Prevalence and Correlates of Criminal Victimization in Taiwanese Outpatients with Severe Mental Illness

Prevalence and Correlates of Criminal Victimization in Taiwanese Outpatients with Severe Mental Illness | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Correlates of Criminal Victimization in Taiwanese Outpatients with Severe Mental Illness Chien-Chi Hsu, Chun-Kai Fang, Ching-Ho Hu, Ying Lin, Shu-I Wu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8149581/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Criminal victimization among individuals with severe mental illness (SMI) remains understudied in Asian contexts, complicating community reintegration. This study examined its prevalence and associated factors among Taiwanese adults with SMI to guide clinical and public health interventions. Method Participants (N = 798) with bipolar disorder (60.2%) or schizophrenia (39.8%) receiving at least one year of outpatient care at a medical center in northern Taiwan were recruited. Data on past-year victimization, sociodemographic traits, and clinical factors were collected, assessed via Patient Health Questionnaire (PHQ-9), Demoralization Scale, Medication Adherence Rating Scale, and Personal and Social Performance Scale. Univariate and logistic regression analyses identified associations. Result Overall, 25.1% (n = 200) reported victimization. Protective factors included family cohabitation (OR = 0.56, 95% CI [0.37–0.85], p = .004) and bipolar diagnosis (vs. schizophrenia; OR = 0.66, 95% CI [0.45–0.98], p = .035). Risk factors included prior suicide attempts (OR = 1.93, 95% CI [1.35–2.75], p = .001), smoking (OR = 1.69, 95% CI [1.18–2.43], p = .004), criminal history (OR = 1.70, 95% CI [1.06–2.73], p = .029), higher depressive symptoms (PHQ-9; OR per point = 1.05, 95% CI [1.03–1.08], p < .001), and prior psychiatric hospitalization (OR = 1.58, 95% CI [1.15–2.18], p = .015). Conclusion The findings highlight the need for targeted interventions addressing depressive symptoms, suicide risk, and prior hospitalizations while leveraging family support to reduce victimization in community settings. crime victimization severe mental illness bipolar disorder schizophrenia depression Highlights • Research on crime victimization risk among individuals with severe mental illness (SMI) in Asia remains insufficient; this study is the largest of its kind in Asia to date utilizing standardized victimization survey instruments. • Living with family and a bipolar disorder diagnosis independently reduce crime victimization risk in SMI. • Identified risk factors for crime victimization include a history of suicide attempts, more severe depressive symptoms, previous psychiatric hospitalization, smoking, and a prior criminal record. • Despite East-West cultural differences, crime victimization among individuals with SMI in Taiwan requires more attention to enhance their well-being. 1. Introduction Mental illness has remained one of the top ten global disease burdens for the past 30 years, primarily impacting quality of life rather than mortality, as measured by disability-adjusted life years (DALYs) (Collaborators, 2022 ). This burden is especially severe for individuals with severe mental illness (SMI), who often experience poor insight, substance use, and treatment nonadherence. Although mental health care has shifted toward community-based services to reduce the negative effects of long-term hospitalization (Drake et al., 2003 ), stigma—particularly fears of violence—has hindered reintegration (Whiting et al., 2021 ). Many countries still use “dangerousness” as a criterion for involuntary hospitalization (Large et al., 2008 ), further complicating recovery. People with mental disorders are disproportionately arrested due to factors such as homelessness, poverty, and limited access to care (Bonfine et al., 2020 ; Prins, 2011 ; Vogel et al., 2014 ). Despite growing research, victimization among individuals with SMI remains underexplored, partly due to underreporting (Maniglio, 2009 ; Teplin et al., 2005 ). Victimization is closely linked to symptom severity and poor outcomes (Bhavsar et al., 2019 ; Khalifeh et al., 2015 ). Prevalence estimates vary by study design. One U.S. study found SMI patients were 11 times more likely to be victimized than the general population (Teplin et al., 2005 ). A Dutch study reported a 47% annual victimization rate among psychiatric outpatients, with violent crime rates 2.8 times higher than the general population (Kamperman et al., 2014 ). Lifetime prevalence rates for violent, non-violent, and sexual victimization among individuals with psychosis are 66%, 39%, and 27%, respectively (de Vries et al., 2018 ). Risk factors include severe psychopathology, poverty, social isolation, and substance use (Crisanti et al., 2014 ; Hsu et al., 2009 ; Kamperman et al., 2014 ). Depression, common in SMI, increases vulnerability by impairing self-efficacy and social functioning, and is associated with demoralization and reduced help-seeking (Hansson, 2006 ; Tecuta et al., 2015 ). Victimization can worsen psychological distress and quality of life (Hanson et al., 2010 ; Maniglio, 2009 ; Raphael et al., 2008 ). In Asian cultures influenced by collectivism, stigma may delay treatment and reduce willingness to report victimization (Papadopoulos et al., 2013 ; Smith & Robinson, 2019 ). While family support may offer protection (Hsu et al., 2009 ), victimization among Asian individuals with SMI remains under-researched. Existing data suggest elevated risks linked to prior risky behaviors, specific diagnoses (schizophrenia, affective, or anxiety disorders), and substance use, with repeated victimization further impairing functioning (Wang et al., 2020 ). This study aims to address these gaps by directly surveying Taiwanese outpatients with SMI to assess victimization prevalence and its clinical correlates. Understanding these experiences is essential for developing targeted interventions and informing public health strategies to support recovery and community integration. 2. Methods 2.1. Study Design and Participants This cross-sectional survey study utilized convenience sampling and was conducted between March 2013 and December 2013. Participants were recruited from the psychiatric outpatient clinic at Mackay Memorial Hospital, a major medical center in Taipei, Taiwan that manages approximately 8,000 psychiatric visits per month. As patients can self-register without requiring referrals, the participants’ socioeconomic background is considered broadly representative of psychiatric outpatients utilizing medical centers in northern Taiwan. 2.2. Inclusion and Exclusion Criteria Participants were required to meet the following criteria: Medical record confirmation of schizophrenia, related psychoses (ICD-9-CM(Health et al., 2006 ): 295, 297), or bipolar disorder (ICD-9-CM: 296.0-296.1, 296.4-296.9). Diagnosis and treatment regimen stable for > 1-year preceding enrollment. Minimum age of 20 years at enrollment. Proficiency in spoken Mandarin or Taiwanese and literacy in written Chinese. Provided written informed consent prior to participation. Excluded if participants met any of the following criteria at the time of enrollment: Presence of acute psychotic symptoms. Significant cognitive impairment. Evident risk of suicide or violence. 2.3. Participant Recruitment and Ethical Approval Potential participants were identified by reviewing outpatient medical records based on the inclusion criteria. A research nurse approached eligible individuals, explained the study's purpose, and obtained written informed consent prior to participation. A total of 798 individuals consented and participated. The Institutional Review Board (IRB) of Mackay Memorial Hospital approved this study (Approval No. 12MMHIS141). 2.4. Research Tools The study utilized the following instruments: a sociodemographic and clinical information, the Taiwan Crime Victimization Survey (TCVS) (Hsu et al., 2009 ; Sheu et al., 2000 ), the Medication Adherence Rating Scale (MARS) (Kao and Liu, 2010 ; Thompson et al., 2000 ), the Demoralization Scale (DS) (Clarke and Kissane, 2002 ; Kissane et al., 2004 ; Lee et al., 2012 ), the Patient Health Questionnaire (PHQ-9) (Liu et al., 2011 ; Spitzer et al., 1999 ), and the Personal and Social Performance scale (PSP) (Morosini et al., 2000 ). Sociodemographic and clinical data: This form collected demographic and clinical data. Demographic information included gender, age, educational level, occupation, marital status, living situation, and possession of a low-income certificate, disability certificate, or major psychiatric illness card. Clinical information included criminal record history, duration of illness, number of hospitalizations, diagnosis, alcohol use patterns, smoking status, and use of long-acting injectable antipsychotics. Demographic data was self-reported by participants, while clinical data was extracted from medical records by researchers. Harmful drinking was defined according to previous research as consuming alcohol more than three times per week (Hartz et al., 2018). TCVS was developed by Taiwan's Ministry of Justice and National Police Agency (Sheu et al., 2000 ) and based on the U.S. National Crime Victimization Survey (NCVS) (Rennison, 1999 ), the TCVS assesses victimization experiences. Using interviews and questionnaires, it probes personal or household victimization, including violent and property crimes, within the past year. Similar methods have previously assessed personal victimization among individuals with SMI in Taiwan(Hsu et al., 2009 ). This study focused on personal experiences of property and violent crimes over the past year, specifically asking about incidents of theft, assault, robbery, mugging, kidnapping, intimidation, rape, sexual assault, fraud, and identity theft, including the frequency of these occurrences. The MARS is a 10-item measure assessing medication adherence behaviors over the past week(Thompson et al., 2000 ). Each item requires a 'yes' or 'no' response, yielding a total score from 0 to 10, with higher scores indicating better adherence but does not specify a distinct cut-off score to define poor adherence. The reliability and validity of the Chinese version of the MARS have been previously established (Kao and Liu, 2010 ). The DS is a 24-item self-report measure evaluating existential distress, including meaninglessness, helplessness, despair, sense of failure, and related emotional distress, often experienced by individuals with severe illnesses(Clarke and Kissane, 2002 ; Kissane et al., 2004 ). Items are scored on a 0-to-4 Likert scale, resulting in a total score range of 0 to 96. Higher scores reflect greater levels of demoralization, with a score ≥ 30 suggested as a threshold for moderate levels. The Chinese version of the DS has demonstrated good reliability and validity (Lee et al., 2012 ). The PHQ-9 is a 9-item self-administered questionnaire screening for the severity of depressive symptoms over the preceding two weeks(Spitzer et al., 1999 ). Each item is scored from 0 ("Not at all") to 3 ("Nearly every day"), with total scores ranging from 0 to 27. Higher scores indicate more severe depressive symptoms. A suggested cut-off for moderate depression is a score of ≥ 10. The reliability and validity of the Chinese version have been confirmed(Liu et al., 2011 ). The PSP measures functioning across four key domains: socially useful activities (including work and study), personal and social relationships, self-care, and disturbing and aggressive behaviors (Morosini et al., 2000 ). Functioning levels are rated based on participant interviews. Scores range from 1 to 100, with higher scores indicating better overall personal and social performance, with levels of impairment defined as: 71–100 signifies mild functional difficulty; 31–70 indicates varying degrees of disability; and 1–30 reflects severe disability with minimal functioning needing intense support/supervision(Suttajit et al., 2015 ). The Chinese version of the PSP has established good reliability and validity (Wu et al., 2013 ). 2.5. Statistical Analysis All statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY(IBMCorp Ibm, 2017 ) ). Initially, descriptive statistics were generated to outline the sociodemographic and clinical profiles of the study participants. This included calculating frequencies and percentages for categorical variables, means and standard deviations (SD) for continuous variables, encompassing scores derived from the MARS, DS, PHQ-9, and PSP instruments. Participants were dichotomized into two groups based on their reported victimization experiences for comparative analyses, with differences in sociodemographic and clinical variables examined using independent samples t-tests for continuous data and Pearson's chi-square tests (or Fisher's exact test where appropriate) for categorical data. To identify factors associated with victimization, a binary logistic regression model was employed, with overall victimization served as the dependent variable and relevant sociodemographic and clinical characteristics as independent variables. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated to quantify the strength of associations. The goodness-of-fit for the final logistic regression model was assessed using the Hosmer-Lemeshow test; a non-significant result (p > 0.05) indicated acceptable model calibration. Statistical significance for all inferential tests was defined at an alpha level of p < 0.05. 3. Results 3.1 Sample Characteristics Of the 798 participants, 34.6% were male (n = 276) and 65.4% female (n = 522), with a mean age of 43.35 years (SD = 11.27; range 20–83), with majority unmarried (73.7%, n = 588) and lived with family (77.4%, n = 618). 