Adults living with severe mental illness may face a considerable risk of experiencing violence, according to a 2025 systematic review by Rocha and colleagues.
The review’s pooled estimate suggested that approximately one-third of people included in the studies had experienced violence victimisation during a 12-month period. In this review, victimisation meant exposure to any form of violence.
The finding describes people as victims of violence. It should not be read as evidence that people with severe mental illness are generally violent toward others. The review noted that mental health services often assess the risk a patient may pose to other people, but less often ask about whether the patient has experienced violence.
What the review examined
Researchers searched five databases and narrowed more than 1,500 initial results to 30 articles. The studies included 22 cross-sectional investigations and eight longitudinal studies, with sample sizes ranging from 150 to 4,168 participants.
The review used a broad working definition of severe mental illness. It included major depressive disorder, bipolar disorder, schizophrenia, post-traumatic stress disorder and substance use disorders.
The evidence came from 13 studies in Europe, seven in the United States, four in Australia, three in Asia and three in Africa. No studies from South or Central America were included.
Rates varied widely between studies
Individual study estimates ranged from 13% to 94%, showing how differently victimisation appeared across the research. For studies covering 13 to 60 months, the pooled estimate was 27%. For studies covering more than 60 months, including lifetime periods, it was 41%.
These figures cannot be treated as a simple timeline showing that risk consistently rises or falls. Each estimate came from a different and relatively small set of studies, and the review found no consistent pattern linked to the length of the period studied.
Factors linked with victimisation
The review identified several factors associated with experiencing violence:
- younger age;
- being female;
- homelessness;
- substance abuse;
- more severe mental health symptoms; and
- previous victimisation.
These associations do not establish that any one factor causes violence victimisation. The authors described the relationships between risk factors as complex, and different groups may have different experiences.
Why the findings need careful interpretation
Most studies had at least one methodological shortcoming, and 70% were judged to have samples that were not sufficiently representative of the general population. The studies also differed substantially in their design and the people they included.
The review combined several clinical sub-groups, whose experiences of violence may not be the same. Its search terms focused on “victimisation” and “victim”, meaning that research using terms such as “abuse” or “maltreatment” may not have been captured.
For these reasons, the one-third estimate is a pooled research finding rather than a universal rate for every person with severe mental illness or every setting.
Implications for mental health care
Rocha and colleagues concluded that people with severe mental illness are at significantly elevated risk of becoming victims of violence. They recommended that mental health policy and practice give greater attention to violence experienced by patients.
In practical terms, the review supports making questions about safety and past victimisation part of appropriate mental health conversations, alongside existing attention to risk involving other people. The evidence also points to the need for better-designed studies with more representative samples and broader geographical coverage.
AI tools were used to assist with the preparation of this article.
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