Prevalence and correlates of fire-setting in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Intervention for Firesetting Offenders: A Case Study

There is little research on treatment for firesetting, especially for those who were incarcerated for their offenses. Of the treatment programs that do exist, there are limitations to feasibly implementing these in correctional settings. We propose a short-term (eight-session) program, Intervention for Firesetting Offenses (INFO), based on techniques that have been empirically supported for this population, including psychoeducation, motivational interviewing, cognitive behavioral therapy-based strategies, and relapse prevention. We provide a description of INFO using the case study of Mr. A, a man who was incarcerated for an arson offense. Overall, INFO was feasibly and effectively implemented, as the individual improved his understanding of firesetting in general and his own motivations and risk factors for engaging in firesetting and developed a relapse prevention plan to avoid future offending behaviors.

Bringing Light Into the Dark: Associations of Fire Interest and Fire Setting With the Dark Tetrad

Fire setting is a significant problem for society, costing many human lives and causing great property damage. One important risk factor of fire setting observed in forensic samples is fire interest. However, less is known about the relationship of fire interest and fire setting to other variables such as personality traits in subclinical samples. In this study, we observed the relationship of potentially important personality traits with fire interest and fire setting in a sample of N = 222 students. In addition to zero-order correlations, we calculated path models and a logistic regression including all predictor variables. From the Dark Tetrad, consisting of psychopathy, narcissism, Machiavellianism, and three facets of sadism, psychopathy, and physical sadism were found to be associated with fire interest and fire setting. Furthermore, vicarious sadism was associated with fire interest. The other Dark Tetrad traits and four sensation seeking facets did not substantially add to the predictions. This confirms the results of previous studies with clinical and forensic samples with psychopathy and sadism as relevant predictors for fire interest and fire setting. Our results also provide evidence for viewing sadism as the multidimensional construct discriminating between vicarious and other forms of sadism, for the distinction of psychopathy and Machiavellianism, and for the Dark Tetrad being linked to object related violence.

A systematic review of gambling-related findings from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND AND AIMS

This systematic review analyzes and summarizes gambling-related findings from the nationally representative US National Epidemiological Survey on Alcohol and Related Conditions (NESARC) data.

METHODS

Systematic literature searches in accordance with PRISMA guidelines found 51 eligible studies that met inclusion criteria. Eight studies utilized both Waves 1 and 2 NESARC data, and selection of sample sizes varied from 185 to 43,093 individuals, consistent with specified research objectives of each study.

RESULTS

The prevalence of lifetime pathological gambling was 0.42% (0.64% among men, 0.23% among women), while past-year prevalence was 0.16%. Pathological gambling rates were generally higher in populations with substance-use disorders and other psychiatric diagnoses. Rates of adverse childhood experiences and suicidal attempts were higher among individuals with problem or pathological gambling. Early-onset gamblers were more likely to be male, be never married, have incomes below $70,000, belong to younger cohorts and have Cluster B personality disorders, but less likely to be diagnosed with mood disorders. While pathological gambling was related to obesity, increased stress, and poorer physical health among general age groups, recreational gambling was linked with improved physical and mental functioning in older adults.

CONCLUSIONS

The NESARC has provided important information on the correlates of pathological gambling and subdiagnostic patterns of gambling behaviors. Additional studies should examine these relationships in the current gambling environment and longitudinally with aims of implementing policies to improve the public health.

Guardianship and Predatory Crimes among Incapacitated Persons in Kentucky

Purpose: Guardianship is a legal process intended to aid incapacitated persons unable to fully care for themselves. Guardianship in the state of Kentucky ranges from total observation (24-hour care) to informal care (such as a group home) and also includes persons who are no longer being supervised but should be. One intent of guardianship includes preventing incapacitated persons from engaging in criminal acts. However, no research has been conducted on incapacitated persons currently in guardianship and the prevalence for committing predatory crimes such as murder, fire starting, or assault.Method: In this study, the authors examine guardianship supervision levels and predatory crimes in the state of Kentucky. Logistic regression analysis was used to determine the variables that significantly contributed to the model.Results: They find that unsupervised incapacitated persons are at higher odds of committing predatory crimes, leading to important policy recommendations for Kentucky guardians.