3.2. Clinical Characteristics Diagnoses included schizophrenia in 39.8% (n = 318) and bipolar disorder in 60.2% (n = 480), with a mean illness duration of 9.98 years (SD = 5.58; range 3–49). Government-issued certifications comprised a major psychiatric illness card from the National Health Insurance Administration (61.5%) and a mental disability certificate from the Social Affairs Bureau (52.3%); 24.9% had at least one comorbid chronic physical illness. Histories of criminal conviction, violent behavior, and suicide attempts were reported by 12.3%, 29.1%, and 48.5%, respectively. 3.3. Treatment History More than half of participants (56.1%, n = 448) had experienced at least one acute psychiatric ward admission; 23.1% (n = 184) had been admitted to a day hospital, and 45.4% (n = 362) had received long-acting injectable antipsychotics. 3.4. Baseline Assessment Scores Mean baseline scores were: PHQ-9, 10.92 (SD = 7.70); Demoralization Scale, 47.02 (SD = 19.69); PSP, 68.16 (SD = 12.37); and MARS, 6.06 (SD = 2.36). 3.5. Lifestyle Factors Current smoking was reported by 38.1% of participants (n = 304), and 3.9% (n = 31) met criteria for harmful alcohol use (Hartz et al., 2018). 3.6. Victimization Experiences In the past year, 25.1% (n = 200) of participants reported victimization: 18.0% (n = 144) experienced property crime and 15.9% (n = 127) violent crime. Notably, 71 participants (8.9% of the total sample; 35.5% of those victimized) endured both types of crime. Additional details are provided in Table 1. 3.7. Univariate Analysis of Factors Associated with Victimization Univariate analyses showed that, compared with non-victimized participants, those who experienced victimization in the past year were significantly more likely to be unmarried or not cohabiting (27.7% vs. 17.6%, p = .004), have low-income status (34.2% vs. 22.3%, p = .001), not live with family (37.8% vs. 21.4%, p < .001) and hold a mental disability certification (30.5% vs. 19.2%, p < .001). They also had higher rates of psychiatric ward admission (29.9% vs. 18.9%, p < .001), suicide attempts (34.9% vs. 15.8%, p < .001), violent behavior (35.8% vs. 20.7%, p < .001), smoking (35.5% vs. 18.6%, p < .001), harmful alcohol consumption ( 45.2% vs. 24.3%, p = .008) and criminal convictions (45.9% vs. 22.1%, p < .001). 3.8. Comparison of Scale Scores Between Victimized and Non-Victimized Groups Victimized participants exhibited significantly more severe symptoms and poorer functioning than their non-victimized counterparts. Specifically, they scored higher on the PHQ-9 (mean ± SD: 13.80 ± 7.57 vs. 9.96 ± 7.50, p < .001) and on the Demoralization Scale (53.91 ± 17.98 vs. 44.72 ± 19.71, p < .001), indicating greater depression and demoralization. They also demonstrated worse treatment adherence, with lower MARS scores (5.51 ± 2.32 vs. 6.24 ± 2.35, p < .001), and diminished social functioning on the PSP (65.58 ± 12.41 vs. 69.03 ± 12.25, p < .001). Other details are provided in Table 2. 3.9. Logistic Regression Analysis of Risk Factors for Victimization Multivariate logistic regression identified several independent predictors of past‐year victimization. Protective factors include living with family (OR = 0.56, 95% CI [ 0.37–0.85 ], p = .004) and a bipolar disorder diagnosis (vs. schizophrenia; OR = 0.66, 95% CI [ 0.45–0.98 ], p = .035). In contrast, victimization odds were significantly increased among participants with suicide attempt history (OR = 1.93, 95% CI [ 1.35–2.75 ], p = .001), current smoking (OR = 1.69, 95% CI [ 1.18–2.43 ], p = .004), criminal convictions (OR = 1.70, 95% CI [ 1.06–2.73 ], p = .029), greater depressive symptom severity (per‐point increase in PHQ-9; OR = 1.05, 95% CI [ 1.03–1.08 ], p < .001), and prior acute psychiatric ward admission (OR = 1.58, 95% CI [ 1.15–2.18 ], p = .015). The Hosmer–Lemeshow test confirmed satisfactory model fit (χ²(8) = 6.79, p = .56). Additional details are provided in Table 3. 4. Discussion This study utilized one of the largest Asian samples and a standardized survey to examine crime victimization among Taiwanese outpatients with SMI, and revealed that over one-fourth of participants experienced a crime in the past year, encompassing violent victimization and non-violent (property) victimization. Our findings align with prior meta-analyses showing significantly higher victimization rates in SMI compared to the general population (Maniglio, 2009 ). Reported rates fall within established ranges—20% for violent and 19% for non-violent victimization over three years (de Vries et al., 2018 ), and 7.1%–56% for one-year violent victimization (Latalova et al., 2014 ). Despite methodological differences across studies, the consistent conclusion is the heightened vulnerability of individuals with SMI. 4.1. Comparison with Previous Local Research Interestingly, our overall victimization rate (25.1%) diverges from a previous, smaller-scale Taiwanese study using similar methods, which reported a rate of 16.8% (Hsu et al., 2009 ). This discrepancy is likely a result of differences in sample characteristics and recruitment settings. The previous study included 155 participants, notably 61 individuals hospitalized in acute psychiatric wards at the time of the survey and featured a higher proportion with schizophrenia (59.4%) (Hsu et al., 2009 ). In contrast, our larger sample (N = 798) consisted entirely of outpatients, with a lower proportion diagnosed with schizophrenia (39.8%). These variations in sample acuity, diagnostic composition, and living situation (community vs. partly inpatient) likely contributed to the differing observed victimization rates. 4.2. Risk Factors for Victimization This study used multivariate analysis to identify significant predictors of victimization. An increased risk was associated with a history of suicide attempts, more severe depressive symptoms, current smoking, a prior criminal record, and previous acute psychiatric hospitalization, while living with family and a diagnosis of bipolar disorder (relative to schizophrenia) were linked to a lower risk of victimization. 4.2.1. Suicide Attempts and Depressive Symptoms: Our findings indicated that a history of suicide attempts nearly doubled the odds of victimization (OR = 1.93), while each one-point increase in PHQ-9 depression score elevated risk by approximately 5% (OR = 1.05). The relationship between depression, suicidality, and victimization is complex and likely bidirectional, as victimization can precipitate or exacerbate depression and related mental health issues (Casiano et al., 2020 ; Zapata Roblyer and Betancourth Zambrano, 2017 ). Conversely, pre-existing depressive symptoms might impair judgment, motivation, or the ability to navigate or exit risky situations, thereby increasing vulnerability (Bhavsar et al., 2020 );this aligns with research showing higher victimization risk among those hospitalized for suicide attempts (Casiano et al., 2020 )and findings linking depressive symptoms with recent victimization and increased severity among those with a suicide attempt history (Bhavsar et al., 2020 ). Furthermore, twin studies suggest gene-environment correlations may be present, indicating that pre-existing mental health vulnerabilities can increase subsequent victimization risk (Gonggrijp et al., 2023 ). Inherent vulnerability, impaired judgment, social isolation, prior trauma, and being perceived as easier targets are possible explanations for the heightened susceptibility of SMI patients. 4.2.2. Smoking Status: Current smoking was associated with a 1.7-fold increased risk of victimization (OR = 1.69). This resonates with large community studies identifying smokers as having elevated risks for both crime perpetration and victimization (Lewis et al., 2015 ). Smokers are more likely to reside in or perceive their neighborhoods as high-crime areas (Shareck and Ellaway, 2011 ), and community violence levels are linked to smoking intensity and reduced cessation attempts (Fleischer et al., 2015 ). Thus, smoking might serve as a marker for exposure to higher-risk environments or lifestyles. In addition, factors like greater exposure to deviant peers, potentially impaired judgment, or reduced impulse control among some smokers could contribute to increased vulnerability (Kristman-Valente et al., 2016 ). 4.2.3. Criminal Record: A prior criminal record increased victimization risk by 1.7 times (OR = 1.70), consistent with established research demonstrating a strong link between offending behavior and subsequent victimization(de Vries et al., 2018 ; Maniglio, 2009 ). A meta-analysis specific to individuals with mental illness reported a 4.3-fold increase in victimization odds associated with a criminal history(de Vries et al., 2018 ). Lifestyle and Routine Activity Theory (L-RAT) (McNeeley, 2015 ; Teasdale, 2009 ; Teasdale et al., 2021 )offers a framework, suggesting victimization occurs at the confluence of a motivated offender, a suitable target, and the absence of capable guardianship. Individuals with SMI and a criminal record may experience increased exposure to risky situations or offenders (lifestyle/environment), share underlying risk factors contributing to both offending and vulnerability (e.g., impulsivity, substance use), and potentially lack of effective guardianship(Teasdale, 2009 ; Teasdale et al., 2021 ) . 4.2.4. History of Acute Psychiatric Hospitalization: A history of acute psychiatric hospitalization predicted a 1.6-fold increase in victimization risk (OR = 1.58), corresponding with prior research that suggest recent or frequent hospitalizations elevate risk (Maniglio, 2009 ), a Danish study found discharged psychiatric patients had a five times higher 10-year homicide mortality rate (Walter et al., 2019 ), and within healthcare systems, hospitalization frequency correlated with increased physical victimization risk (Rossa-Roccor et al., 2020 ). A history of acute hospitalization often signifies greater illness severity or chronicity (Rossa-Roccor et al., 2020 ), potentially rendering individuals more vulnerable or marking them as more suitable targets in the eyes of perpetrators. 4.3. Protective Factors for Victimization 4.3.1. Living with Family: Living with family significantly reduced victimization risk (OR = 0.56) since family members can serve as capable guardians, effectively mitigating risk according to L-RAT framework (McNeeley, 2015 ; Teasdale, 2009 ; Teasdale et al., 2021 ), as family members can serve as capable guardians. This contrasts sharply with the well-documented increased vulnerability associated with homelessness or unstable housing among individuals with SMI(de Vries et al., 2018 ; Khalifeh et al., 2016 ; Latalova et al., 2014 ; Maniglio, 2009 ; Teasdale, 2009 ), where meta-analyses indicate a 2.6-fold increased risk (Khalifeh et al., 2016 ). Living with family likely provides a safer environment and effective supervision, thereby reducing exposure and opportunities for victimization. 4.3.2. Bipolar Disorder Diagnosis: Compared to schizophrenia, a diagnosis of bipolar disorder was associated with a lower risk of victimization (OR = 0.66). Plausible explanations include potentially better average functioning, longer periods of stability, or stronger family connections among individuals with bipolar disorders relative to schizophrenia, enhancing self-protection capabilities. The literature examining specific diagnoses and victimization risk presents inconsistent findings. While some studies suggest any psychiatric symptoms increase risk, potentially additively (Bhavsar et al., 2019 ), or link specific symptoms like psychosis or mania to risk without differentiating primary diagnosis (de Vries et al., 2018 ), others find no difference between schizophrenia and bipolar disorder (Khalifeh et al., 2016 ), or even suggest lower risk for schizophrenia (Hsu et al., 2009 ; Sariaslan et al., 2020 )or higher risk (Dean et al., 2024 ). Methodological variations, study populations, and control for confounders like offending behavior likely contribute to these discrepancies (Dean et al., 2018 ). Our finding adds to this complex picture, underscoring the need for further nuanced research. 4.4 Interpretation of Other Scale Findings 4.5 Although univariate analyses showed that higher demoralization (DS), poorer medication adherence (MARS), and lower social functioning (PSP) were associated with victimization, these associations lost significance in the multivariate model—likely due to confounding and interrelated variables. For instance, poor adherence is linked to increased hospitalization and offending (Ascher-Svanum et al., 2009 ; Rezansoff et al., 2017 ), both of which were significant predictors. Similarly, functional impairment is more common in schizophrenia than bipolar disorder (Ryu et al., 2020 ), supporting our finding that bipolar diagnosis was protective. Demoralization is also closely tied to depression and suicidality (Costanza et al., 2022 ), which remained independent risk factors. Thus, while not independently predictive, these factors likely contribute indirectly to victimization risk and remain clinically relevant. Limitations and Future Directions This study possesses several limitations inherent in its design. First, the cross-sectional nature precludes definitive causal inferences regarding the temporal sequence between identified risk factors and victimization. Reliance on self-report measures for victimization and other variables introduces potential recall and social desirability biases. Furthermore, the findings are derived from a specific sample in Taiwan, potentially limiting generalizability to individuals with SMI in different cultural or healthcare contexts. Future studies could benefit from being longitudinal, having more data sources, and incorporating multiple culture or healthcare contexts. Despite these limitations, this study has notable strengths: the utilization of a standardized version of the TCVS, designed to capture unreported crime (Hsu et al., 2009 ), the ethnic Chinese focused demographic, and the scale of the study. Additional efforts are crucially needed to develop, implement, and evaluate targeted prevention and intervention strategies designed to mitigate victimization risk and support recovery for this vulnerable population. 