Preventing violent crime and suicide in mental illness (360G-Wellcome-202836_Z_16_Z)

Risks of violent crime and suicide are increased in mental illness, but the most effective approaches to assess and manage these risks are uncertain. This proposal will focus on the prevention of violent crime and suicide in individuals with schizophrenia-spectrum disorders, bipolar disorder, and depression. I will use population-based datasets to investigate how risk assessment for violent crime and suicide can be improved, and using validated pharmaco-epidemiological approaches, examine whether these risks can be modified with medication. For risk assessment, the focus will be on deriving and validating scalable approaches that use web-based calculators (similar to the Framingham score) that are novel in psychiatry. This work will be mainly conducted using high quality population registers in Sweden with further validations in Denmark, Scotland, British Columbia, Queensland, and Pelotas, Brazil. For risk modification, I will use Swedish linked registers to examine specific psychotropic and common non-psychotropic medications for associations with violent crime and suicide using within-individual designs. Further, in a high-risk population under community supervision, I will use within-individual approaches to study psychological and behavioural interventions. Finally, I will examine how to link effective interventions to these novel risk assessment tools, and study the feasibility of a trial of risk assessment.