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Schizophrenia and Violence Systematic Review and Meta-Analysis 英文参考文献.doc

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SchizophreniaandViolence:SystematicReviewand Meta-Analysis SeenaFazel1*,GautamGulati1,LouiseLinsell1,JohnR.Geddes1,MartinGrann2 1DepartmentofPsychiatry,UniversityofOxford,WarnefordHospital,Oxford,UnitedKingdom,2CentreforViolencePrevention,KarolinskaInstitute,Stockholm,Sweden PrisonandProbationServiceHeadOffice,Norrkoping,Sweden Abstract Background: Although expert opinion has asserted that there is an increased risk of violence in individuals with schizophrenia and other psychoses, there is substantial heterogeneity between studies reporting risk of violence, and uncertaintyoverthecausesofthisheterogeneity.Weundertookasystematicreviewofstudiesthatreportonassociations betweenviolenceandschizophreniaandotherpsychoses.Inaddition,weconductedasystematicreviewofinvestigations thatreportedonriskofhomicideinindividualswithschizophreniaandotherpsychoses. MethodsandFindings:Bibliographicdatabasesandreferencelistsweresearchedfrom1970toFebruary2009forstudies that reported on risks of interpersonal violence and/or violent criminality in individuals with schizophrenia and other psychosescomparedwithgeneralpopulationsamples.Thesedataweremeta-analysedandoddsratios(ORs)werepooled using random-effects models. Ten demographic and clinical variables were extracted from each study to test for any observedheterogeneityintheriskestimates.Weidentified20individualstudiesreportingdatafrom18,423individualswith schizophrenia and other psychoses. In men, ORs for the comparison of violence in those with schizophrenia and other psychoseswiththosewithoutmentaldisordersvariedfrom1to7withsubstantialheterogeneity(I2=86%).Inwomen,ORs rangedfrom4to29withsubstantialheterogeneity(I2=85%).Theeffectofcomorbidsubstanceabusewasmarkedwiththe random-effectsORsof2.1(95%confidenceinterval[CI]1.7–2.7)withoutcomorbidity,andanORof8.9(95%CI5.4–14.7) withcomorbidity(p,0.001onmetaregression).Riskestimatesofviolenceinindividualswithsubstanceabuse(butwithout psychosis)weresimilartothoseinindividualswithpsychosiswithsu