Homicide committed by individuals with severe mental illnesses: A comparative study before and after the Tunisian revolution of January 14th, 2011

Aggressive behaviour in antipsychotic-naive first-episode schizophrenia patients, their unaffected siblings and healthy controls

AIM

While patients with schizophrenia are more likely to be victims rather than perpetrators of aggressive behaviour, prior research has shown increased rates of aggressive behaviours in these patients that appear very early in the course of illness. We aimed to assess aggression in antipsychotic-naive first-episode schizophrenia patients, their healthy siblings, and controls; and to investigate correlates of aggression in the patients group.

METHODS

Patients (N = 55), siblings (N = 55) and healthy controls (N = 71) were evaluated on Buss and Perry Aggression Questionnaire (AQ), Life History of Aggression (LHA), Barratt Impulsiveness Scale, and Levenson Self-Report Psychopathy Scale. Age, gender and substance use were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance. Hierarchical regression was performed to determine which variables were associated with aggression level in the patients group.

RESULTS

The Tukey multiple comparison test showed that both patients (p < .001) and siblings (p = .023) scored higher on the LHA Aggression than controls. Siblings scored higher than controls (p = .010) for the Anger subscale of the AQ. Patients scored significantly higher than controls in the three impulsiveness dimensions; whereas siblings scored higher than controls in the motor (p = .023) and non-planning (p = .004) dimensions. Multivariate analyses showed that, after controlling for confounders, only attentional impulsiveness (β = .446, p = .0244) and psychopathy traits (β = .359, p = .010) helped predict AQ total scores among patients.

CONCLUSION

Aggression and some of its risk factors including impulsiveness are likely to be trait variables that might provide important vulnerability markers for people at heightened risk of developing psychosis.

Homicide in Relation to Mental Illness: Stigma Versus Reality

This narrative review examines different aspects of homicide among mentally ill individuals to compare the rates of homicide by offenders with and without mental illness and investigate the stigma of mental illness and its consequences. It also evaluates the motives of mentally ill perpetrators and their characteristics and explores weapons of choice in homicides related to different mental disorders. Studies confirmed higher homicide rates among specific categories of mentally ill individuals who experienced maltreatment, unemployment, abuse in childhood, and substance abuse resulting from stigma and discrimination. The motives were mainly revenge, argument, financial gain, sexuality, sadism, and filicide, with revenge being the top motive. Offenders were found to have close relationships with their victims in most cases. Sharp instruments were the most commonly used weapons. Our review confirms the lack of evidence linking mental illness independently with homicide, both globally and in Arab countries, and highlights the impact of discrimination toward mentally ill individuals. This discrimination and stigma lead to delayed care-seeking and self-destructive behavior, which is linked to higher homicide rates among persons with and without mental illness.

Patterns of homicide in Sfax, Tunisia: A 9-year cohort study (2011-2019)

INTRODUCTION

In Tunisia, since the January 2011 revolution, there has been considerable media interest in violence, particularly homicides. A popular perspective is, aside from any politically motivated killings, of a rise in homicides from year to year. In the absence of Tunisian national homicide statistics, a more accurate picture may be obtainable from area pathologist records.

AIMS

To examine annual homicide rates from post-mortem data for the second largest administrative area of Tunisia, Sfax, with a mixed urban-rural population of about one million people.

METHODS

All victims of common law homicide for the region are taken to the forensic department of one hospital in Sfax. We conducted a retrospective and descriptive study of all such cases of homicide for the 9 year period from the date of the fall of the Tunisian government in 14 January 2011 to 31 December 2019 and linked these data to those from earlier studies in the same department.

RESULTS

One hundred and nine victims of unlawful homicide were identified during this nine year period, with an average of 12 cases per year and a peak of 17 cases in 2016, yielding a broadly consistent rate of 1.2 homicides per 100,000 inhabitants and no consistent pattern in fluctuations. Just over two-thirds of the victims were men. Mean age of victims was 34.85 years (range 8-90 years). Just under half were married (45%); largest employment groups were of low-paid casual workers (40%) or unemployed (28%). One third of the killings had taken place in a private residence, with interpersonal conflict given as the largest explanatory category; over one quarter were intra-familial and 14% between intimate partners. There was some seasonal variation, with nearly two-thirds of homicides occurring in the spring and summer months.

CONCLUSION

Contrary to press hype, we found no evidence of rising homicide rates in Southern Tunisia, although this does represent a different picture from that in the north of the country. The seasonal variation would merit further exploration as it raises questions around impact of fluctuations in mental health.

Criminal behavior and mental illness in the Arab world

Numerous studies have highlighted significant correlations between major psychiatric disorders and criminal behavior. However, the plethora of literature on criminality among patients with major psychiatric disorders originated in the West. The objective of the present paper is to review criminal behavior among individuals with mental illness in Arab countries. Attributes of individuals assessed by forensic psychiatric committees and identifying various aspects that may reinforce criminality among individuals with mental illness were considered. Following the PRISMA guidelines, a systematic review of literature from three databases (Scopus, PubMed, and Web of Science) was carried out. A total of 20 articles were included. The publications span between 1975 and 2020 and originated in seven different Arab countries including Egypt, Kuwait, Iraq, Saudi Arabia, Tunisia, Jordan, and Algeria. Individuals evaluated by forensic psychiatric committees were predominantly males. Excluding substance use disorder, psychotic disorders were the most commonly diagnosed disorders among individuals evaluated by forensic psychiatry committees. Concerning schizophrenia, concomitant substance use and nonadherence to therapy were significantly associated with increased criminality. The review demonstrates that substance use is certainly linked to violence. There is a significant association between mental illness and criminal behavior. Therefore, awareness of different characteristics and risk factors behind criminal behavior among mentally ill offenders could allow us to design and implement effective preventative measures. The Arab's contribution in this field of forensic psychiatry is relatively small. Indeed, further investigation and contributions from the Arab world are required.