5. Conclusion and Implications In summary, this study highlights the high prevalence of crime victimization among community-dwelling individuals with severe mental illness (SMI) in Taiwan. Key risk factors include a history of suicide attempts, depression severity, smoking, criminal history, and prior psychiatric hospitalization, while protective factors include living with family and having a bipolar disorder diagnosis compared to schizophrenia. These findings call for greater awareness and targeted interventions from clinicians and policymakers to reduce victimization and support recovery. Ongoing research is essential to better understand and address the complex dynamics of victimization in this population. Declarations CRediT authorship contribution statement Chien-Chi Hsu: Conceptualization, Methodology, Software, Validation, Formal Analysis, Investigation, Resources, Data Curation, Writing, Supervision. Chun-Kai Fang: Conceptualization, Methodology, Validation. Shu-I Wu: Conceptualization, Methodology, Validation, Resources, Writing, Supervision. Ying Lin: Software, Writing. Ching-Ho Hu: Investigation, Writing Declaration of Competing Interest All authors declare no competing interests. Funding This study was conducted without financial support from any governmental, commercial, or nonprofit funding agencies. Acknowledgement We sincerely thank Vivian Hsu for her professional English editing, which improved the clarity of our manuscript. Data Availability Datasets being analyzed and results being generated and reported in this article are not publicly available due to protections of personal privacy. Restrictions applied to these data, which were used under license for our study, and so are not publicly available for duplication. Further data analysis may be requested after discussion with authors. Ethical approval and informed consent statements The Institutional Review Board (IRB) of Mackay Memorial Hospital approved this study (Approval No. 12MMHIS141). References Ascher-Svanum H, Zhu B, Faries DE, Furiak NM, Montgomery W (2009) Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia. BMC Res Notes 2:6. https://doi.org/10.1186/1756-0500-2-6 Bhavsar V, Dean K, Hatch SL, MacCabe JH, Hotopf M (2019) Psychiatric symptoms and risk of victimisation: a population-based study from Southeast London. Epidemiol Psychiatr Sci 28(2):168–178. https://doi.org/10.1017/S2045796018000537 Bhavsar V, Hatch SL, Dean K, McManus S (2020) Association of prior depressive symptoms and suicide attempts with subsequent victimization: analysis of population-based data from the Adult Psychiatric Morbidity Survey. Eur Psychiatry 63(1):e51. https://doi.org/10.1192/j.eurpsy.2020.50 Bonfine N, Wilson AB, Munetz MR (2020) Behav Health Syst Psychiatr Serv 71(4):355–363. https://doi.org/10.1176/appi.ps.201900453 . Meeting the Needs of Justice-Involved People With Serious Mental Illness Within Community Casiano H, Hensel JM, Chartier MJ, Ekuma O, MacWilliam L, Mota N, McDougall C, Bolton JM (2020) The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study. Can J Psychiatry 65(7):492–501. https://doi.org/10.1177/0706743720919660 Clarke DM, Kissane DW (2002) Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 36(6):733–742. https://doi.org/10.1046/j.1440-1614.2002.01086.x Collaborators GBDMD (2022) Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 9(2):137–150. https://doi.org/10.1016/S2215-0366(21)00395-3 Costanza A, Vasileios C, Ambrosetti J, Shah S, Amerio A, Aguglia A, Serafini G, Piguet V, Luthy C, Cedraschi C, Bondolfi G, Berardelli I (2022) Demoralization in suicide: A systematic review. J Psychosom Res 157:110788. https://doi.org/10.1016/j.jpsychores.2022.110788 Crisanti AS, Frueh BC, Archambeau O, Steffen JJ, Wolff N (2014) Prevalence and correlates of criminal victimization among new admissions to outpatient mental health services in Hawaii. Commun Ment Health J 50(3):296–304. https://doi.org/10.1007/s10597-013-9688-1 de Vries B, van Busschbach JT, van der Stouwe ECD, Aleman A, van Dijk JJM, Lysaker PH, Arends J, Nijman SA, Pijnenborg GHM (2018) Prevalence Rate and Risk Factors of Victimization in Adult Patients With a Psychotic Disorder: A Systematic Review and Meta-analysis. Schizophr Bull 45(1):114–126. https://doi.org/10.1093/schbul/sby020 Dean K, Laursen TM, Marr C, Pedersen CB, Webb RT, Agerbo E (2024) Absolute and relative risk of violent victimisation and perpetration following onset of mental illness: a Danish register-based study. Lancet Reg Health – Europe 36. https://doi.org/10.1016/j.lanepe.2023.100781 Dean K, Laursen TM, Pedersen CB, Webb RT, Mortensen PB, Agerbo E (2018) Risk of Being Subjected to Crime, Including Violent Crime, After Onset of Mental Illness: A Danish National Registry Study Using Police Data. JAMA Psychiatry 75(7):689–696. https://doi.org/10.1001/jamapsychiatry.2018.0534 Drake RE, Green AI, Mueser KT, Goldman HH (2003) The History of Community Mental Health Treatment and Rehabilitation for Persons with Severe Mental Illness. Commun Ment Health J 39(5):427–440. https://doi.org/10.1023/a:1025860919277 Fleischer NL, Lozano P, Arillo Santillán E, Reynales Shigematsu LM, Thrasher JF (2015) The impact of neighbourhood violence and social cohesion on smoking behaviours among a cohort of smokers in Mexico. J Epidemiol Community Health 69(11):1083–1090. https://doi.org/10.1136/jech-2014-205115 Gonggrijp BMA, van de Weijer SGA, van Dongen J, Slob EMA, Bijleveld CCJH, Boomsma DI (2023) Exploring the Relationships of Crime Victimization with Depression, Anxiety, and Loneliness in Twin Families. J Dev Life-Course Criminol 9(3):455–482. https://doi.org/10.1007/s40865-023-00234-1 Hanson RF, Sawyer GK, Begle AM, Hubel GS (2010) The impact of crime victimization on quality of life. J Trauma Stress 23(2):189–197. https://doi.org/10.1002/jts.20508 Hansson L (2006) Determinants of quality of life in people with severe mental illness. Acta psychiatrica Scandinavica 113(s429):46–50. https://doi.org/10.1111/j.1600-0447.2005.00717.x Hartz SM, Oehlert M, Horton AC, Grucza RA, Fisher SL, Culverhouse RC, Nelson KG, Sumerall SW, Neal PC, Regnier P, Chen G, Williams A, Bhattarai J, Evanoff B, Bierut LJ 2018. Daily Drinking Is Associated with Increased Mortality. Alcohol Clin Exp Res 42 (11), 2246–2255. https://doi.org/10.1111/acer.13886 Health USDo, Services H, Medicare Cf, Services M (2006) International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), 6th edn. U.S. Government Printing Office, Washington, D.C. Hsu C-C, Sheu C-J, Liu S-I, Sun Y-W, Wu S-I, Lin Y (2009) Crime victimization of persons with severe mental illness in Taiwan. Australian New Z J Psychiatry 43(5):460–466. https://psycnet.apa.org/doi/10.1080/00048670902817737 IBMCorp Ibm S (2017) statistics for windows, version 25.0. Armonk. IBM Corp, NY Kamperman AM, Henrichs J, Bogaerts S, Lesaffre EM, Wierdsma AI, Ghauharali RR, Swildens W, Nijssen Y, van der Gaag M, Theunissen JR, Delespaul PA, van Weeghel J, van Busschbach JT, Kroon H, Teplin LA, van de Mheen D, Mulder CL (2014) Criminal victimisation in people with severe mental illness: a multi-site prevalence and incidence survey in the Netherlands. PLoS ONE 9(3):e91029. https://doi.org/10.1371/journal.pone.0091029 Kao YC, Liu YP (2010) Compliance and schizophrenia: the predictive potential of insight into illness, symptoms, and side effects. Compr Psychiatry 51(6):557–565. https://doi.org/10.1016/j.comppsych.2010.03.007 Khalifeh H, Moran P, Borschmann R, Dean K, Hart C, Hogg J, Osborn D, Johnson S, Howard LM (2015) Domestic and sexual violence against patients with severe mental illness. Psychol Med 45(4):875–886. https://doi.org/10.1017/s0033291714001962 Khalifeh H, Oram S, Osborn D, Howard LM, Johnson S (2016) Recent physical and sexual violence against adults with severe mental illness: a systematic review and meta-analysis. Int Rev Psychiatry 28(5):433–451. https://doi.org/10.1017/s0033291714001962 Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care 20(4):269–276. https://doi.org/10.1177/082585970402000402 Kristman-Valente AN, Oesterle S, Hill KG, Wells EA, Epstein M, Jones TM, Hawkins JD (2016) The Relationship between Interpersonal Violence Victimization and Smoking Behavior across Time and by Gender. J Soc Work Pract Addict 16(1–2):132–159. https://doi.org/10.1080/1533256x.2016.1146612 Large MM, Ryan CJ, Nielssen OB, Hayes RA (2008) The danger of dangerousness: why we must remove the dangerousness criterion from our mental health acts. J Med Ethics 34(12):877–881. https://doi.org/10.1136/jme.2008.025098 Latalova K, Kamaradova D, Prasko J (2014) Violent victimization of adult patients with severe mental illness: a systematic review. Neuropsychiatr Dis Treat 10:1925–1939. https://doi.org/10.2147/NDT.S68321 Lee C-Y, Fang C-K, Yang Y-C, Liu C-L, Leu Y-S, Wang T-E, Chang Y-F, Hsieh R-K, Chen Y-J, Tsai L-Y (2012) Demoralization syndrome among cancer outpatients in Taiwan. Support Care Cancer 20:2259–2267. https://doi.org/10.1007/s00520-011-1332-4 Lewis AS, Oberleitner LMS, Morgan PT, Picciotto MR, McKee SA (2015) Association of Cigarette Smoking With Interpersonal and Self-Directed Violence in a Large Community-Based Sample. Nicotine Tob Res 18(6):1456–1462. https://doi.org/10.1093/ntr/ntv287 Liu S-I, Yeh Z-T, Huang H-C, Sun F-J, Tjung J-J, Hwang L-C, Shih Y-H, Yeh AW-C (2011) Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan. Compr Psychiatr 52(1):96–101. https://doi.org/10.1016/j.comppsych.2010.04.013 Maniglio R (2009) Severe mental illness and criminal victimization: a systematic review. Acta Psychiatr Scand 119(3):180–191. https://doi.org/10.1111/j.1600-0447.2008.01300.x McNeeley S (2015) Lifestyle-Routine Activities and Crime Events. J Contemp Crim Justice 31(1):30–52. https://doi.org/10.1177/1043986214552607 Morosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R (2000) Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 101(4):323–329. https://doi.org/10.1034/j.1600-0447.2000.101004323.x Papadopoulos C, Foster J, Caldwell K (2013) Individualism-Collectivism’ as an Explanatory Device for Mental Illness Stigma. Commun Ment Health J 49(3):270–280. https://doi.org/10.1007/s10597-012-9534-x Prins SJ (2011) Does transinstitutionalization explain the overrepresentation of people with serious mental illnesses in the criminal justice system? Community Ment Health J 47(6):716–722. https://doi.org/10.1007/s10597-011-9420-y Raphael B, Taylor M, McAndrew V (2008) Women, catastrophe and mental health. Aust N Z J Psychiatry 42(1):13–23. https://doi.org/10.1080/00048670701732707 Rennison CM (1999) Criminal Victimization, 1998: Changes 1997-98 with Trends 1993-98. US Department of Justice, Bureau of Justice Statistics Washington, DC Rezansoff SN, Moniruzzaman A, Fazel S, McCandless L, Somers JM (2017) Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population. Schizophr Bull 43(5):1002–1010. https://doi.org/10.1093/schbul/sbx084 Rossa-Roccor V, Schmid P, Steinert T (2020) Victimization of People With Severe Mental Illness Outside and Within the Mental Health Care System: Results on Prevalence and Risk Factors From a Multicenter Study. Front Psychiatry 11:563860. https://doi.org/10.3389/fpsyt.2020.563860 Ryu S, Lee H, Lee DK, Nam HJ, Chung YC, Kim SW (2020) Network Structures of Social Functioning Domains in Schizophrenia and Bipolar Disorder: A Preliminary Study. Clin Psychopharmacol Neurosci 18(4):571–579. https://doi.org/10.9758/cpn.2020.18.4.571 Sariaslan A, Arseneault L, Larsson H, Lichtenstein P, Fazel S (2020) Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden. JAMA Psychiatry 77(4):359–367. https://doi.org/10.1001/jamapsychiatry.2019.4275 Shareck M, Ellaway A (2011) Neighbourhood crime and smoking: the role of objective and perceived crime measures. BMC Public Health 11:930. https://doi.org/10.1186/1471-2458-11-930 Sheu C-J, Moh C-Y, Chen Y-S (2000) Taiwan Crime Victimization Survey. In: Taiwan CPU (ed) Graduate School of Crime Prevention and Corrections. Minister of Justices and National Police Agency, pp 1–261 Smith PK, Robinson S (2019) How Does Individualism-Collectivism Relate to Bullying Victimisation? Int J Bullying Prev 1(1):3–13. https://doi.org/10.1007/s42380-018-0005-y Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire JAMA 282(18):1737–1744. https://doi.org/10.1001/jama.282.18.1737 Suttajit S, Arunpongpaisal S, Srisurapanont M, Thavichachart N, Kongsakon R, Chantakarn S, Chantarasak V, Jariyavilas A, Jaroensook P, Kittiwattanagul K, Nerapusee O (2015) Psychosocial functioning in schizophrenia: are some symptoms or demographic characteristics predictors across the functioning domains? Neuropsychiatr Dis Treat 11:2471–2477. https://doi.org/10.2147/ndt.s88085 Teasdale B (2009) Mental Disorder and Violent Victimization. Criminal Justice Behav 36(5):513–535. https://psycnet.apa.org/doi/ 10.1177/0093854809331793 Teasdale B, Daigle LE, Gann T (2021) The contingent effect of guardianship on victimization: An examination of people with and without mental health problems. J interpers Violence 36(11–12):5186–5208. https://doi.org/10.1177/0886260518804174 Tecuta L, Tomba E, Grandi S, Fava GA (2015) Demoralization: a systematic review on its clinical characterization. Psychol Med 45(4):673–691. https://doi.org/10.1017/s0033291714001597 Teplin LA, McClelland GM, Abram KM, Weiner DA (2005) Crime