AccScience Publishing / JCBP / Online First / DOI: 10.36922/JCBP025520102
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ORIGINAL RESEARCH ARTICLE

Synergistic interactions of aggressive behavior, gender, and persecutory delusions on violent behavior in schizophrenia: A case–control study

Youhu Lu1 ,  Guanjun Li2* ,  Jian Wang1 ,  Jiangli He1 ,  Yuanyuan Zhou1 ,  Yin Chen1
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1 Second Ward, Sixth People’s Hospital of Anqing City, Anhui, China
2 Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai, China
JCBP, 025520102 https://doi.org/10.36922/JCBP025520102
Received: 26 December 2025 | Revised: 3 February 2026 | Accepted: 12 February 2026 | Published online: 8 May 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Violent behavior in patients with schizophrenia represents a significant clinical and public health concern, with risk influenced by the interplay of sociodemographic and clinical characteristics. However, the underlying mechanisms remain unclear. This study aimed to investigate the interaction effects between violent behavior and sociodemographic as well as clinical features in patients with schizophrenia. Using an age-matched 1:1 case–control design, 208 patients (104 in the violence group and 104 in the control group) were enrolled from the Sixth People’s Hospital of Anqing. Demographic data were collected, and clinical characteristics were assessed using standardized scales. Univariate and multivariate logistic regression analyses identified male sex (odds ratio [OR] = 2.89, 95% confidence interval [CI]: 1.26–6.63), primary school education or below (OR = 2.36, 95% CI 1.12–4.98), severity of aggressive behavior (OR = 8.23, 95% CI 3.51–19.32), and persecutory delusions (OR = 3.57,95% CI: 1.56–8.18) as independent risk factors. The key finding was the presence of significant multiplicative interactions between male sex and severity of aggressive behavior (interaction OR = 4.57, p = 0.002) and between persecutory delusions and severity of aggressive behavior (interaction OR = 3.26, p = 0.009). These results indicate that when these factors co-occur, the combined risk significantly exceeds the sum of their independent risks, suggesting a synergistic effect. The conclusion highlights that the severity of aggressive behavior is a critical risk factor. Targeted interventions for patients exhibiting the combined profiles of “male sex with aggressive behavior” and “persecutory delusions with aggressive behavior” may help reduce the occurrence of related risky behaviors. Study limitations include a single-center sample, a cross-sectional design that precludes causal inference, and the absence of biomarker data, warranting caution in generalizing the conclusions.

Keywords
Schizophrenia
Violent behavior
Sociodemographic characteristics
Clinical characteristics
Interaction effect
Multifactorial logistic regression analysis
Funding
None.
Conflict of interest
The authors declare no competing interests.
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Journal of Clinical and Basic Psychosomatics, Electronic ISSN: 2972-4414 Print ISSN: 3060-8562, Published by AccScience Publishing
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