Is Depression Linked to Violence?

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A 2013 review of literature revealed that mental illness stigma is widespread in the United States. The review found that negative perceptions are held by both children and adults; the most common of which is that people with mental illness are more likely to be violent—even dangerous.

Surveys conducted around the world have found similar results, indicating that the perception of people with mental illness as being violent is a global one. 

The public may see a clear link between mental illness and violence, but the research supports a much more complex relationship. One reason for the disconnect is that when a tragedy (such as a mass shooting) occurs, the initial information available to the public that forms perceptions is often incomplete and can be inaccurate.

The media (and the general public by way of social media) are quick to speculate whether a person responsible for a crime has a mental illness. The practice is not just unhelpful but perpetuates harmful stigma. Research has also indicated that using these perceptions to motivate action or justify policy won’t necessarily improve public safety.    

Law enforcement and mental health professionals often want to determine if a person who has committed a violent crime has a history of violence. A person’s mental health may be routinely assessed in the course of an investigation. 

However, these actions do not imply violence and mental illness have a fully causal relationship. Crimes may be committed by someone who has a mental illness, but crimes are also committed by people who are not mentally ill. 

Violent thoughts and behaviors can be a sign of an underlying mental illness, but they are not unique to people with a mental health disorder. People who do not have a mental illness can have violent thoughts, display violent behaviors, and engage in criminal activity. 

Research has demonstrated repeatedly that the vast majority of people with mental illness do not display violent behaviors nor do they commit violent crimes. 

Mental Illness & Violence

Research on potential links between violence and mental illness is ongoing, but results have been mixed. One reason is that it can be difficult to design studies that accurately assess and measure violent behaviors, as many rely on self-reporting.

Most studies consider multiple factors that could influence violent behavior in any person, including people with mental illness. Researchers have examined the effect of everything from gun sales to video games as having an influence on violent behavior. 

Although guidelines have, and continue to be, created based on the results of these studies, the potential link between mental illness and violence is not as clear or as well-understood compared to other risk factors. 

An example that tends to be widely covered by the media are crimes that occur when a person commits a murder, then commits suicide. Although depression has been identified as a contributing factor in some cases of murder-suicide, the association does not mean people who have depression are dangerous.

The vast majority of people with depression do not commit violent crimes. In fact, experts generally do not associate depression with violence unless a person has symptoms of psychosis that increase the risk of violent behavior.

The characteristics of certain mental illnesses may make a person more likely to demonstrate violent behavior. Research has indicated that people who experience paranoia, hallucinations, or delusions are more likely to become violent than people with mental illness who do not have these symptoms. 

When people with depression do commit a crime, mental illness is typically not the only contributing factor. More often, it’s a combination of certain risk factors, such as substance abuse, socioeconomic stress, exposure to violence in childhood, and/or experiencing domestic violence, that make a vulnerable person feel that violence is necessary. 

One of the major studies that support this claim, the MacArthur Violence Risk Assessment Study, found that people with a dual diagnosis (mental illness and substance abuse) were more likely to commit an act of violence than people with mental illness alone (31% vs. 18%). 

Other studies have supported the findings. For example, a 2010 study of people diagnosed with bipolar disorder found that 8.5% had been convicted of at least one violent crime, which wasn’t much higher than the group of controls (5.1%). However, the rate of people with bipolar disorder and a substance use disorder who had been convicted of violent crime was significantly higher: 21.3%.

Public Perception & Stigma

There are many different types of violent crime, but some are more likely to make headlines. For example, murder-suicides are more likely to be covered in the news, which makes them seem more frequent than they really are. 

Surveys have shown that these perceptions are even common among people who regularly work with people who have a mental illness (such as doctors) and even among people with mental illness themselves. 

A survey of more than 3,000 people published in 2018 found that when asked about the most common means and causes of death in their state, only 20% of the health care professionals surveyed correctly identified suicide as being more common than homicide. Of the adult respondents who reported a history of mental illness, just 12.4% gave the correct answer.