Victimization in Adults With Severe Mental Illness: Comparison With the National Crime Victimization Survey. Arch Gen Psychiatry 62(8):911–921. https://doi.org/10.1001/archpsyc.62.8.911 Thompson K, Kulkarni J, Sergejew AA (2000) Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res 42(3):241–247. https://doi.org/10.1016/s0920-9964(99)00130-9 Vogel M, Stephens KD, Siebels D (2014) Mental Illness and the Criminal Justice System. Sociol Compass 8(6):627–638. http://dx.doi.org/10.1111/soc4.12174 Walter F, Carr MJ, Mok PLH, Antonsen S, Pedersen CB, Appleby L, Fazel S, Shaw J, Webb RT (2019) Multiple adverse outcomes following first discharge from inpatient psychiatric care: a national cohort study. Lancet Psychiatry 6(7):582–589. https://doi.org/10.1016/s2215-0366(19)30180-4 Wang Q-W, Hou C-L, Wang S-B, Huang Z-H, Huang Y-H, Zhang J-J, Jia F-J (2020) Frequency and correlates of violence against patients with schizophrenia living in rural China. BMC Psychiatry 20(1):286. https://doi.org/10.1186/s12888-020-02696-9 Whiting D, Lichtenstein P, Fazel S (2021) Violence and mental disorders: a structured review of associations by individual diagnoses, risk factors, and risk assessment. Lancet Psychiatry 8(2):150–161. https://doi.org/10.1016/s2215-0366(20)30262-5 Wu B-J, Lin C-H, Tseng H-F, Liu W-M, Chen W-C, Huang L-S, Sun H-J, Chiang S-K, Lee S-M (2013) Validation of the Taiwanese Mandarin version of the Personal and Social Performance scale in a sample of 655 stable schizophrenic patients. Schizophr Res 146(1–3):34–39. https://doi.org/10.1016/j.schres.2013.01.036 Zapata Roblyer MI, Betancourth Zambrano S (2017) Crime Victimization and Suicidal Ideation Among Colombian College Students: The Role of Depressive Symptoms, Familism, and Social Support. J interpers Violence 35(5–6):1367–1388. https://doi.org/10.1177/0886260517696856 Tables Table 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Table3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8149581","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":564557681,"identity":"33b189e7-0fda-4629-b612-6b721da32aba","order_by":0,"name":"Chien-Chi Hsu","email":"","orcid":"","institution":"MacKay Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chien-Chi","middleName":"","lastName":"Hsu","suffix":""},{"id":564557682,"identity":"05b4b47b-1ea6-44c0-9486-c791672ebc0a","order_by":1,"name":"Chun-Kai Fang","email":"","orcid":"","institution":"MacKay Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Chun-Kai","middleName":"","lastName":"Fang","suffix":""},{"id":564557683,"identity":"1fbf1f3a-75d1-4357-9e83-e94541b1b04b","order_by":2,"name":"Ching-Ho Hu","email":"","orcid":"","institution":"MacKay Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ching-Ho","middleName":"","lastName":"Hu","suffix":""},{"id":564557684,"identity":"7083ce9e-5185-45bc-9f85-fc0c7781957b","order_by":3,"name":"Ying Lin","email":"","orcid":"","institution":"MacKay Memorial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Lin","suffix":""},{"id":564557685,"identity":"eea7a36d-a9de-4ede-a2eb-e5ebf13ff47c","order_by":4,"name":"Shu-I Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAq0lEQVRIiWNgGAWjYDACZoaEAx8gTAPidPCwMzx8OAOuJYEYLfyMj415SNJiz8ycJm2bsy2xgb15mwTjj8NE2MLMliadu+12YgPPsTIJhgSitPBAtUjkmAG13CZGC/83aUuQFvk3RGthSDZmBNvCQ6yWwwyJD3u33TZu40krtkhI+09YC3v/gYQDP7fdlu1nP7zxxgebNMJa4IANRCSQoGEUjIJRMApGAR4AACeeNZ1b0FneAAAAAElFTkSuQmCC","orcid":"","institution":"MacKay Memorial Hospital","correspondingAuthor":true,"prefix":"","firstName":"Shu-I","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2025-11-19 01:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8149581/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8149581/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98929242,"identity":"46c2f226-3322-41ad-becf-d9d0ab05f773","added_by":"auto","created_at":"2025-12-24 08:31:24","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":63497,"visible":true,"origin":"","legend":"","description":"","filename":"250601psychiatricresearchplaintextV1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/4e8d5d120e84dc7ba6392d06.docx"},{"id":98929246,"identity":"12739a41-eba2-4d91-bb4a-7c2343a81778","added_by":"auto","created_at":"2025-12-24 08:31:24","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":20376,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/ef821fd1b65ef81a99d6af65.docx"},{"id":98929240,"identity":"5d9464ce-caa8-446b-aaff-0c85f40eb256","added_by":"auto","created_at":"2025-12-24 08:31:24","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":25145,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/f2350a5222874877c138f3c2.docx"},{"id":99310900,"identity":"dfc776ed-ffbf-4638-8e96-430ec37d3b7a","added_by":"auto","created_at":"2025-12-31 16:13:32","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17607,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/98d35cfc389e5de190a534c8.docx"},{"id":99310372,"identity":"b442bda8-05c4-4187-beca-d7e133d96e2d","added_by":"auto","created_at":"2025-12-31 16:12:39","extension":"json","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7205,"visible":true,"origin":"","legend":"","description":"","filename":"031cdb7407874d94858e9f971f7fccab.json","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/7cb0a2806583529794fbf24b.json"},{"id":98929249,"identity":"134da132-9df5-480a-a289-35e797522604","added_by":"auto","created_at":"2025-12-24 08:31:24","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":188914,"visible":true,"origin":"","legend":"","description":"","filename":"031cdb7407874d94858e9f971f7fccab1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/1965b2cc216c989c532dfa47.xml"},{"id":98929250,"identity":"a6b01264-ecf6-4300-93fe-aebb220cb7d1","added_by":"auto","created_at":"2025-12-24 08:31:24","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":186614,"visible":true,"origin":"","legend":"","description":"","filename":"031cdb7407874d94858e9f971f7fccab1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/748e15925250ef05316d84c5.xml"},{"id":99310546,"identity":"a2168d0a-59c6-4ae6-9698-d55a9cf47aa9","added_by":"auto","created_at":"2025-12-31 16:12:59","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":198547,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/bdfcbc8bfd5ff21606c9b800.html"},{"id":103143857,"identity":"5563c09f-3ff5-498b-97d4-8d8d0a854bd9","added_by":"auto","created_at":"2026-02-21 20:24:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":760616,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/1f5942b8-f0b4-48d9-91d2-e04f9cc434b1.pdf"},{"id":99310297,"identity":"8aabad8c-cafc-4958-af64-fb4bf3b71096","added_by":"auto","created_at":"2025-12-31 16:12:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20376,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/42c8d1c2dfa9e45b2812d47a.docx"},{"id":98929243,"identity":"ed5fb0c4-9626-4887-ab86-1ffe90a33096","added_by":"auto","created_at":"2025-12-24 08:31:24","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":25145,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/94370a5deec89f5e933f7c5c.docx"},{"id":98929245,"identity":"75c16900-2bb1-40c6-a84c-2e586604d974","added_by":"auto","created_at":"2025-12-24 08:31:24","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":17607,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-8149581/v1/a4f2ab9e4d5573bfbd140a6b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Correlates of Criminal Victimization in Taiwanese Outpatients with Severe Mental Illness","fulltext":[{"header":"Highlights","content":"\u003cp\u003e\u0026bull; Research on crime victimization risk among individuals with severe mental illness (SMI) in Asia remains insufficient; this study is the largest of its kind in Asia to date utilizing standardized victimization survey instruments.\u003c/p\u003e\u003cp\u003e\u0026bull; Living with family and a bipolar disorder diagnosis independently reduce crime victimization risk in SMI.\u003c/p\u003e\u003cp\u003e\u0026bull; Identified risk factors for crime victimization include a history of suicide attempts, more severe depressive symptoms, previous psychiatric hospitalization, smoking, and a prior criminal record.\u003c/p\u003e\u003cp\u003e\u0026bull; Despite East-West cultural differences, crime victimization among individuals with SMI in Taiwan requires more attention to enhance their well-being.\u003c/p\u003e"},{"header":"1. Introduction","content":"\u003cp\u003eMental illness has remained one of the top ten global disease burdens for the past 30 years, primarily impacting quality of life rather than mortality, as measured by disability-adjusted life years (DALYs) (Collaborators, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This burden is especially severe for individuals with severe mental illness (SMI), who often experience poor insight, substance use, and treatment nonadherence. Although mental health care has shifted toward community-based services to reduce the negative effects of long-term hospitalization (Drake et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2003\u003c/span\u003e), stigma\u0026mdash;particularly fears of violence\u0026mdash;has hindered reintegration (Whiting et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Many countries still use \u0026ldquo;dangerousness\u0026rdquo; as a criterion for involuntary hospitalization (Large et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2008\u003c/span\u003e), further complicating recovery.\u003c/p\u003e \u003cp\u003ePeople with mental disorders are disproportionately arrested due to factors such as homelessness, poverty, and limited access to care (Bonfine et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Prins, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Vogel et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Despite growing research, victimization among individuals with SMI remains underexplored, partly due to underreporting (Maniglio, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Teplin et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Victimization is closely linked to symptom severity and poor outcomes (Bhavsar et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Khalifeh et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePrevalence estimates vary by study design. One U.S. study found SMI patients were 11 times more likely to be victimized than the general population (Teplin et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). A Dutch study reported a 47% annual victimization rate among psychiatric outpatients, with violent crime rates 2.8 times higher than the general population (Kamperman et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Lifetime prevalence rates for violent, non-violent, and sexual victimization among individuals with psychosis are 66%, 39%, and 27%, respectively (de Vries et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Risk factors include severe psychopathology, poverty, social isolation, and substance use (Crisanti et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Hsu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Kamperman et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDepression, common in SMI, increases vulnerability by impairing self-efficacy and social functioning, and is associated with demoralization and reduced help-seeking (Hansson, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Tecuta et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Victimization can worsen psychological distress and quality of life (Hanson et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Maniglio, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Raphael et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). In Asian cultures influenced by collectivism, stigma may delay treatment and reduce willingness to report victimization (Papadopoulos et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Smith \u0026amp; Robinson, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). While family support may offer protection (Hsu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), victimization among Asian individuals with SMI remains under-researched. Existing data suggest elevated risks linked to prior risky behaviors, specific diagnoses (schizophrenia, affective, or anxiety disorders), and substance use, with repeated victimization further impairing functioning (Wang et al., \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study aims to address these gaps by directly surveying Taiwanese outpatients with SMI to assess victimization prevalence and its clinical correlates. Understanding these experiences is essential for developing targeted interventions and informing public health strategies to support recovery and community integration.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design and Participants\u003c/h2\u003e \u003cp\u003eThis cross-sectional survey study utilized convenience sampling and was conducted between March 2013 and December 2013. Participants were recruited from the psychiatric outpatient clinic at Mackay Memorial Hospital, a major medical center in Taipei, Taiwan that manages approximately 8,000 psychiatric visits per month. As patients can self-register without requiring referrals, the participants\u0026rsquo; socioeconomic background is considered broadly representative of psychiatric outpatients utilizing medical centers in northern Taiwan.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Inclusion and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eParticipants were required to meet the following criteria:\u003c/p\u003e \u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMedical record confirmation of schizophrenia, related psychoses (ICD-9-CM(Health et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2006\u003c/span\u003e): 295, 297), or bipolar disorder (ICD-9-CM: 296.0-296.1, 296.4-296.9).