Childhood maltreatment and impulsivity as predictors of interpersonal violence, self-injury and suicide attempts: A national study

Prior research indicates that childhood maltreatment and impulsivity increase the risk for different types of violence, including violent behaviors directed toward the self and others. However, it is not known whether childhood maltreatment and impulsivity have independent effects on different violent behaviors. Therefore, this study examined the differential effects of childhood maltreatment and impulsivity on interpersonal violence, suicide attempts, and self-injury. Data were drawn from a nationally representative survey of 34,653 US adults, the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Structural equation modeling was used to simultaneously examine the shared and specific effects of five types of childhood maltreatment and impulsivity on the risk of different violent behaviors (i.e. interpersonal violence, suicide attempts, and self-injury). Analyses were stratified by gender and adjusted for age and ethnicity. Impulsivity and childhood maltreatment independently increased the risk of suicide attempt, self-injury, and interpersonal violence. Childhood maltreatment had stronger effects on violence directed towards the self than on interpersonal violence in both genders, while impulsivity had a stronger effect on self-injury than on suicide attempt or interpersonal violence in men. These findings indicate that childhood maltreatment and impulsivity relate differently to the risk of different types of violence.

Primary and Secondary Diagnoses of Gambling Disorder and Psychiatric Comorbidity in the Swedish Health Care System-A Nationwide Register Study

Background: Psychiatric comorbidity is common in gambling disorder, a condition with low rates of treatment seeking. There is a paucity of documented nationwide data on gambling disorder and its co-occurring psychiatric comorbidities in the health care system. Methods: This is a nationwide register-based study of all patients aged above 18 years who were diagnosed with gambling disorder (corresponding to pathological gambling, code F63.0, in the ICD-10) in Swedish specialized out-patient health care or in-patient care, from 2005 through 2016. All psychiatric disorders co-occurring with the diagnoses were recorded, along with age, gender and the type of medical specialty. Results: A total of 2,099 patients were included (1,784 in out-patient care and 629 patients in in-patient care), among whom 77 percent were men. Treatment uptake during the study period increased significantly in out-patient care, with an increasing uptake of younger individuals, whereas in-patient treatment uptake remained stable. A co-occurring psychiatric diagnosis was registered in 73 percent of patients, more commonly in females (77 vs. 71 percent, p < 0.01). Several diagnostic subgroups were more common in women, with anxiety and affective disorders being the most common subgroups. Prevalence of substance use disorders did not differ with respect to gender. Conclusions: Despite a large gap between probable population prevalence of gambling disorder and the number of treated patients, the number of patients treated in out-patient health care with a gambling disorder diagnosis increased over time, with an increasing treatment uptake in younger individuals. Psychiatric comorbidity is common in gambling disorder patients in the health care system, with a higher prevalence in women.

Fire-setting performed in adolescence or early adulthood predicts schizophrenia: a register-based follow-up study of pre-trial offenders

BACKGROUND

Aggressive and disruptive behaviours often precede the onset of serious mental illnesses. Fire-setting is a type of crime that is associated with psychotic disorders.

AIM

The aim of this prospective follow-up study was to investigate if fire-setting performed in adolescence or early adulthood was associated with future diagnoses of schizophrenia or schizoaffective disorder.

METHODS

The consecutive sample consisted of 111 Finnish 15-25-year old males with fire-setting crimes, decreed to a pre-trial forensic psychiatric examination in 1973-1998, and showing no past nor current psychosis at the time of examination. For each firesetter, four age-, gender-, and place of birth-matched controls were randomly selected from the Central Population Register. The subjects were followed until the death of the individual, until they moved abroad, or until the end of 2012.

RESULTS

Fourteen firesetters (12.6%) and five controls (1.1%) were diagnosed with either schizophrenia or schizoaffective disorder later in life, corresponding to a hazard ratio of 12.5. The delay between the fire-setting offense and the future diagnosis was on average nearly 10 years.

CONCLUSIONS

Young male offenders undergoing a forensic psychiatric examination because of fire-setting crimes had a significant propensity for schizophrenia and schizoaffective disorder. Accurate assessments should be made both during imprisonment and later in life to detect possible psychotic signs in these individuals.

Subtypes of firesetters

BACKGROUND

Prior research has classified firesetters by motive. The multi-trajectory theory of adult firesetting (M-TTAF) takes a more aetiological perspective, differentiating between five hypothesised trajectories towards firesetting: antisocial cognition, grievance, fire interest, emotionally expressive/need for recognition and multifaceted trajectories.

AIM

The objective of this study was to validate the five routes to firesetting as proposed in the M-TTAF.

