In a new study, researchers found that women suffering from severe mental illness are five times more likely to be victims of sexual violence than women in the general population. They are also at increased risk for domestic violence, the study found.



Women with severe mental illness are up to five times more likely than the general population to be victims of sexual assault and two to three times more likely to suffer domestic violence, reveals new research led by scientists at University College London and King’s College London.

The study, published in the journal Psychological Medicine, found that 40 percent of women surveyed with severe mental illness had suffered rape or attempted rape in adulthood, of whom 53 percent had attempted suicide as a result. In the general population, 7 percent of women had been victims of rape or attempted rape, of whom 3 percent had attempted suicide. Twelve percent of men with severe mental illness had been seriously sexually assaulted, compared with 0.5 percent of the general population.

The findings are based on a recent survey of 303 randomly-recruited psychiatric outpatients who had been in contact with community services for a year or more, 60 percent of whom had a diagnosis of schizophrenia. Participants were interviewed using the British Crime Survey questionnaire for domestic and sexual violence, and their responses were compared to those from 22,606 respondents to the 2011/12 national crime survey. The results were adjusted for a wide range of socioeconomic factors including age, ethnicity and marital status.

“The number of rape victims among women with severe mental illness is staggering,” says lead author Dr. Hind Khalifeh of UCL’s Division of Psychiatry. “At the time of the survey, 10 percent had experienced sexual assault in the past year, showing that the problems continue throughout adulthood. Considering the high rate of suicide attempts among rape victims in this group, clinicians assessing people after a suicide attempt should consider asking them if they have been sexually assaulted. Currently this is not done and so patients may miss opportunities to receive specialist support.”

Mental illness is a risk factor for violent crime victimization, not perpetration

Men and women with mental illness were also found to be more likely to be victims of domestic violence — which includes emotional, physical and sexual abuse — than the general population. Nearly 7 out of 10 women (69 percent) and 5 out of 10 men (49 percent) with severe mental illness reported adulthood domestic violence, the researchers found.

Domestic violence from family members (other than partners) made up 63 percent of total domestic violence cases against psychiatric patients compared with 35 percent of the general population. One reason for the difference may be that adults with severe mental illness are less likely to be married and more likely to live with family, the researchers note. “Most domestic violence prevention policies for adults focus on partner violence, but this study shows that interventions for psychiatric patients also need to target family violence,” adds Dr. Khalifeh.

The study shows a strong association between mental illness and sexual and domestic violence, but the direction of causality is not certain. In some cases, experiences of violence may have contributed to the onset of mental illness. However, violence experienced in the past year would have been after diagnosis of severe mental illness since all participating patients had been under the care of mental health services for at least a year.

The results were adjusted for drug and alcohol use in the past year, but this did not significantly affect the outcomes and causality is hard to determine. Drug and alcohol use may increase the risk of being a victim, but equally victims of violence may turn to drugs or alcohol as a way of coping.

“This study highlights that patients with severe mental illness are at substantially increased risk of being a victim of domestic and sexual violence,” concludes senior author Dr. Louise Howard, Professor in Women’s Mental Health at King’s College London. “Despite the public’s concern about violence being perpetrated by patients with severe mental illness, the reality for patients is that they are at increased risk of being victims of some of the most damaging types of violence.”

Indeed, other studies confirm the new findings, showing that mental illness is a significant risk factor for victimization. In one recent study, researchers found that women with a severe mental health condition are four times more likely to be victims of intimate partner violence than women in the general population. The team behind that study noted that serious mental illnesses often lead to social isolation, which may put women at greater risk for being in — and staying in — an abusive relationship.

In another study, published just last month in the Journal of Autism and Developmental Disorders, researchers discovered that adults with autism are at a much higher risk of sexual victimization than those without the disorder. Of the 95 participants with autism included in the study, a staggering 78 percent reported at least one occurrence of sexual victimization compared to just over 47 percent of the 117 adults without autism who participated in the study. The researchers explained that a lack of sex education is driving the risk, and they said that with improved interventions focused on sexual knowledge and skill building, the risk could be reduced.

And in June, a large analysis of violent crime data found that people with mental disorders are significantly more likely to be victims of violent crime, particularly homicide, than people in the general population. Unfortunately, despite the clear evidence showing that people with mental illness are far more likely to be victims of violence than perpetrators of it, we continue to stigmatize this population by implicating them as dangerous and violent criminals.