Childhood risk factors for offending before first psychiatric admission for people with schizophrenia: a case-control study of high security hospital admissions.

Background: People with schizophrenia who offend do not constitute a homogenous population. Pre-illness characteristics may distinguish groups.

Aims: To test for differences in prevalence of childhood risk factors for offending between serious offenders with schizophrenia who had started offending before their first ever psychiatric admission (pre-admission offenders) and those who had started after it (post-admission offenders). Our hypothesis was that such adverse childhood factors would be more prevalent in the pre-admission offenders.

Method: Retrospective interview and records case-control study of all first high security hospital admissions diagnosed with schizophrenia in England 1972-2000. Risk factors were identified by multivariate logistic regression.

Results: 853 patients were pre- and 741 post-admission offenders. Our hypothesis was confirmed in that factors associated with pre-admission offending were paternal criminal convictions, larger family size, and younger age at first use of illicit drugs, on first smoking cigarettes, and at maternal separation. There were differences too in pre-high security hospital treatment: pre-admission offenders had been younger at first court appearance and had more criminal justice system disposals, post-admission offenders were younger at first ever psychiatric hospital admission and more often hospitalized.

Conclusions: While early offending among people with schizophrenia may delay treatment, making the distinction between pre-admission and post-admission offending may be useful in understanding the aetiology of the offending, and establishment of such a history may help in targeting interventions supplementary to treatment specific for the psychosis.