Prevalence and Impact of Abuse Experienced by Persons with Severe Mental Illness: A Systematic Review

Severe mental illness (SMI) and victimization are intersectional as one preceded the other. This study estimated the prevalence rates of different forms of abuse and the multidimensional impact of abuse among persons with SMI. Eleven electronic databases were searched for studies published during 2010-2021. A total of 38 studies in English were included if full-text articles published in peer-reviewed journals; cross-sectional, cohort, and case-control studies; measuring abuse among males and females >= 16 years with psychiatric illness but excluded studies if focusing on populations such as prisoners or homeless, or individuals with substance abuse or intellectual developmental disorder; review articles, qualitative studies, case series, and experimental studies. A total of 76,499 participants with SMI were included in 28 (73.7%) cross-sectional studies, 3 (7.9%) case-control studies, and 7 (18.4%) cohort design studies. The prevalence of physical abuse ranged from 5% to 64% among men and 6-37.7% among women; sexual abuse ranged from 3% to 22.9% among men and from 2% to 62% among women; psychological abuse was 27% among men and women ranging from 39% to 83%; domestic violence ranged from 14.8% to 95.2% among men and from 10% to 67% among women, and criminal victimization ranged from 3.5% to 70% among the mixed psychiatric sample. The systematic review showed the following significant impact: poor clinical outcomes; physical injury; higher level of depression, anxiety, somatic symptoms, and self-harm tendencies among women, and substance abuse and aggressive behavior among men; role strain; parentification; social withdrawal and interpersonal difficulties. Psychiatric populations were at higher risk of victimization by multiple perpetrators at different points in time. Physical abuse was easily identified and reported largely; but sexual and emotional abuse present subtly, depends upon clinician skills, judgment, and confidence to explore and report. Often, victimization has a negative impact on physical and mental well-being, relationships, and community life.