Gang membership and involvement in gang violence should be routinely assessed in young men presenting to health care services with psychiatric morbidity in urban areas with high levels of gang activity.
That’s the take-home message from a study appearing online in AJP in Advance July 12 that showed extraordinarily high rates of mental illness among young male gang members in Great Britain.
The study found rates of psychosis, antisocial personality disorder, alcohol dependence, and anxiety, among other disorders, far in excess of the expected prevalence in the general population.
“No research has previously investigated whether gang violence is related to psychiatric illness, other than substance misuse, or if it places a burden on mental health services,” said lead author Jeremy Coid, M.D., of the Forensic Psychiatry Research Unit, Queen Mary University of London, in a statement. “Here we have shown unprecedented levels among this group, identifying a complex public-health problem at the intersection of violence, substance misuse, and mental health problems among young men.”
Coid and colleagues conducted a cross-sectional survey of 4,664 men aged 18 to 34 in Great Britain using random location sampling, oversampling men from areas with high levels of violence and gang activity.
Respondents completed a questionnaire that incorporated questions from several tested instruments for measuring psychopathology—the Psychosis Screening Questionnaire, the Structured Clinical Interview for DSM-IV Personality Disorders Screening Questionnaire, the Hospital Anxiety and Depression Scale, the Alcohol Use Disorders Identification Test, and the Drug Use Disorders Identification Test.
Participants were asked if they had ever deliberately attempted to kill themselves. They were also asked if they were currently taking any prescribed psychotropic medications, had consulted a medical practitioner over the prior 12 months for mental health problems, had ever seen a psychiatrist or psychologist, or had ever been admitted to a psychiatric hospital.
Finally, they were asked about gang membership and involvement in violence, including whether they had been “in a physical fight [or] assaulted or deliberately hit anyone in the past five years.”
They were paid 5 pounds British for their participation (about $7.55 U.S.).
Of the total sample, 3,284 (70.4 percent) reported that they had not been violent in the past five years, 1,272 (27.3 percent) said they had assaulted another person or been involved in a fight, and 108 (2.1 percent) said they were currently a member of a gang.
For the purposes of analysis, participants were divided into three mutually exclusive groups according to their answers: (1) nonviolent men—participants reporting no violent behavior over the past five years and no gang membership; (2) violent men—those reporting violence over the past five years but no gang membership or involvement in gang fights; and (3) gang members.
Results show a marked gradient with psychiatric morbidity and service use infrequent among nonviolent men but increasing progressively from violent nonmembers to gang members. Of the 108 gang members surveyed, 85.8 percent had an antisocial personality disorder, 67 percent were alcohol dependent, and 25.1 percent screened positive for psychosis.
In addition, about 57 percent were drug dependent, 34 percent had attempted suicide, and nearly 59 percent had an anxiety disorder.
Regarding psychiatric service use, 27.1 percent said they had consulted a medical professional about symptoms, and 20.7 percent acknowledged a psychiatric admission. Twelve percent said they had consulted a psychiatrist, and 15.9 percent had received a psychiatric medication.
As a result of their findings, “it is important that physicians and other health professionals assess gang membership in young urban men,” the researchers said. “Risk of relapse and failed intervention are elevated among those who return to gang activities, and gang members should be helped to understand the risks to their mental health.”
Commenting on the study to Psychiatric News, past APA President Paul Appelbaum, M.D., chair of the APA Committee on Judicial Action, called the report a pioneering study of psychopathology among gang members. Appelbaum is the Dollard Professor of Psychiatry, Medicine, and Law and director of the Division of Law, Ethics, and Psychiatry at Columbia University.
“Their study raises, but cannot answer, the question of whether targeted efforts to address mental disorders in members of gangs might reduce their involvement in antisocial behaviors, including violence,” he said. “However, replication of these findings in the U.S., with more direct methods for assessing psychopathology, is important for at least two reasons: (1) the self-reported rates of psychopathology are so high that one must wonder about the accuracy of gang members’ responses—screening instruments based on self-report often identify cases that would not qualify for a formal diagnosis; and (2) whether British gangs differ in some systematic way from their American counterparts that would result in elevated rates of mental disorders is unclear.” ■