METHODS

All 389 adult firesetters referred for forensic mental health assessment to one central clinic in the Netherlands between 1950 and 2012 were rated on variables linked to the M-TTAF. Cluster analysis was then applied.

RESULTS

A reliable cluster solution emerged revealing five subtypes of firesetters - labelled instrumental, reward, multi-problem, disturbed relationship and disordered. Significant differences were observed regarding both offender and offence characteristics.

DISCUSSION

Our five-cluster solution with five subtypes of firesetters partially validates the proposed M-TTAF trajectories and suggests that for offenders with and without mental disorder, this classification may be useful. If further validated with larger and more diverse samples, the M-TTAF could provide guidance on staging evidence-based treatment. Copyright © 2015 John Wiley & Sons, Ltd.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.

Specific risk factors of arsonists in a forensic psychiatric hospital

Arsonists are often treated in forensic settings. However, high recidivism rates indicate that treatment is not yet optimal for these offenders. The aim of this case series study is to identify arsonist specific dynamic risk factors that can be targeted during treatment. For this study, we used patient files of and interviews with all patients that were currently housed at a forensic psychiatric hospital in the Netherlands (14 arsonists, 59 non-arsonists). To delineate differences in risk factors between arsonists and non-arsonists, scores on the risk assessment instrument the Historical Clinical Future-30 (HKT-30; completed for 11 arsonists and 35 non-arsonists), an instrument similar to the Historical Clinical Risk Management-20 (HCR-20), were compared. The groups did not differ on demographic factors and psychopathology. Concerning dynamic risk factors, arsonists had significantly poorer social and relational skills and were more hostile. Although this study needs replication, these findings suggest that the treatment of people involved in firesetting should particularly target these risk factors.

Prevalence and correlates of anger in the community: results from a national survey

INTRODUCTION

Little is known about the prevalence and correlates of anger in the community.

METHODS

We used data derived from a large national sample of the U.S. population, which included more than 34,000 adults ages 18 years and older. We defined inappropriate, intense, or poorly controlled anger by means of self-report of the following: (1) anger that was triggered by small things or that was difficult to control, (2) frequent temper outbursts or anger that lead to loss of control, or (3) hitting people or throwing objects in anger.

RESULTS

The overall prevalence of inappropriate, intense, or poorly controlled anger in the U.S. population was 7.8%. Anger was especially common among men and younger adults, and was associated with decreased psychosocial functioning. Significant and positive associations were evident between anger and parental factors, childhood, and adulthood adverse events. There were strong associations between anger and bipolar disorder, drug dependence, psychotic disorder, borderline, and schizotypal personality disorders. There was a dose-response relationship between anger and a broad range of psychopathology.

CONCLUSIONS

A rationale exists for developing screening tools and early intervention strategies, especially for young adults, to identify and help reduce anger.

Clinical risk factors for bipolar disorders: a systematic review of prospective studies

BACKGROUND

Early phases and suspected precursor states of bipolar disorder are not well characterized. We evaluate the prevalence, duration, clinical features and predictive value of non-affective psychopathology as clinical risk factors for bipolar disorder in prospective studies.

METHODS

We screened PubMed, CINAHL, PsycINFO, Embase, SCOPUS, and ISI-Web of Science databases from inception up to January 31, 2014, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and searched: bipolar disorder AND [antecedent⁎ OR predict⁎ OR prodrom⁎ OR prospect⁎ OR risk⁎] AND [diagnosis OR development]. We included only English language reports on prospective, longitudinal studies with two structured clinical assessments (intake and follow-up); no DSM intake diagnosis of bipolar-I or -II; diagnostic outcome was bipolar-I or -II. Details of study design, risk factors, and predictive value were tabulated.

RESULTS

We found 16 published reports meeting selection criteria, with varying study design. Despite heterogeneity in methods, findings across studies were consistent. Clinical risk factors of bipolar disorder were early-onset panic attacks and disorder, separation anxiety and generalized anxiety disorders, conduct symptoms and disorder, ADHD, impulsivity and criminal behavior.

LIMITATIONS

Since risk factors identified in some prospective studies are predictive of other conditions besides bipolar disorder, these preliminary findings require replication, and their sensitivity, specificity and predictive value need to be assessed.

CONCLUSIONS

Clinical risk factors for bipolar disorder typically arise years prior to syndromal onset, include anxiety and behavioral disorders with unclear sensitivity and specificity. Prospectively identified clinical risk factors for bipolar disorder are consistent with retrospective and family-risk studies. Combining clinical risk factors with precursors and family-risk may improve early identification and timely and appropriate treatment of bipolar disorder.

