Baseline injurious violence, recent violent victimization, and medication nonadherence are strong predictors of future injurious violence among individuals with schizophrenia, according to new research published in the American Journal of Psychiatry.

The longitudinal multivariable study enrolled 1435 individuals diagnosed with schizophrenia who participated in the National Institute of Mental Health’s Clinical Antipsychotic Trials of Intervention Effectiveness study. The mean age of participants was 40.9 years of age and 74.5% were male. Participants were followed and examined for 18 months. Researchers collected self-reported data on injurious and noninjurious violence as well as demographic and background data, childhood risk factors, clinical condition, current circumstances, and recent interaction with hospitals and prisons. To generate bivariable and multivariable hazard ratios for all participants, researchers used proportional hazards models of time to first injurious violence.

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Of the participants, 5.4% reported engaging in injurious violence and 8.3% reported engaging in noninjurious violence. The multivariable analysis showed that baseline injurious violence (hazard ratio [HR], 4.02), recent violent victimization (HR, 3.52), severity of drug use (HR, 2.93), baseline noninjurious violence (HR, 2.72), childhood sexual abuse (HR, 1.85), and medication nonadherence (HR, 1.39) were all associated with future injurious violence. Baseline injurious violence was the strongest predictor for participants who did not have a history of injurious violence at baseline.

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The study was limited by its reliance on self-reported data as well as its short follow-up period.

These findings illuminated the strong effects of previous injurious violence and recent violent victimization on violent behavior among individuals with schizophrenia. Researchers noted that of the clinical variables, poor medication adherence was the strongest predictor of injurious violence. “Treatment strategies to reduce risk should emphasize medication adherence,” they concluded.


Buchanan A, Sint K, Swanson J, Rosenheck R. Correlates of future violence in people being treated for schizophrenia [published online April 24, 2019]. Am J Psychiatry. doi:10.1176/appi.ajp.2019.18080909