A systematic review and three-level meta-analysis published in BMC Psychiatry has synthesized the factors associated with violent behavior in people with schizophrenia, giving systematic attention to protective factors that previous research largely overlooked. Guided by the social-ecological model, the study integrated evidence across individual, family, community and health-service levels, and its results reveal a striking asymmetry: the strongest associations were classic risk exposures, while protective associations were spread more thinly across multiple levels.
The researchers searched ten Chinese- and English-language databases from inception to January 26, 2026, and included 40 studies. From these, 45 factors were identified, of which 39 entered the meta-analysis: 20 protective factors and 19 risk factors. The team used three-level random-effects meta-analyses, supplemented by methodological quality assessment, publication bias assessment, moderator analyses and sensitivity analyses. The review was prospectively registered with PROSPERO under registration number CRD420261287987.
Overall, 22 of the factors were significantly associated with violent behavior, split evenly between 11 protective factors linked to lower violent behavior and 11 risk factors linked to higher violent behavior. The strongest risk associations were observed for a history of violence or criminal offending, depressive symptoms, a history of suicide attempts, and substance or alcohol use problems. At the family level, a family history of psychiatric disorders emerged as a significant risk factor. Significant risk factors were concentrated mainly at the individual and family levels.
The protective side of the picture was broader. Factors associated with lower violent behavior included longer illness duration, longer education, female sex, higher social functioning, not being single, employment, not living alone, timely treatment, treatment adherence, a longer interval between clinical visits, and active help-seeking from professionals. Among these, treatment adherence showed the strongest protective association. Unlike the risk factors, significant protective factors spanned individual, family, community and social, and health service levels.
The analysis also identified three significant moderator effects, indicating that the strength of some associations varied with study characteristics, although the abstract does not detail which moderators these were. The authors caution that the protective associations require further longitudinal evaluation regarding their stability, contextual dependence and incremental value.
Subject of Research: Risk and protective factors for violent behavior in people with schizophrenia
Article Title: Protective and risk factors of violent behavior in people with schizophrenia: a systematic review and three-level meta-analysis
Article References: Yan, L., Xiao, T., Wang, Y.-R., Zhang, Y., Ji, C.-F., Xia, L.-P., Xi, W.-W., Shi, J.-Q., Liu, L., & Wu, X.-D. (2026). Protective and risk factors of violent behavior in people with schizophrenia: a systematic review and three-level meta-analysis. BMC Psychiatry. https://doi.org/10.1186/s12888-026-08772-w
Image Credits: AI Generated
DOI: 10.1186/s12888-026-08772-w
Keywords: schizophrenia, violent behavior, meta-analysis, systematic review, risk factors, protective factors, social-ecological model, treatment adherence, substance use, psychiatry, Protective, risk
News Source: Glenn Wilkins. (October 29, 2026). Meta-Analysis Maps Risk and Protective Factors for Violence in Schizophrenia. Scienmag.