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eDiagnosis and treatment regimen stable for \u0026gt;\u0026thinsp;1-year preceding enrollment.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMinimum age of 20 years at enrollment.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eProficiency in spoken Mandarin or Taiwanese and literacy in written Chinese.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e Provided written informed consent prior to participation.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003cp\u003eExcluded if participants met any of the following criteria at the time of enrollment:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePresence of acute psychotic symptoms.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSignificant cognitive impairment.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEvident risk of suicide or violence.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Participant Recruitment and Ethical Approval\u003c/h2\u003e \u003cp\u003ePotential participants were identified by reviewing outpatient medical records based on the inclusion criteria. A research nurse approached eligible individuals, explained the study's purpose, and obtained written informed consent prior to participation. A total of 798 individuals consented and participated. The Institutional Review Board (IRB) of Mackay Memorial Hospital approved this study (Approval No. 12MMHIS141).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Research Tools\u003c/h2\u003e \u003cp\u003eThe study utilized the following instruments: a sociodemographic and clinical information, the Taiwan Crime Victimization Survey (TCVS) (Hsu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Sheu et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), the Medication Adherence Rating Scale (MARS) (Kao and Liu, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Thompson et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), the Demoralization Scale (DS) (Clarke and Kissane, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Kissane et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Lee et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), the Patient Health Questionnaire (PHQ-9) (Liu et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Spitzer et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e1999\u003c/span\u003e), and the Personal and Social Performance scale (PSP) (Morosini et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSociodemographic and clinical data: This form collected demographic and clinical data. Demographic information included gender, age, educational level, occupation, marital status, living situation, and possession of a low-income certificate, disability certificate, or major psychiatric illness card. Clinical information included criminal record history, duration of illness, number of hospitalizations, diagnosis, alcohol use patterns, smoking status, and use of long-acting injectable antipsychotics. Demographic data was self-reported by participants, while clinical data was extracted from medical records by researchers. Harmful drinking was defined according to previous research as consuming alcohol more than three times per week (Hartz et al., 2018).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTCVS was developed by Taiwan's Ministry of Justice and National Police Agency (Sheu et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2000\u003c/span\u003e) and based on the U.S. National Crime Victimization Survey (NCVS) (Rennison, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1999\u003c/span\u003e), the TCVS assesses victimization experiences. Using interviews and questionnaires, it probes personal or household victimization, including violent and property crimes, within the past year. Similar methods have previously assessed personal victimization among individuals with SMI in Taiwan(Hsu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). This study focused on personal experiences of property and violent crimes over the past year, specifically asking about incidents of theft, assault, robbery, mugging, kidnapping, intimidation, rape, sexual assault, fraud, and identity theft, including the frequency of these occurrences.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe MARS is a 10-item measure assessing medication adherence behaviors over the past week(Thompson et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Each item requires a 'yes' or 'no' response, yielding a total score from 0 to 10, with higher scores indicating better adherence but does not specify a distinct cut-off score to define poor adherence. The reliability and validity of the Chinese version of the MARS have been previously established (Kao and Liu, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe DS is a 24-item self-report measure evaluating existential distress, including meaninglessness, helplessness, despair, sense of failure, and related emotional distress, often experienced by individuals with severe illnesses(Clarke and Kissane, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Kissane et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Items are scored on a 0-to-4 Likert scale, resulting in a total score range of 0 to 96. Higher scores reflect greater levels of demoralization, with a score\u0026thinsp;\u0026ge;\u0026thinsp;30 suggested as a threshold for moderate levels. The Chinese version of the DS has demonstrated good reliability and validity (Lee et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe PHQ-9 is a 9-item self-administered questionnaire screening for the severity of depressive symptoms over the preceding two weeks(Spitzer et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). Each item is scored from 0 (\"Not at all\") to 3 (\"Nearly every day\"), with total scores ranging from 0 to 27. Higher scores indicate more severe depressive symptoms. A suggested cut-off for moderate depression is a score of \u0026ge;\u0026thinsp;10. The reliability and validity of the Chinese version have been confirmed(Liu et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe PSP measures functioning across four key domains: socially useful activities (including work and study), personal and social relationships, self-care, and disturbing and aggressive behaviors (Morosini et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Functioning levels are rated based on participant interviews. Scores range from 1 to 100, with higher scores indicating better overall personal and social performance, with levels of impairment defined as: 71\u0026ndash;100 signifies mild functional difficulty; 31\u0026ndash;70 indicates varying degrees of disability; and 1\u0026ndash;30 reflects severe disability with minimal functioning needing intense support/supervision(Suttajit et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The Chinese version of the PSP has established good reliability and validity (Wu et al., \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Statistical Analysis\u003c/h2\u003e \u003cp\u003eAll statistical analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY(IBMCorp Ibm, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) ). Initially, descriptive statistics were generated to outline the sociodemographic and clinical profiles of the study participants. This included calculating frequencies and percentages for categorical variables, means and standard deviations (SD) for continuous variables, encompassing scores derived from the MARS, DS, PHQ-9, and PSP instruments.\u003c/p\u003e \u003cp\u003eParticipants were dichotomized into two groups based on their reported victimization experiences for comparative analyses, with differences in sociodemographic and clinical variables examined using independent samples t-tests for continuous data and Pearson's chi-square tests (or Fisher's exact test where appropriate) for categorical data.\u003c/p\u003e \u003cp\u003eTo identify factors associated with victimization, a binary logistic regression model was employed, with overall victimization served as the dependent variable and relevant sociodemographic and clinical characteristics as independent variables. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were calculated to quantify the strength of associations. The goodness-of-fit for the final logistic regression model was assessed using the Hosmer-Lemeshow test; a non-significant result (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) indicated acceptable model calibration.\u003c/p\u003e \u003cp\u003eStatistical significance for all inferential tests was defined at an alpha level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e3.1 \u0026nbsp; \u0026nbsp; \u0026nbsp;Sample Characteristics\u003cbr\u003e\u0026nbsp;Of the 798 participants, 34.6% were male (n = 276) and 65.4% female (n = 522), with a mean age of 43.35 years (SD = 11.27; range 20\u0026ndash;83), with majority unmarried (73.7%, n = 588) and lived with family (77.4%, n = 618).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2. \u0026nbsp; \u0026nbsp; \u0026nbsp;Clinical Characteristics\u003c/p\u003e\n\u003cp\u003eDiagnoses included schizophrenia in 39.8% (n = 318) and bipolar disorder in 60.2% (n = 480), with a mean illness duration of 9.98 years (SD = 5.58; range 3\u0026ndash;49). Government-issued certifications comprised a major psychiatric illness card from the National Health Insurance Administration (61.5%) and a mental disability certificate from the Social Affairs Bureau (52.3%); 24.9% had at least one comorbid chronic physical illness. Histories of criminal conviction, violent behavior, and suicide attempts were reported by 12.3%, 29.1%, and 48.5%, respectively.\u003c/p\u003e\n\u003cp\u003e3.3. \u0026nbsp; \u0026nbsp; \u0026nbsp;Treatment History\u003c/p\u003e\n\u003cp\u003eMore than half of participants (56.1%, n = 448) had experienced at least one acute psychiatric ward admission; 23.1% (n = 184) had been admitted to a day hospital, and 45.4% (n = 362) had received long-acting injectable antipsychotics.\u003c/p\u003e\n\u003cp\u003e3.4. \u0026nbsp; \u0026nbsp; \u0026nbsp;Baseline Assessment Scores\u003c/p\u003e\n\u003cp\u003eMean baseline scores were: PHQ-9, 10.92 (SD = 7.70); Demoralization Scale, 47.02 (SD = 19.69); PSP, 68.16 (SD = 12.37); and MARS, 6.06 (SD = 2.36).\u003c/p\u003e\n\u003cp\u003e3.5.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Lifestyle Factors\u003c/p\u003e\n\u003cp\u003eCurrent smoking was reported by 38.1% of participants (n = 304), and 3.9% (n = 31) met criteria for harmful alcohol use (Hartz et al., 2018).\u003c/p\u003e\n\u003cp\u003e3.6.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Victimization Experiences\u003c/p\u003e\n\u003cp\u003eIn the past year, 25.1% (n = 200) of participants reported victimization: 18.0% (n = 144) experienced property crime and 15.9% (n = 127) violent crime. Notably, 71 participants (8.9% of the total sample; 35.5% of those victimized) endured both types of crime. Additional details are provided in Table 1.\u003c/p\u003e\n\u003cp\u003e3.7.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Univariate Analysis of Factors Associated with Victimization\u003c/p\u003e\n\u003cp\u003eUnivariate analyses showed that, compared with non-victimized participants, those who experienced victimization in the past year were significantly more likely to be unmarried or not cohabiting (27.7% vs. 17.6%, p = .004), have low-income status (34.2% vs. 22.3%, p = .001), not live with family (37.8% vs. 21.4%, p \u0026lt; .001) and hold a mental disability certification (30.5% vs. 19.2%, p \u0026lt; .001). They also had higher rates of psychiatric ward admission (29.9% vs. 18.9%, p \u0026lt; .001), suicide attempts (34.9% vs. 15.8%, p \u0026lt; .001), violent behavior (35.8% vs. 20.7%, p \u0026lt; .001), smoking (35.5% vs. 18.6%, p \u0026lt; .001), harmful alcohol consumption ( 45.2% vs. 24.3%, p = .008) and criminal convictions (45.9% vs. 22.1%, p \u0026lt; .001).\u003c/p\u003e\n\u003cp\u003e3.8.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Comparison of Scale Scores Between Victimized and Non-Victimized Groups\u003c/p\u003e\n\u003cp\u003eVictimized participants exhibited significantly more severe symptoms and poorer functioning than their non-victimized counterparts. Specifically, they scored higher on the PHQ-9 (mean \u0026plusmn; SD: 13.80 \u0026plusmn; 7.57 vs. 9.96 \u0026plusmn; 7.50, p \u0026lt; .001) and on the Demoralization Scale (53.91 \u0026plusmn; 17.98 vs. 44.72 \u0026plusmn; 19.71, p \u0026lt; .001), indicating greater depression and demoralization. They also demonstrated worse treatment adherence, with lower MARS scores (5.51 \u0026plusmn; 2.32 vs. 6.24 \u0026plusmn; 2.35, p \u0026lt; .001), and diminished social functioning on the PSP (65.58 \u0026plusmn; 12.41 vs. 69.03 \u0026plusmn; 12.25, p \u0026lt; .001). Other details are provided in Table 2.\u003c/p\u003e\n\u003cp\u003e3.9.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; Logistic Regression Analysis of Risk Factors for Victimization\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression identified several independent predictors of past‐year victimization. Protective factors include living with family (OR = 0.56, 95% CI [ 0.37\u0026ndash;0.85 ], p = .004) and a bipolar disorder diagnosis (vs. schizophrenia; OR = 0.66, 95% CI [ 0.45\u0026ndash;0.98 ], p = .035). In contrast, victimization odds were significantly increased among participants with suicide attempt history (OR = 1.93, 95% CI [ 1.35\u0026ndash;2.75 ], p = .001), current smoking (OR = 1.69, 95% CI [ 1.18\u0026ndash;2.43 ], p = .004), criminal convictions (OR = 1.70, 95% CI [ 1.06\u0026ndash;2.73 ], p = .029), greater depressive symptom severity (per‐point increase in PHQ-9; OR = 1.05, 95% CI [ 1.03\u0026ndash;1.08 ], p \u0026lt; .001), and prior acute psychiatric ward admission (OR = 1.58, 95% CI [ 1.15\u0026ndash;2.18 ], p = .015). The Hosmer\u0026ndash;Lemeshow test confirmed satisfactory model fit (\u0026chi;\u0026sup2;(8) = 6.79, p = .56). Additional details are provided in Table 3.