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Articles   |    
Gang Membership, Violence, and Psychiatric Morbidity
Jeremy W. Coid, M.D.; Simone Ullrich, Ph.D.; Robert Keers, Ph.D.; Paul Bebbington, M.D.; Bianca L. DeStavola, Ph.D.; Constantinos Kallis, Ph.D.; Min Yang, M.D.; David Reiss, M.D.; Rachel Jenkins, M.D.; Peter Donnelly, M.D.
Am J Psychiatry 2013;170:985-993. doi:10.1176/appi.ajp.2013.12091188
View Author and Article Information

All authors report no financial relationships with commercial interests.

The survey was funded by the Maurice and Jacqueline Bennett Charitable Trust and the U.K. National Institute for Health Research (NIHR). Drs. Coid, Kallis, Keers, and Ullrich were supported by a Program Grant for Applied Research, program RP-PG-0407-10500, from NIHR.

From the Forensic Psychiatry Research Unit, Queen Mary University of London.

Address correspondence to Dr. Coid (j.w.coid@qmul.ac.uk).

Copyright © 2013 by the American Psychiatric Association

Received September 10, 2012; Revised March 19, 2013; Accepted April 25, 2013.

Abstract

Objective  Gang members engage in many high-risk activities associated with psychiatric morbidity, particularly violence-related ones. The authors investigated associations between gang membership, violent behavior, psychiatric morbidity, and use of mental health services.

Method  The authors conducted a cross-sectional survey of 4,664 men 18–34 years of age in Great Britain using random location sampling. The survey oversampled men from areas with high levels of violence and gang activities. Participants completed questionnaires covering gang membership, violence, use of mental health services, and psychiatric diagnoses measured using standardized screening instruments.

Results  Violent men and gang members had higher prevalences of mental disorders and use of psychiatric services than nonviolent men, but a lower prevalence of depression. Violent ruminative thinking, violent victimization, and fear of further victimization accounted for the high levels of psychosis and anxiety disorders in gang members, and with service use in gang members and other violent men. Associations with antisocial personality disorder, substance misuse, and suicide attempts were explained by factors other than violence.

Conclusions  Gang members show inordinately high levels of psychiatric morbidity, placing a heavy burden on mental health services. Traumatization and fear of further violence, exceptionally prevalent in gang members, are associated with service use. Gang membership should be routinely assessed in individuals presenting to health care services in areas with high levels of violence and gang activity. Health care professionals may have an important role in promoting desistence from gang activity.

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FIGURE 1. Adjusted Odds Ratios of Psychiatric Morbidity and Service Use for Violent Men and Gang Members Compared With Nonviolent Men as Reference Groupa

a Error bars indicate 95% confidence intervals.

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TABLE 1.Demographic Characteristics of Nonviolent and Violent Men and Gang Members
Table Footer Note

* p<0.05. **p<0.01. ***p<0.001.

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TABLE 2.Independent Associations of Violence and Gang Membership With Psychiatric Morbidity and Service Usea
Table Footer Note

a All 95% confidence intervals are computed using robust standard errors to account for correlations within survey areas due to clustering within postal codes.

Table Footer Note

b Adjusted for all other psychiatric morbidity outcomes, non-U.K. birth, being single, unemployment, ethnicity, age, Index of Multiple Deprivation (a relative measure of deprivation at small-area level across the United Kingdom), and survey type.

Table Footer Note

cAdjusted for non-U.K. birth, being single, unemployment, ethnicity, age, Index of Multiple Deprivation, and survey type.

Table Footer Note

* p<0.05. **p<0.01. ***p<0.001.

Anchor for Jump
TABLE 3.Testing Explanations for the Links Between Gang Membership, Violence, and Psychopathology and Service Use: Violent Compared With Nonviolent Mena
Table Footer Note

a All 95% confidence intervals are computed using robust standard errors to account for correlations within survey areas resulting from clustering within postal codes.

Table Footer Note

b Percentage change in beta coefficient (beta=log[odds ratio]) from baseline model to final adjusted model.

Table Footer Note

* p<0.05. **p<0.01. ***p<0.001.

Anchor for Jump
TABLE 4.Testing Explanations for the Link Between Gang Membership, Violence, and Psychopathology and Service Use: Gang Members Compared With Nonviolent Mena
Table Footer Note

a All 95% confidence intervals are computed using robust standard errors to account for correlations within survey areas resulting from clustering within postal codes.

Table Footer Note

bPercentage change in beta coefficient (beta=log[odds ratio]) from baseline model to final adjusted model.

Table Footer Note

* p<0.05. **p<0.01. ***p<0.001.

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