Schizophrenia Medical Nonadherence Linked to Increased Risk of Violence to Others

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The risk of minor nuisances, violating APS law, and violating criminal law were higher in the nonadherence group.

Patients with schizophrenia who do not adhere to their medication are at an increased risk of committing violent acts toward others. However, this risk does not increase in higher rates of medical nonadherence.1

A team, led by Yang Li, MD, Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, examined the association between medication nonadherence and violence to others in community-based patients with schizophrenia.

A Growing Problem in China

The rate of schizophrenia is exceedingly high, with 25% of the patients with the disease worldwide living in China.

“Some studies have suggested that patients with schizophrenia are more likely than the general population to commit violent behaviors,” the authors wrote. “The occurrence of violent behaviors seriously affects the quality of life of patients and their families and has a negative impact on social security.”

While there are obvious benefits to reducing violence to others in community-based patients with schizophrenia, there is little known about the association between medication nonadherence and violence to others in this patient population.

Looking at the Data

In the large, naturalistic, prospective cohort study, the investigators examined patients in western China between May 1, 2006 and December 31, 2018. At the conclusion of the study there were 292,667 patients with schizophrenia registered in the platform. Each participant was allowed to enter or leave the cohort at any time during the follow-up.

The maximum follow-up time was 12.8 years, with a mean of 4.2 years.

The investigators sought main outcomes of violence to other throughout the follow-up period, including minor nuisances, violating the Law of the People’s Republic of China on Penalties for Administration of Public Security (APS law), and violating criminal law.

This data was collected by the public security department. The investigators also identified and controlled confounders using directed acyclic graphs.

The final sample of participants included 207,569 patients with schizophrenia with a mean age of 51.3 years. The analysis show 13.3% (n = 27,698) individuals who perpetrated violence to others.

Comparing the Groups

Of this group, 15.7% (n = 22,312) were identified for medical nonadherence and 8.3% (n = 5386) were labeled as having adhered to medication.

The results from 112,710 propensity score-matched cases show the risk of minor nuisances (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.75-1.90; P <.001), violating APS law (OR, 1.91; 95% CI, 1.78-2.05; P <.001), and violating criminal law (OR, 1.50; 95% CI, 1.33-1.71; P <.001) were higher in the nonadherence group.

However, the risk ultimately did not increase with higher medication nonadherence and there were differences found in the risk of violating APS law between urban and rural areas.

“Medication nonadherence was associated with a higher risk of violence to others among community-based patients with schizophrenia, but the risk did not increase as medication nonadherence increased,” the authors wrote.


Li Y, Wen H, Xiong C, et al. Medication Nonadherence and Risk of Violence to Others Among Patients With Schizophrenia in Western China. JAMA Netw Open. 2023;6(4):e235891. doi:10.1001/jamanetworkopen.2023.5891