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study utilized one of the largest Asian samples and a standardized survey to examine crime victimization among Taiwanese outpatients with SMI, and revealed that over one-fourth of participants experienced a crime in the past year, encompassing violent victimization and non-violent (property) victimization. Our findings align with prior meta-analyses showing significantly higher victimization rates in SMI compared to the general population (Maniglio, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Reported rates fall within established ranges\u0026mdash;20% for violent and 19% for non-violent victimization over three years (de Vries et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), and 7.1%\u0026ndash;56% for one-year violent victimization (Latalova et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Despite methodological differences across studies, the consistent conclusion is the heightened vulnerability of individuals with SMI.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Comparison with Previous Local Research\u003c/h2\u003e \u003cp\u003eInterestingly, our overall victimization rate (25.1%) diverges from a previous, smaller-scale Taiwanese study using similar methods, which reported a rate of 16.8% (Hsu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). This discrepancy is likely a result of differences in sample characteristics and recruitment settings. The previous study included 155 participants, notably 61 individuals hospitalized in acute psychiatric wards at the time of the survey and featured a higher proportion with schizophrenia (59.4%) (Hsu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). In contrast, our larger sample (N\u0026thinsp;=\u0026thinsp;798) consisted entirely of outpatients, with a lower proportion diagnosed with schizophrenia (39.8%). These variations in sample acuity, diagnostic composition, and living situation (community vs. partly inpatient) likely contributed to the differing observed victimization rates.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Risk Factors for Victimization\u003c/h2\u003e \u003cp\u003eThis study used multivariate analysis to identify significant predictors of victimization. An increased risk was associated with a history of suicide attempts, more severe depressive symptoms, current smoking, a prior criminal record, and previous acute psychiatric hospitalization, while living with family and a diagnosis of bipolar disorder (relative to schizophrenia) were linked to a lower risk of victimization.\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003e4.2.1. Suicide Attempts and Depressive Symptoms:\u003c/h2\u003e \u003cp\u003eOur findings indicated that a history of suicide attempts nearly doubled the odds of victimization (OR\u0026thinsp;=\u0026thinsp;1.93), while each one-point increase in PHQ-9 depression score elevated risk by approximately 5% (OR\u0026thinsp;=\u0026thinsp;1.05). The relationship between depression, suicidality, and victimization is complex and likely bidirectional, as victimization can precipitate or exacerbate depression and related mental health issues (Casiano et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zapata Roblyer and Betancourth Zambrano, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Conversely, pre-existing depressive symptoms might impair judgment, motivation, or the ability to navigate or exit risky situations, thereby increasing vulnerability (Bhavsar et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e);this aligns with research showing higher victimization risk among those hospitalized for suicide attempts (Casiano et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)and findings linking depressive symptoms with recent victimization and increased severity among those with a suicide attempt history (Bhavsar et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Furthermore, twin studies suggest gene-environment correlations may be present, indicating that pre-existing mental health vulnerabilities can increase subsequent victimization risk (Gonggrijp et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Inherent vulnerability, impaired judgment, social isolation, prior trauma, and being perceived as easier targets are possible explanations for the heightened susceptibility of SMI patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section3\"\u003e \u003ch2\u003e4.2.2. Smoking Status:\u003c/h2\u003e \u003cp\u003eCurrent smoking was associated with a 1.7-fold increased risk of victimization (OR\u0026thinsp;=\u0026thinsp;1.69). This resonates with large community studies identifying smokers as having elevated risks for both crime perpetration and victimization (Lewis et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Smokers are more likely to reside in or perceive their neighborhoods as high-crime areas (Shareck and Ellaway, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2011\u003c/span\u003e), and community violence levels are linked to smoking intensity and reduced cessation attempts (Fleischer et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Thus, smoking might serve as a marker for exposure to higher-risk environments or lifestyles. In addition, factors like greater exposure to deviant peers, potentially impaired judgment, or reduced impulse control among some smokers could contribute to increased vulnerability (Kristman-Valente et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003e4.2.3. Criminal Record:\u003c/h2\u003e \u003cp\u003eA prior criminal record increased victimization risk by 1.7 times (OR\u0026thinsp;=\u0026thinsp;1.70), consistent with established research demonstrating a strong link between offending behavior and subsequent victimization(de Vries et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Maniglio, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). A meta-analysis specific to individuals with mental illness reported a 4.3-fold increase in victimization odds associated with a criminal history(de Vries et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Lifestyle and Routine Activity Theory (L-RAT) (McNeeley, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Teasdale, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Teasdale et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)offers a framework, suggesting victimization occurs at the confluence of a motivated offender, a suitable target, and the absence of capable guardianship. Individuals with SMI and a criminal record may experience increased exposure to risky situations or offenders (lifestyle/environment), share underlying risk factors contributing to both offending and vulnerability (e.g., impulsivity, substance use), and potentially lack of effective guardianship(Teasdale, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Teasdale et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) .\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section3\"\u003e \u003ch2\u003e4.2.4. History of Acute Psychiatric Hospitalization:\u003c/h2\u003e \u003cp\u003eA history of acute psychiatric hospitalization predicted a 1.6-fold increase in victimization risk (OR\u0026thinsp;=\u0026thinsp;1.58), corresponding with prior research that suggest recent or frequent hospitalizations elevate risk (Maniglio, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), a Danish study found discharged psychiatric patients had a five times higher 10-year homicide mortality rate (Walter et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), and within healthcare systems, hospitalization frequency correlated with increased physical victimization risk (Rossa-Roccor et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A history of acute hospitalization often signifies greater illness severity or chronicity (Rossa-Roccor et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), potentially rendering individuals more vulnerable or marking them as more suitable targets in the eyes of perpetrators.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Protective Factors for Victimization\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003ch2\u003e4.3.1. Living with Family:\u003c/h2\u003e \u003cp\u003eLiving with family significantly reduced victimization risk (OR\u0026thinsp;=\u0026thinsp;0.56) since family members can serve as capable guardians, effectively mitigating risk according to L-RAT framework (McNeeley, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Teasdale, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Teasdale et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), as family members can serve as capable guardians. This contrasts sharply with the well-documented increased vulnerability associated with homelessness or unstable housing among individuals with SMI(de Vries et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Khalifeh et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Latalova et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Maniglio, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Teasdale, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), where meta-analyses indicate a 2.6-fold increased risk (Khalifeh et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Living with family likely provides a safer environment and effective supervision, thereby reducing exposure and opportunities for victimization.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e4.3.2. Bipolar Disorder Diagnosis:\u003c/h2\u003e \u003cp\u003eCompared to schizophrenia, a diagnosis of bipolar disorder was associated with a lower risk of victimization (OR\u0026thinsp;=\u0026thinsp;0.66). Plausible explanations include potentially better average functioning, longer periods of stability, or stronger family connections among individuals with bipolar disorders relative to schizophrenia, enhancing self-protection capabilities. The literature examining specific diagnoses and victimization risk presents inconsistent findings. While some studies suggest any psychiatric symptoms increase risk, potentially additively (Bhavsar et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), or link specific symptoms like psychosis or mania to risk without differentiating primary diagnosis (de Vries et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), others find no difference between schizophrenia and bipolar disorder (Khalifeh et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), or even suggest lower risk for schizophrenia (Hsu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Sariaslan et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)or higher risk (Dean et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Methodological variations, study populations, and control for confounders like offending behavior likely contribute to these discrepancies (Dean et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Our finding adds to this complex picture, underscoring the need for further nuanced research.\u003c/p\u003e \u003cp\u003e4.4 Interpretation of Other Scale Findings\u003c/p\u003e \u003cp\u003e4.5 Although univariate analyses showed that higher demoralization (DS), poorer medication adherence (MARS), and lower social functioning (PSP) were associated with victimization, these associations lost significance in the multivariate model\u0026mdash;likely due to confounding and interrelated variables. For instance, poor adherence is linked to increased hospitalization and offending (Ascher-Svanum et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Rezansoff et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), both of which were significant predictors. Similarly, functional impairment is more common in schizophrenia than bipolar disorder (Ryu et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2020\u003c/span\u003e), supporting our finding that bipolar diagnosis was protective. Demoralization is also closely tied to depression and suicidality (Costanza et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), which remained independent risk factors. Thus, while not independently predictive, these factors likely contribute indirectly to victimization risk and remain clinically relevant. Limitations and Future Directions\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThis study possesses several limitations inherent in its design. First, the cross-sectional nature precludes definitive causal inferences regarding the temporal sequence between identified risk factors and victimization. Reliance on self-report measures for victimization and other variables introduces potential recall and social desirability biases. Furthermore, the findings are derived from a specific sample in Taiwan, potentially limiting generalizability to individuals with SMI in different cultural or healthcare contexts. Future studies could benefit from being longitudinal, having more data sources, and incorporating multiple culture or healthcare contexts.\u003c/p\u003e \u003cp\u003eDespite these limitations, this study has notable strengths: the utilization of a standardized version of the TCVS, designed to capture unreported crime (Hsu et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2009\u003c/span\u003e), the ethnic Chinese focused demographic, and the scale of the study. Additional efforts are crucially needed to develop, implement, and evaluate targeted prevention and intervention strategies designed to mitigate victimization risk and support recovery for this vulnerable population.