The public’s awareness of this type of crime also fuels the perception of a link between violence and mental illness. In the case of murder-suicide, research has suggested a connection: a 2009 literature review found that anywhere from 19 to 65% of people who committed murder-suicides had depression. An additional study found that 80% of people who committed murder-suicide had some form of mental illness. 

A disproportionate amount of media coverage can make it seem like murder-suicides are common and frequently committed by a narrow range of people (specifically pointing to people with a history of mental illness).

However, statistics show that murder-suicides are quite rare. The 2009 literature review found the incidence to be in the range of 0.2-0.3 persons per 100,000.

Other forms of violent crime, such as domestic violence, are much more common and are committed by a wider range of individuals (including many people who are not mentally ill) but they don’t tend to receive as much media attention. 

A 2015 population study in Sweden found that people diagnosed with depression were roughly three times more likely than the general population to commit violent crimes including robbery, sexual offenses, and assault.

The authors of the study emphasized that the overwhelming majority of people with depression are neither violent nor criminal and that they should not be stigmatized. 

Seena Fazel, who led the study, pointed out that rates of violent crime in people diagnosed with depression were “...below those for schizophrenia and bipolar disorder, and considerably lower than for alcohol or drug abuse.” 

Studies have shown that the stigma attached to mental illness may itself be a risk factor for criminality and violence. A 2018 study found that stigma can be a barrier to treatment for people with mental illness. In the context of the available research, it is untreated mental illness and substance use disorders that increase a person’s risk for violence. 

Stigma can also make a person with mental illness reluctant to seek treatment. A person may not even feel they can openly discuss mental illness, as societal stigma can reinforce feelings of shame or guilt toward loved ones. Society’s attitude about mental illness can also make people fear retaliation or prejudice at school or work, making it less likely they will seek support from their community. 

Mental Illness & Gun Violence

Of the acts of violence most widely covered by the media, and most often discussed in relation to mental illness, there is a growing body of research exploring possible connections between gun violence and mental illness. 

In a 2019 study, researchers looked at cases where people with diagnosed mental illness had engaged in gun violence. Specifically, the researchers wanted to know if certain behaviors associated with mental illness could predict gun violence. The study actually found that access to firearms, not mental illness behaviors, was the strongest predictor of gun violence amongst subjects in the study. 

A study from 2011 looked at specific disorders considered “serious” or “severe” mental illness found that there was a small, but notable, increase in risk for violence in people who had one of these disorders compared to people who had no mental illness. The risk was highest when someone had both mental illness and issues with substance use. 

As with previous research, the authors of the study stated that other factors, such as abuse and neglect in childhood or current social stressors, were also of importance when determining a person’s risk for violent behavior. 

Research on the incidence of all types of violence on a national level estimates only 3-5% of violent acts are directly attributable to serious mental illness. Furthermore, guns were not used in the majority of those acts.

Suicide & Self-Harm

In many surveys, public perceptions of people with mental illness held not just in terms of an individual’s potential to be violent toward others, but to themselves. 

Research has indicated that people who are depressed are particularly vulnerable to being victims of violent crimes. They are also more likely to self-harm rather than harm others. This includes being more likely to commit suicide than homicide. 

According to the National Institute of Mental Health, in 2017 there were twice as many suicides as homicides in the United States (47,173 vs. 19,510).

People with mental illness may be at a higher risk of experiencing multiple forms of violence. During the MacArthur study, the researchers asked mental health patients taking part in the research about their lived experiences with three different forms of violence: self-harm, harming others, and being harmed by others. Over half of the patients (58%) reported experiencing at least one form of violence.

If someone you love has depression or another form of mental illness and you are concerned they may harm themselves or someone else, there are resources you can turn to. The laws will vary from state to state, but there are options that can help keep your loved one safe, as well as provide you with support.

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Article Sources

  1. Parcesepe AM, Cabassa LJ. Public stigma of mental illness in the United States: a systematic literature review. Adm Policy Ment Health. 2013;40(5):384–399. doi:10.1007/s10488-012-0430-z

  2. Steadman, H. et al. Gun Violence and Victimization of Strangers by Persons With a Mental Illness: Data From the MacArthur Violence Risk Assessment Study | Psychiatric Services. Psychiatric Services.