Mental illness and psychiatric treatment amongst firesetters, other offenders and the general community

OBJECTIVE

Firesetting is often reported to be associated with psychopathology, but frequently these conclusions are based on studies reliant on selective forensic psychiatric samples without the use of comparison groups. The aim of the study was to examine the rates of mental illness, substance use disorders, personality pathology and psychiatric service usage in a population of convicted firesetters compared with other offenders and community controls.

METHOD

Using a data-linkage design, the study examined the psychiatric histories and usage of public mental health services by 1328 arsonists convicted between 2000 and 2009 in Victoria, Australia. These were compared with 1328 matched community controls and 421 non-firesetting offenders.

RESULTS

Firesetters were significantly more likely to have been registered with psychiatric services (37%) compared with other offenders (29.3%) and community controls (8.7%). The firesetters were also more likely to have utilised a diverse range of public mental health services. Firesetters attracted psychiatric diagnoses more often than community controls and other offenders, particularly affective, substance use, and personality disorders.

CONCLUSIONS

This study confirms that there is a link between firesetting and psychopathology, suggesting that there is a role for the psychiatric screening of known firesetters, and a need to consider psychopathology in formulating the risk for further firesetting.

The structure of common and uncommon mental disorders

BACKGROUND

Co-morbidity patterns in epidemiological studies of mental illness consistently demonstrate that a latent internalizing factor accounts for co-morbidity patterns among unipolar mood and anxiety disorders, whereas a latent externalizing factor underlies the covariation of substance-use disorders and antisocial behaviors. However, this structure needs to be extended to include a broader range of disorders.

METHOD

Exploratory and confirmatory factor analyses were used to examine the structure of co-morbidity using data from the Collaborative Psychiatric Epidemiological Surveys (n = 16 233).

RESULTS

In the best-fitting model, eating and bipolar disorders formed subfactors within internalizing, impulse control disorders were indicators of externalizing, and factor-analytically derived personality disorder scales split between internalizing and externalizing.

CONCLUSIONS

This was the first large-scale nationally representative study that has included uncommon mental disorders with sufficient power to examine their fit within a structural model of psychopathology. The results of this study have important implications for conceptualizing myriad mental disorders.

Explanations of firesetting in mentally disordered offenders: a review of the literature

This paper reviews current explanations of firesetting in adult mentally disordered offenders. In particular, attention is given to contemporary research that has examined developmental and background characteristics, personality and associated traits, motivation for firesetting, neurobiological explanations, psychiatric diagnoses, and frequency of self-injurious behavior, including suicide. The likelihood of recidivism and associated risk factors is also considered. Evaluation of the existing research has highlighted that even though a significant proportion has been conducted with psychiatric populations, little is understood about firesetting by mentally disordered offenders. In addition, little research has been conducted that compares mentally disordered firesetters to both other mentally disordered offenders and non-mentally disordered offenders. Recommendations are made for future research to further develop knowledge of this behavior.

Gender differences in firesetting: results from the national epidemiologic survey on alcohol and related conditions (NESARC)

This study presents gender differences in sociodemographics and in psychiatric correlates of firesetting in the United States. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative sample of U.S. adults. Face-to-face interviews of more than 43,000 adults were conducted in the 2001-2002 period. This study focused on the 407 subjects with a lifetime history of firesetting. The prevalence of lifetime firesetting in the U.S. was 1.7% in men and 0.4% in women. Firesetting was significantly associated with a wide range of antisocial behaviors that differed by gender. Multivariate logistic regression analyses indicated associations in both genders with psychiatric and addictive disorders. Men with a lifetime history of firesetting were significantly more likely than men without such history to have lifetime generalized anxiety disorder as well as a diagnosis of conduct disorder, antisocial personality disorder, alcohol or cannabis use disorder, and obsessive-compulsive personality disorder. Women with a lifetime history of firesetting were significantly more likely than women without such history to have lifetime alcohol or cannabis use disorder, conduct disorder, and antisocial or obsessive compulsive personality disorder, as well as psychotic disorder, bipolar disorder or schizoid personality disorder. Women with a lifetime history of firesetting were significantly more likely than men with such history to have a lifetime diagnosis of alcohol abuse and antisocial personality disorder as well as a diagnosis of schizoid personality disorder. Our findings indicate that firesetting in women could represent a behavioral manifestation of a broader spectrum than firesetting in men.