Violence risk and mental disorders (VIORMED-2): A prospective multicenter study in Italy

S. Barlati, A. Stefana, F. Bartoli, G. Bianconi, V. Bulgari, V. Candini, G. Carrà, C. Cavalera, M. Clerici, M. Cricelli, M.T. Ferla, C. Ferrari, L. Iozzino, A. Macis, A. Vita, G. de Girolamo

Research output: Contribution to journalArticlepeer-review


Background The management of mentally ill offenders in the community is one of the great challenges imposed on community psychiatry. Aim The aim of this study was to analyze the association between sociodemographic, clinical, and psychosocial factors and violent behavior in a sample of outpatients with severe mental disorders. Method This was a prospective cohort study with a baseline cross-sectional design used to provide a detailed analysis of patients’ profiles, followed by a longitudinal design to measure aggressive and violent behavior during a 1-year follow-up. Patients with severe mental disorders, with or without a history of violence, were enrolled in four Italian Departments of Mental Health and underwent a comprehensive multidimensional assessment. Results The sample included 247 outpatients, for a total of 126 cases and 121 controls. Compared to controls, patients with a history of violence had a greater frequency of lifetime domestic violence, a greater lifetime propensity to misuse substances, and a higher number of compulsory admissions. The forthnightly monitoring during the 1-year follow-up did show statistically significant differences in aggressive and violent behavior rates between the two groups. Verbal aggression was significantly associated with aggression against objects and physical aggression. Moreover, outpatients with an history of violence showed statistically significant higher MOAS scores compared to both residential patients with an history of violence, assessed in the first wave of this project, and all controls. Conclusions Patients with a history of violence had specific characteristics and showed a greater occurrence of additional community violence during a 1-year observation period. Our results may assist clinicians in implementing standardized methods of patient assessment and violence monitoring in outpatient mental health services and may prompt improved collaboration between different community services. © 2019 Barlati et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Original languageEnglish
Article numbere0214924
JournalPLoS One
Issue number4
Publication statusPublished - 2019


  • adult
  • aged
  • aggression
  • Article
  • clinical feature
  • cohort analysis
  • controlled study
  • cross-sectional study
  • demography
  • disease association
  • disease severity
  • domestic violence
  • female
  • follow up
  • hospital admission
  • human
  • longitudinal study
  • major clinical study
  • male
  • mental disease
  • mental health service
  • meta analysis
  • offender
  • prospective study
  • risk assessment
  • risk factor
  • social psychology
  • social status
  • verbal hostility
  • violence
  • adolescent
  • ambulatory care
  • clinical trial
  • comparative study
  • hospitalization
  • Italy
  • middle aged
  • multicenter study
  • pathophysiology
  • psychology
  • Adolescent
  • Adult
  • Aggression
  • Ambulatory Care
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Hospitalization
  • Humans
  • Male
  • Mental Disorders
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Violence


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