What question did this study set out to answer?

This study examines how violence exposure impacts mortality rates among individuals using mental health services.

January 14, 2026BJPsych Open0 citationsOpen Access

The association between violence exposure and general and cause-specific mortality in people using mental health services: cohort study

NRNabihah RafiKing's College London RSRobert StewartKing's College London AJAmelia JewellSouth London and Maudsley NHS Foundation Trust

Key Points

This study examines how violence exposure impacts mortality rates among individuals using mental health services.
Cohort study utilizing electronic health records from a treatment provider in South-East London.
Linked records to medical admissions, emergency presentations, and a national mortality register.
Cox regressions estimated associations between violence exposure and mortality after adjusting for confounders.
Hazard ratio for assault admission indicating all-cause mortality was 2.14 after adjustment.
Significant associations with mortality were found for suicide, respiratory, and diabetes-related causes.
Cumulative assault also demonstrated consistent results in both direction and magnitude.

Abstract

Background Many studies have observed a link between mortality and mental illness, although the contribution of violence exposure to mortality in people with mental illness remains under-researched. Aims To examine the association of violence exposure, such as being physically assaulted, with general and cause-specific mortality in a population using mental health services. Method We assembled a cohort study using electronic health records from a mental health and substance use treatment provider in south-east London. Records were linked to acute medical admission and emergency department presentation data, as well as to a national mortality register with death certificates for deaths registered in England and Wales. Cox regressions estimated the associations of binary and cumulative violence exposure, as indicated by assault admission and presentation to emergency departments for violence-related reasons. Mortality was adjusted for sociodemographic and clinical potential confounders. Results The hazard ratio for assault admission with all-cause mortality was 2.14 (95% CI: 1.93–2.36) following covariate adjustment. Adjusted associations were also found with mortality from the following causes: internal (natural) (hazard ratio 1.72, 95% CI: 1.50–1.98), external (hazard ratio 1.94, 95% CI: 1.51–2.48), suicide (hazard ratio 2.20, 95% CI: 1.38–3.52), respiratory (hazard ratio 2.01, 95% CI: 1.41–2.85), circulatory (hazard ratio 1.71, 95% CI: 1.27–2.28), diabetes-related (hazard ratio 2.86, 95% CI: 1.20–6.86) and alcohol-related (hazard ratio 1.56, 95% CI: 1.10–2.22). Results for cumulative assault were consistent with these in both direction and magnitude. There was evidence for an association of weapon-related assault admission with all-cause mortality (hazard ratio 1.58, 95% CI: 1.14–2.18). Conclusions People with mental illness, who are exposed to assault, experience greater mortality than those who are not exposed. Excess mortality attributable to violence exposure in people with mental illness was related to deaths from natural and external causes.

问 AI

Bookmark

View Full Paper