  3. Knoll, J. L. IV, & Annas, G. D. (2016). Mass shootings and mental illness. In L. H. Gold & R. I. Simon (Eds.), Gun violence and mental illness (pp. 81-104). Arlington, VA, US: American Psychiatric Association.

  4. Carmichael, V. et al. Media coverage of mental illness: a comparison of citizen journalism vs. professional journalism portrayals. Journal of Mental Health. doi:10.1080/09638237.2019.1608934.

  5. Ross, A.M., Morgan, A.J., Jorm, A.F. et al. Soc Psychiatry Psychiatr Epidemiol (2019) 54: 11.

  6. Johnson KL, Desmarais SL, Tueller SJ, Van Dorn RA. Methodological limitations in the measurement and statistical modeling of violence among adults with mental illness. International Journal of Methods in Psychiatric Research. February 2019:e1776. doi:10.1002/mpr.1776

  7. Kühn S, Kugler DT, Schmalen K, Weichenberger M, Witt C, Gallinat J. Does playing violent video games cause aggression? A longitudinal intervention study. Molecular Psychiatry. 2018;24(8):1220-1234. doi:10.1038/s41380-018-0031-7

  8. Swanson JW, Barry CL, Swartz MS. Gun Violence Prevention and Mental Health Policy. The Palgrave Handbook of American Mental Health Policy. May 2019:509-541. doi:10.1007/978-3-030-11908-9_18

  9. Ahonen L. (2019) The Association Between Mental Illness and Violence. In: Violence and Mental Illness. SpringerBriefs in Criminology. Springer, Cham

  10. Fazel S, Lichtenstein P, Grann M, Goodwin GM, Långström N. Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic reviewArchives of general psychiatry. 2010;67(9):931-938. doi:10.1001/archgenpsychiatry.2010.97

  11. Morgan ER, Rowhani-Rahbar A, Azrael D, Miller M. Public Perceptions of Firearm- and Non–Firearm-Related Violent Death in the United States: A National Study. Ann Intern Med. [Epub ahead of print 30 October 2018]169:734–737. doi: 10.7326/M18-1533

  12. Eliason, Scott. "Murder-Suicide: A Review of the Recent Literature." Journal of the American Academy of Psychiatry and the Law 37.3 (September 2009): 371-376.

  13. Flynn S, Gask L, Appleby L, Shaw J. Homicide-suicide and the role of mental disorder: a national consecutive case series. Soc Psychiatry Psychiatr Epidemiol. 2016;51(6):877–884. doi:10.1007/s00127-016-1209-4

  14. Fazel S, Wolf A, Chang Z, Larsson H, Goodwin GM, Lichtenstein P. Depression and violence: a Swedish population study. The Lancet Psychiatry. 2015;2(3):224-232. doi:10.1016/s2215-0366(14)00128-x

  15. Labrum, T., Simonsson, P. & Solomon, P.L. J. Stigma Contributes to the Risk of Violence by Persons with Mental Illness

    Journal of Psychosocial Rehabilitation and Mental Health (2018) 5: 209. doi:10.1007/s40737-018-0123-3

  16. Lu Y, Temple JR. Dangerous weapons or dangerous people? The temporal associations between gun violence and mental healthPreventive Medicine. 2019;121:1-6. doi:10.1016/j.ypmed.2019.01.008

  17. Van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there a relationship beyond substance use? Social Psychiatry and Psychiatric Epidemiology. 2011;47(3):487-503. doi:10.1007/s00127-011-0356-x

  18. 2. Appelbaum P, Swanson J. Law & Psychiatry: Gun Laws and Mental Illness: How Sensible Are the Current Restrictions?Psychiatric Services. 2010;61(7):652-654. doi:10.1176/ps.2010.61.7.652

  19. Sarah L. Desmarais, Richard A. Van Dorn, Kiersten L. Johnson, Kevin J. Grimm, Kevin S. Douglas, and Marvin S. Swartz, 2014:

    Community Violence Perpetration and Victimization Among Adults With Mental Illnesses

    American Journal of Public Health 104, 2342_2349, doi:10.2105/AJPH.2013.301680

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