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"5. Conclusion and Implications","content":"\u003cp\u003eIn summary, this study highlights the high prevalence of crime victimization among community-dwelling individuals with severe mental illness (SMI) in Taiwan. Key risk factors include a history of suicide attempts, depression severity, smoking, criminal history, and prior psychiatric hospitalization, while protective factors include living with family and having a bipolar disorder diagnosis compared to schizophrenia. These findings call for greater awareness and targeted interventions from clinicians and policymakers to reduce victimization and support recovery. Ongoing research is essential to better understand and address the complex dynamics of victimization in this population.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eCRediT authorship contribution statement\u003c/h2\u003e\n\u003cp\u003eChien-Chi Hsu: Conceptualization, Methodology, Software, Validation, Formal Analysis, Investigation, Resources, Data Curation, Writing, Supervision. Chun-Kai Fang: Conceptualization, Methodology, Validation. Shu-I Wu: Conceptualization, Methodology, Validation, Resources, Writing, Supervision. Ying Lin: Software, Writing. Ching-Ho Hu: Investigation, Writing\u003c/p\u003e\n\u003ch2\u003eDeclaration of Competing Interest\u003c/h2\u003e\n\u003cp\u003eAll authors declare no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was conducted without financial support from any governmental, commercial, or nonprofit funding agencies.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eWe sincerely thank Vivian Hsu for her professional English editing, which improved the clarity of our manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eDatasets being analyzed and results being generated and reported in this article are not publicly available due to protections of personal privacy. Restrictions applied to these data, which were used under license for our study, and so are not publicly available for duplication. Further data analysis may be requested after discussion with authors.\u003c/p\u003e\u003ch2\u003eEthical approval\u003c/strong\u003e and informed consent statements\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe Institutional Review Board (IRB) of Mackay Memorial Hospital approved this study (Approval No. 12MMHIS141).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAscher-Svanum H, Zhu B, Faries DE, Furiak NM, Montgomery W (2009) Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia. BMC Res Notes 2:6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1756-0500-2-6\u003c/span\u003e\u003cspan address=\"10.1186/1756-0500-2-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhavsar V, Dean K, Hatch SL, MacCabe JH, Hotopf M (2019) Psychiatric symptoms and risk of victimisation: a population-based study from Southeast London. Epidemiol Psychiatr Sci 28(2):168\u0026ndash;178. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S2045796018000537\u003c/span\u003e\u003cspan address=\"10.1017/S2045796018000537\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhavsar V, Hatch SL, Dean K, McManus S (2020) Association of prior depressive symptoms and suicide attempts with subsequent victimization: analysis of population-based data from the Adult Psychiatric Morbidity Survey. Eur Psychiatry 63(1):e51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/j.eurpsy.2020.50\u003c/span\u003e\u003cspan address=\"10.1192/j.eurpsy.2020.50\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBonfine N, Wilson AB, Munetz MR (2020) Behav Health Syst Psychiatr Serv 71(4):355\u0026ndash;363. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1176/appi.ps.201900453\u003c/span\u003e\u003cspan address=\"10.1176/appi.ps.201900453\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Meeting the Needs of Justice-Involved People With Serious Mental Illness Within Community\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCasiano H, Hensel JM, Chartier MJ, Ekuma O, MacWilliam L, Mota N, McDougall C, Bolton JM (2020) The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study. Can J Psychiatry 65(7):492\u0026ndash;501. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0706743720919660\u003c/span\u003e\u003cspan address=\"10.1177/0706743720919660\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke DM, Kissane DW (2002) Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 36(6):733\u0026ndash;742. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1046/j.1440-1614.2002.01086.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1440-1614.2002.01086.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCollaborators GBDMD (2022) Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 9(2):137\u0026ndash;150. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2215-0366(21)00395-3\u003c/span\u003e\u003cspan address=\"10.1016/S2215-0366(21)00395-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCostanza A, Vasileios C, Ambrosetti J, Shah S, Amerio A, Aguglia A, Serafini G, Piguet V, Luthy C, Cedraschi C, Bondolfi G, Berardelli I (2022) Demoralization in suicide: A systematic review. J Psychosom Res 157:110788. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jpsychores.2022.110788\u003c/span\u003e\u003cspan address=\"10.1016/j.jpsychores.2022.110788\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrisanti AS, Frueh BC, Archambeau O, Steffen JJ, Wolff N (2014) Prevalence and correlates of criminal victimization among new admissions to outpatient mental health services in Hawaii. Commun Ment Health J 50(3):296\u0026ndash;304. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10597-013-9688-1\u003c/span\u003e\u003cspan address=\"10.1007/s10597-013-9688-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ede Vries B, van Busschbach JT, van der Stouwe ECD, Aleman A, van Dijk JJM, Lysaker PH, Arends J, Nijman SA, Pijnenborg GHM (2018) Prevalence Rate and Risk Factors of Victimization in Adult Patients With a Psychotic Disorder: A Systematic Review and Meta-analysis. Schizophr Bull 45(1):114\u0026ndash;126. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/schbul/sby020\u003c/span\u003e\u003cspan address=\"10.1093/schbul/sby020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDean K, Laursen TM, Marr C, Pedersen CB, Webb RT, Agerbo E (2024) Absolute and relative risk of violent victimisation and perpetration following onset of mental illness: a Danish register-based study. Lancet Reg Health \u0026ndash; Europe 36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.lanepe.2023.100781\u003c/span\u003e\u003cspan address=\"10.1016/j.lanepe.2023.100781\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDean K, Laursen TM, Pedersen CB, Webb RT, Mortensen PB, Agerbo E (2018) Risk of Being Subjected to Crime, Including Violent Crime, After Onset of Mental Illness: A Danish National Registry Study Using Police Data. JAMA Psychiatry 75(7):689\u0026ndash;696. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamapsychiatry.2018.0534\u003c/span\u003e\u003cspan address=\"10.1001/jamapsychiatry.2018.0534\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrake RE, Green AI, Mueser KT, Goldman HH (2003) The History of Community Mental Health Treatment and Rehabilitation for Persons with Severe Mental Illness. Commun Ment Health J 39(5):427\u0026ndash;440. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1023/a:1025860919277\u003c/span\u003e\u003cspan address=\"10.1023/a:1025860919277\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFleischer NL, Lozano P, Arillo Santill\u0026aacute;n E, Reynales Shigematsu LM, Thrasher JF (2015) The impact of neighbourhood violence and social cohesion on smoking behaviours among a cohort of smokers in Mexico. J Epidemiol Community Health 69(11):1083\u0026ndash;1090. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/jech-2014-205115\u003c/span\u003e\u003cspan address=\"10.1136/jech-2014-205115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGonggrijp BMA, van de Weijer SGA, van Dongen J, Slob EMA, Bijleveld CCJH, Boomsma DI (2023) Exploring the Relationships of Crime Victimization with Depression, Anxiety, and Loneliness in Twin Families. J Dev Life-Course Criminol 9(3):455\u0026ndash;482. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s40865-023-00234-1\u003c/span\u003e\u003cspan address=\"10.1007/s40865-023-00234-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHanson RF, Sawyer GK, Begle AM, Hubel GS (2010) The impact of crime victimization on quality of life. J Trauma Stress 23(2):189\u0026ndash;197. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/jts.20508\u003c/span\u003e\u003cspan address=\"10.1002/jts.20508\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHansson L (2006) Determinants of quality of life in people with severe mental illness. Acta psychiatrica Scandinavica 113(s429):46\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1600-0447.2005.00717.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1600-0447.2005.00717.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHartz SM, Oehlert M, Horton AC, Grucza RA, Fisher SL, Culverhouse RC, Nelson KG, Sumerall SW, Neal PC, Regnier P, Chen G, Williams A, Bhattarai J, Evanoff B, Bierut LJ 2018. Daily Drinking Is Associated with Increased Mortality. Alcohol Clin Exp Res 42 (11), 2246\u0026ndash;2255. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/acer.13886\u003c/span\u003e\u003cspan address=\"10.1111/acer.13886\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHealth USDo, Services H, Medicare Cf, Services M (2006) International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), 6th edn. U.S. Government Printing Office, Washington, D.C.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsu C-C, Sheu C-J, Liu S-I, Sun Y-W, Wu S-I, Lin Y (2009) Crime victimization of persons with severe mental illness in Taiwan. Australian New Z J Psychiatry 43(5):460\u0026ndash;466. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://psycnet.apa.org/doi/10.1080/00048670902817737\u003c/span\u003e\u003cspan address=\"https://psycnet.apa.doi/10.1080/00048670902817737\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIBMCorp Ibm S (2017) statistics for windows, version 25.0. Armonk. IBM Corp, NY\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamperman AM, Henrichs J, Bogaerts S, Lesaffre EM, Wierdsma AI, Ghauharali RR, Swildens W, Nijssen Y, van der Gaag M, Theunissen JR, Delespaul PA, van Weeghel J, van Busschbach JT, Kroon H, Teplin LA, van de Mheen D, Mulder CL (2014) Criminal victimisation in people with severe mental illness: a multi-site prevalence and incidence survey in the Netherlands. PLoS ONE 9(3):e91029. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0091029\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0091029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKao YC, Liu YP (2010) Compliance and schizophrenia: the predictive potential of insight into illness, symptoms, and side effects. Compr Psychiatry 51(6):557\u0026ndash;565. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.comppsych.2010.03.007\u003c/span\u003e\u003cspan address=\"10.1016/j.comppsych.2010.03.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhalifeh H, Moran P, Borschmann R, Dean K, Hart C, Hogg J, Osborn D, Johnson S, Howard LM (2015) Domestic and sexual violence against patients with severe mental illness. Psychol Med 45(4):875\u0026ndash;886. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/s0033291714001962\u003c/span\u003e\u003cspan address=\"10.1017/s0033291714001962\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhalifeh H, Oram S, Osborn D, Howard LM, Johnson S (2016) Recent physical and sexual violence against adults with severe mental illness: a systematic review and meta-analysis. Int Rev Psychiatry 28(5):433\u0026ndash;451. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/s0033291714001962\u003c/span\u003e\u003cspan address=\"10.1017/s0033291714001962\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care 20(4):269\u0026ndash;276. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/082585970402000402\u003c/span\u003e\u003cspan address=\"10.1177/082585970402000402\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKristman-Valente AN, Oesterle S, Hill KG, Wells EA, Epstein M, Jones TM, Hawkins JD (2016) The Relationship between Interpersonal Violence Victimization and Smoking Behavior across Time and by Gender. J Soc Work Pract Addict 16(1\u0026ndash;2):132\u0026ndash;159. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/1533256x.2016.1146612\u003c/span\u003e\u003cspan address=\"10.1080/1533256x.2016.1146612\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLarge MM, Ryan CJ, Nielssen OB, Hayes RA (2008) The danger of dangerousness: why we must remove the dangerousness criterion from our mental health acts. J Med Ethics 34(12):877\u0026ndash;881. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/jme.2008.025098\u003c/span\u003e\u003cspan address=\"10.1136/jme.2008.025098\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLatalova K, Kamaradova D, Prasko J (2014) Violent victimization of adult patients with severe mental illness: a systematic review. Neuropsychiatr Dis Treat 10:1925\u0026ndash;1939. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/NDT.S68321\u003c/span\u003e\u003cspan address=\"10.2147/NDT.S68321\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee C-Y, Fang C-K, Yang Y-C, Liu C-L, Leu Y-S, Wang T-E, Chang Y-F, Hsieh R-K, Chen Y-J, Tsai L-Y (2012) Demoralization syndrome among cancer outpatients in Taiwan. Support Care Cancer 20:2259\u0026ndash;2267. