Dataset Information

Poor Health and Violent Crime Hot Spots: Mitigating the Undesirable Co-Occurrence Through Focused Place-Based Interventions.

ABSTRACT:

Introduction

The geographic overlap of violence and poor health is a major public health concern. To understand whether and how place-based interventions targeting micro-geographic places can reduce this undesirable co-occurrence, the study addresses 2 important questions. First, to what extent are deteriorated health conditions associated with living at violent crime hot spots? Second, through what mechanisms can focused place-based interventions break the association between living with violence and deteriorated health?

Methods

This study used survey data from 2,724 respondents living on 328 street segments that were categorized as violent crime hot spots (181 segments with 1,532 respondents) versus non-hot spots (147 segments with 1,192 respondents) in 2013-2014 in Baltimore, Maryland. Propensity score analysis assessed whether individuals living at violent crime hot spots had lower general health perceptions than people living at non-hot spots. Marginal structural models estimated the proportion of total effects mediated by 3 theoretically informed intervening mechanisms. Analyses were conducted in 2019.

Results

Respondents living at violent crime hot spots had a lower level of self-rated general health (b= -0.096, 95% CI= -0.176, -0.015) and higher levels of health limitations (b=0.068, 95% CI=0.027, 0.109) and problems (OR=2.026, 95% CI=1.225, 3.349) than those living at non-hot spots. Enhanced perceptions of safety, collective efficacy, and police legitimacy may break the association between living in places with extremely high levels of violence and deteriorated health.

Conclusions

Indicated or selective strategies are urgently needed to target micro-geographic locations with known increased risks, supplementing universal strategies applied to a broader community.

SUBMITTER: Dong B

PROVIDER: S-EPMC7246177 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundAntipsychotics and mood stabilisers are prescribed widely to patients with psychiatric disorders worldwide. Despite clear evidence for their efficacy in relapse prevention and symptom relief, their effect on some adverse outcomes, including the perpetration of violent crime, is unclear. We aimed to establish the effect of antipsychotics and mood stabilisers on the rate of violent crime committed by patients with psychiatric disorders in Sweden.MethodsWe used linked Swedish national registers to study 82,647 patients who were prescribed antipsychotics or mood stabilisers, their psychiatric diagnoses, and subsequent criminal convictions in 2006-09. We did within-individual analyses to compare the rate of violent criminality during the time that patients were prescribed these medications versus the rate for the same patients while they were not receiving the drugs to adjust for all confounders that remained constant within each participant during follow-up. The primary outcome was the occurrence of violent crime, according to Sweden's national crime register.FindingsIn 2006-09, 40,937 men in Sweden were prescribed antipsychotics or mood stabilisers, of whom 2657 (6·5%) were convicted of a violent crime during the study period. In the same period, 41,710 women were prescribed these drugs, of whom 604 (1·4 %) had convictions for violent crime. Compared with periods when participants were not on medication, violent crime fell by 45% in patients receiving antipsychotics (hazard ratio [HR] 0·55, 95% CI 0·47-0·64) and by 24% in patients prescribed mood stabilisers (0·76, 0·62-0·93). However, we identified potentially important differences by diagnosis-mood stabilisers were associated with a reduced rate of violent crime only in patients with bipolar disorder. The rate of violence reduction for antipsychotics remained between 22% and 29% in sensitivity analyses that used different outcomes (any crime, drug-related crime, less severe crime, and violent arrest), and was stronger in patients who were prescribed higher drug doses than in those prescribed low doses. Notable reductions in violent crime were also recorded for depot medication (HR adjusted for concomitant oral medications 0·60, 95% CI 0·39-0·92).InterpretationIn addition to relapse prevention and psychiatric symptom relief, the benefits of antipsychotics and mood stabilisers might also include reductions in the rates of violent crime. The potential effects of these drugs on violence and crime should be taken into account when treatment options for patients with psychiatric disorders are being considered.FundingThe Wellcome Trust, the Swedish Prison and Probation Service, the Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare.