The role of stress, coping and negative affect as dynamic risk factors of interpersonal violence and victimization

Individuals living with major mental illness (MMI) have an elevated risk of committing violence against others as well as experiencing violent victimization relative to those without psychiatric symptoms. A vast body of research has focused on identifying risk factors for engaging in violence; however, factors that contribute to violent victimization among this population are less explored. Identifying dynamic risk factors to target for intervention assists in mitigating the risk for harmful outcomes. Reducing the likelihood of becoming involved in violent interactions protects the individual and potential victims of violence, as well as curtails personal, economic and societal costs. The purpose of this study was to explore stress, coping, and negative affect as potential risk factors for both prospective violence and victimization among individuals with MMI. The sample consisted of 74 civil psychiatric patients admitted to an emergency room of an urban hospital with a psychiatric facility in British Columbia. Participants completed a series of interviews and self-report measures assessing demographic information, psychiatric symptoms, mental health history, history of substance use, history of violence, and static and dynamic risk factors for adverse outcomes. Assessments took place at hospital discharge and every four weeks in the community for six months. Violence and victimization outcomes were collapsed across the follow-up period for analyses. One third of the sample reported engaging in violence, as well as experiencing violent victimization. After controlling for psychopathy, higher levels of stressful daily hassles were associated with an increased risk of violence perpetration. Daily hassles and perceived stress (marginal significance) were predictive of increased risk of victimization. Coping was associated with a reduced likelihood of victimization. Gender did not moderate the effects of coping on victimization or violence; however, there was some evidence that gender moderated the effect of Task coping on violence. Coping was not found to mediate the effect of stress on victimization. Higher levels of daily hassles were associated with quicker post hospitalization violence perpetration and victimization. Increased levels of perceived coping were marginally associated with slower rates of victimization post discharge. Implications of the findings for risk management and prevention are discussed.