An investigation of recorded physical, domestic and sexual victimisation as risk factors for adverse clinical outcomes in severe mental illness: longitudinal study

Abstract

Background: Receipt of violence (victimisation) is associated with a higher risk of severe mental illness and with worse illness severity; however, associations with routine clinical outcomes are less clear.

Aims: To investigate associations between victimisation and subsequent clinical outcomes in people presenting with severe mental illness, using a south London health records data resource.

Method: Data were extracted for 16 372 patients presenting between January 2007 and October 2022, aged 18+ years and receiving diagnoses of schizophrenia-related disorders, mania or bipolar disorder. Recorded victimisation and subtype (any, physical, domestic or sexual) were ascertained via natural language processing from the first 3 months of the record following presentation. Cox regression models were deployed to investigate subsequent risk of mental health emergency care assessment, crisis intervention, in-patient care, Mental Health Act (MHA) detention and mortality. Poisson regression models investigated the numbers of attended healthcare events and antipsychotic agents received. Covariates included sociodemographic characteristics and clinical status (service receipt, medication, symptom profile).

Results: All victimisation exposures were associated with a higher risk of all outcomes, apart from mortality and number of antipsychotics, following adjustment for sociodemographic factors, and with emergency assessment (hazard ratio for any victimisation 1.17, 95% CI 1.09-1.27), in-patient/MHA detention (hazard ratio 1.32, 95% CI 1.06-1.65/1.82, 95% CI 1.31-2.55) and higher numbers of attended events (incidence rate ratio 1.17, 95% CI 1.16-1.19) following full adjustment. Associations were similar for subtypes of victimisation and exposures, and between men and women following sociodemographic adjustment, but the associations were slightly weaker for women following full adjustment.

Conclusion: Experiences of violence, to the extent to which patients report their experiences and these are recorded, are risk factors for worse outcomes in severe mental illness, only partly accounted for by clinical status around the time of presentation. More systematic ascertainment and recording of victimisation needs to be considered if interventions are to be appropriately targeted.