W., Rae, D., Muehrer, P., Kelley, D., Davis, T., Waldman, I. & Wyatt, R. (1989). Murder and assault arrests of white house cases: clinical and demographic correlates of violence subsequent to civil commitment. American Journal of Psychiatry 146, 645651.Google ScholarPubMed
Smith, D. & Gray, J. (1983). Police and People in London, Vol IV: The Police in Action. Policy Studies Institute: London.Google Scholar
South East London Commissioning Agency (1992). The Health of South East Londoners. Annual Public Health Report (SELCA): London.Google Scholar
Steadman, H., Cocozza, J. & Melick, M. (1978). Explaining the increased arrest rate among mental patients: the changing clientele of state hospitals. American Journal of Psychiatry 135, 816820.Google ScholarPubMed
Steer, D. (1973). The elusive conviction. British Journal of Criminology 13, 373383.Google Scholar
Stevens, P. & Willis, C. (1979). Race, Crime and Arrests. Home Office Research Unit Report No 58. HMSO: London.Google Scholar
Swanson, J., Holzer, C., Ganju, V. & Jono, R. (1990). Violence and psychiatric disorder in the community: evidence from the epidemiologic catchment area surveys. Hospital Community Psychiatry 41, 761770.Google ScholarPubMed
Taylor, P. (1985). Motives for offending amongst violent and psychotic men. British Journal of Psychiatry 147, 491498.Google Scholar
Taylor, P. (1994). Schizophrenia and crime: distinctive patterns in association. In Crime and Mental Disorder (ed. Hodgins, S.), pp. 6385. Sage: Newbury Park, California.Google Scholar
Taylor, P. & Gunn, J. (1984). Violence and psychosis. 1. Risk of violence among psychotic men. British Medical Journal 288, 19451949.Google Scholar
Taylor, P., Mullen, P. & Wessely, S. (1993). Psychosis, violence and crime. In Forensic Psychiatry: Clinical, Ethical and Legal Issues (ed. Gunn, J. and Taylor, P.), pp. 330371. Heinemann-Butterworth: Oxford.Google Scholar
Wessely, S. & Castle, D. (1992). How valid are case notes afor assessing criminal history? Journal of Forensic Psychiatry 3, 359363.Google Scholar
Wessely, S. & Taylor, P. (1991). Madness and crime; criminology or psychiatry? Criminal Behaviour and Mental Health 1, 193228.CrossRefGoogle Scholar
Wessely, S., Castle, D., Der, G. & Murray, R. (1991). Schizophrenia and Afro-Caribbeans: a case control study. British Journal of Psychiatry 159, 795801.Google Scholar
Wing, J. & Hailey, A. (1972). Evaluating a Community Psychiatric Service: The Camberwell Register, 1964–1971. Oxford University Press: London.Google Scholar
World Health Organization. (1978). Mental Disorders Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classifications of Diseases (ICD-9). WHO: Geneva.Google Scholar