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00520-011-1332-4\u003c/span\u003e\u003cspan address=\"10.1007/s00520-011-1332-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewis AS, Oberleitner LMS, Morgan PT, Picciotto MR, McKee SA (2015) Association of Cigarette Smoking With Interpersonal and Self-Directed Violence in a Large Community-Based Sample. Nicotine Tob Res 18(6):1456\u0026ndash;1462. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/ntr/ntv287\u003c/span\u003e\u003cspan address=\"10.1093/ntr/ntv287\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu S-I, Yeh Z-T, Huang H-C, Sun F-J, Tjung J-J, Hwang L-C, Shih Y-H, Yeh AW-C (2011) Validation of Patient Health Questionnaire for depression screening among primary care patients in Taiwan. Compr Psychiatr 52(1):96\u0026ndash;101. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.comppsych.2010.04.013\u003c/span\u003e\u003cspan address=\"10.1016/j.comppsych.2010.04.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManiglio R (2009) Severe mental illness and criminal victimization: a systematic review. Acta Psychiatr Scand 119(3):180\u0026ndash;191. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1600-0447.2008.01300.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1600-0447.2008.01300.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcNeeley S (2015) Lifestyle-Routine Activities and Crime Events. J Contemp Crim Justice 31(1):30\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1043986214552607\u003c/span\u003e\u003cspan address=\"10.1177/1043986214552607\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorosini PL, Magliano L, Brambilla L, Ugolini S, Pioli R (2000) Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 101(4):323\u0026ndash;329. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1034/j.1600-0447.2000.101004323.x\u003c/span\u003e\u003cspan address=\"10.1034/j.1600-0447.2000.101004323.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapadopoulos C, Foster J, Caldwell K (2013) Individualism-Collectivism\u0026rsquo; as an Explanatory Device for Mental Illness Stigma. Commun Ment Health J 49(3):270\u0026ndash;280. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10597-012-9534-x\u003c/span\u003e\u003cspan address=\"10.1007/s10597-012-9534-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrins SJ (2011) Does transinstitutionalization explain the overrepresentation of people with serious mental illnesses in the criminal justice system? Community Ment Health J 47(6):716\u0026ndash;722. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10597-011-9420-y\u003c/span\u003e\u003cspan address=\"10.1007/s10597-011-9420-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaphael B, Taylor M, McAndrew V (2008) Women, catastrophe and mental health. Aust N Z J Psychiatry 42(1):13\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00048670701732707\u003c/span\u003e\u003cspan address=\"10.1080/00048670701732707\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRennison CM (1999) Criminal Victimization, 1998: Changes 1997-98 with Trends 1993-98. US Department of Justice, Bureau of Justice Statistics Washington, DC\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRezansoff SN, Moniruzzaman A, Fazel S, McCandless L, Somers JM (2017) Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population. Schizophr Bull 43(5):1002\u0026ndash;1010. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/schbul/sbx084\u003c/span\u003e\u003cspan address=\"10.1093/schbul/sbx084\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRossa-Roccor V, Schmid P, Steinert T (2020) Victimization of People With Severe Mental Illness Outside and Within the Mental Health Care System: Results on Prevalence and Risk Factors From a Multicenter Study. Front Psychiatry 11:563860. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyt.2020.563860\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2020.563860\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyu S, Lee H, Lee DK, Nam HJ, Chung YC, Kim SW (2020) Network Structures of Social Functioning Domains in Schizophrenia and Bipolar Disorder: A Preliminary Study. Clin Psychopharmacol Neurosci 18(4):571\u0026ndash;579. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.9758/cpn.2020.18.4.571\u003c/span\u003e\u003cspan address=\"10.9758/cpn.2020.18.4.571\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSariaslan A, Arseneault L, Larsson H, Lichtenstein P, Fazel S (2020) Risk of Subjection to Violence and Perpetration of Violence in Persons With Psychiatric Disorders in Sweden. JAMA Psychiatry 77(4):359\u0026ndash;367. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jamapsychiatry.2019.4275\u003c/span\u003e\u003cspan address=\"10.1001/jamapsychiatry.2019.4275\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShareck M, Ellaway A (2011) Neighbourhood crime and smoking: the role of objective and perceived crime measures. BMC Public Health 11:930. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-2458-11-930\u003c/span\u003e\u003cspan address=\"10.1186/1471-2458-11-930\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheu C-J, Moh C-Y, Chen Y-S (2000) Taiwan Crime Victimization Survey. In: Taiwan CPU (ed) Graduate School of Crime Prevention and Corrections. Minister of Justices and National Police Agency, pp 1\u0026ndash;261\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith PK, Robinson S (2019) How Does Individualism-Collectivism Relate to Bullying Victimisation? Int J Bullying Prev 1(1):3\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s42380-018-0005-y\u003c/span\u003e\u003cspan address=\"10.1007/s42380-018-0005-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire JAMA 282(18):1737\u0026ndash;1744. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/jama.282.18.1737\u003c/span\u003e\u003cspan address=\"10.1001/jama.282.18.1737\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuttajit S, Arunpongpaisal S, Srisurapanont M, Thavichachart N, Kongsakon R, Chantakarn S, Chantarasak V, Jariyavilas A, Jaroensook P, Kittiwattanagul K, Nerapusee O (2015) Psychosocial functioning in schizophrenia: are some symptoms or demographic characteristics predictors across the functioning domains? Neuropsychiatr Dis Treat 11:2471\u0026ndash;2477. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/ndt.s88085\u003c/span\u003e\u003cspan address=\"10.2147/ndt.s88085\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeasdale B (2009) Mental Disorder and Violent Victimization. Criminal Justice Behav 36(5):513\u0026ndash;535. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://psycnet.apa.org/doi/\u003c/span\u003e\u003cspan address=\"https://psycnet.apa.org/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0093854809331793\u003c/span\u003e\u003cspan address=\"10.1177/0093854809331793\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeasdale B, Daigle LE, Gann T (2021) The contingent effect of guardianship on victimization: An examination of people with and without mental health problems. J interpers Violence 36(11\u0026ndash;12):5186\u0026ndash;5208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0886260518804174\u003c/span\u003e\u003cspan address=\"10.1177/0886260518804174\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTecuta L, Tomba E, Grandi S, Fava GA (2015) Demoralization: a systematic review on its clinical characterization. Psychol Med 45(4):673\u0026ndash;691. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/s0033291714001597\u003c/span\u003e\u003cspan address=\"10.1017/s0033291714001597\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeplin LA, McClelland GM, Abram KM, Weiner DA (2005) Crime Victimization in Adults With Severe Mental Illness: Comparison With the National Crime Victimization Survey. Arch Gen Psychiatry 62(8):911\u0026ndash;921. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1001/archpsyc.62.8.911\u003c/span\u003e\u003cspan address=\"10.1001/archpsyc.62.8.911\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThompson K, Kulkarni J, Sergejew AA (2000) Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res 42(3):241\u0026ndash;247. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s0920-9964(99)00130-9\u003c/span\u003e\u003cspan address=\"10.1016/s0920-9964(99)00130-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVogel M, Stephens KD, Siebels D (2014) Mental Illness and the Criminal Justice System. Sociol Compass 8(6):627\u0026ndash;638. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1111/soc4.12174\u003c/span\u003e\u003cspan address=\"10.1111/soc4.12174\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalter F, Carr MJ, Mok PLH, Antonsen S, Pedersen CB, Appleby L, Fazel S, Shaw J, Webb RT (2019) Multiple adverse outcomes following first discharge from inpatient psychiatric care: a national cohort study. Lancet Psychiatry 6(7):582\u0026ndash;589. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s2215-0366(19)30180-4\u003c/span\u003e\u003cspan address=\"10.1016/s2215-0366(19)30180-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Q-W, Hou C-L, Wang S-B, Huang Z-H, Huang Y-H, Zhang J-J, Jia F-J (2020) Frequency and correlates of violence against patients with schizophrenia living in rural China. BMC Psychiatry 20(1):286. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12888-020-02696-9\u003c/span\u003e\u003cspan address=\"10.1186/s12888-020-02696-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhiting D, Lichtenstein P, Fazel S (2021) Violence and mental disorders: a structured review of associations by individual diagnoses, risk factors, and risk assessment. Lancet Psychiatry 8(2):150\u0026ndash;161. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/s2215-0366(20)30262-5\u003c/span\u003e\u003cspan address=\"10.1016/s2215-0366(20)30262-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu B-J, Lin C-H, Tseng H-F, Liu W-M, Chen W-C, Huang L-S, Sun H-J, Chiang S-K, Lee S-M (2013) Validation of the Taiwanese Mandarin version of the Personal and Social Performance scale in a sample of 655 stable schizophrenic patients. Schizophr Res 146(1\u0026ndash;3):34\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.schres.2013.01.036\u003c/span\u003e\u003cspan address=\"10.1016/j.schres.2013.01.036\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZapata Roblyer MI, Betancourth Zambrano S (2017) Crime Victimization and Suicidal Ideation Among Colombian College Students: The Role of Depressive Symptoms, Familism, and Social Support. J interpers Violence 35(5\u0026ndash;6):1367\u0026ndash;1388. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0886260517696856\u003c/span\u003e\u003cspan address=\"10.1177/0886260517696856\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"crime victimization, severe mental illness, bipolar disorder, schizophrenia, depression","lastPublishedDoi":"10.21203/rs.3.rs-8149581/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8149581/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eCriminal victimization among individuals with severe mental illness (SMI) remains understudied in Asian contexts, complicating community reintegration. This study examined its prevalence and associated factors among Taiwanese adults with SMI to guide clinical and public health interventions.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eParticipants (N\u0026thinsp;=\u0026thinsp;798) with bipolar disorder (60.2%) or schizophrenia (39.8%) receiving at least one year of outpatient care at a medical center in northern Taiwan were recruited. Data on past-year victimization, sociodemographic traits, and clinical factors were collected, assessed via Patient Health Questionnaire (PHQ-9), Demoralization Scale, Medication Adherence Rating Scale, and Personal and Social Performance Scale. Univariate and logistic regression analyses identified associations.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eOverall, 25.1% (n\u0026thinsp;=\u0026thinsp;200) reported victimization. Protective factors included family cohabitation (OR\u0026thinsp;=\u0026thinsp;0.56, 95% CI [0.37\u0026ndash;0.85], p\u0026thinsp;=\u0026thinsp;.004) and bipolar diagnosis (vs. schizophrenia; OR\u0026thinsp;=\u0026thinsp;0.66, 95% CI [0.45\u0026ndash;0.98], p\u0026thinsp;=\u0026thinsp;.035). Risk factors included prior suicide attempts (OR\u0026thinsp;=\u0026thinsp;1.93, 95% CI [1.35\u0026ndash;2.75], p\u0026thinsp;=\u0026thinsp;.001), smoking (OR\u0026thinsp;=\u0026thinsp;1.69, 95% CI [1.18\u0026ndash;2.43], p\u0026thinsp;=\u0026thinsp;.004), criminal history (OR\u0026thinsp;=\u0026thinsp;1.70, 95% CI [1.06\u0026ndash;2.73], p\u0026thinsp;=\u0026thinsp;.029), higher depressive symptoms (PHQ-9; OR per point\u0026thinsp;=\u0026thinsp;1.05, 95% CI [1.03\u0026ndash;1.08], p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and prior psychiatric hospitalization (OR\u0026thinsp;=\u0026thinsp;1.58, 95% CI [1.15\u0026ndash;2.18], p\u0026thinsp;=\u0026thinsp;.015).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe findings highlight the need for targeted interventions addressing depressive symptoms, suicide risk, and prior hospitalizations while leveraging family support to reduce victimization in community settings.\u003c/p\u003e","manuscriptTitle":"Prevalence and Correlates of Criminal Victimization in Taiwanese Outpatients with Severe Mental Illness","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-24 08:31:19","doi":"10.21203/rs.3.rs-8149581/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c230750-fb03-4568-974a-5b460a3a3fc6","owner":[],"postedDate":"December 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-21T20:23:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-24 08:31:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8149581","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8149581","identity":"rs-8149581","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}