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Prevalence and Correlates of Fire-Setting in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)
Objective: To estimate the prevalence, sociodemographic correlates, comorbidity, and rates of mental health service utilization of fire-setters in the general population.
Method: A face-to-face survey of more than 43,000 adults aged 18 years and older residing in households was conducted during the 2001–2002 period. Diagnoses of mood, anxiety, substance use disorders, and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV).
Results: The prevalence of lifetime fire-setting in the US population was 1.13 (95% CI, 1.0–1.3). Being male, never married, and US-born and having a yearly income over $70,000 were risk factors for lifetime fire-setting, while being Asian or Hispanic and older than 30 years were protective factors for lifetime fire-setting. The strongest associations with fire-setting were with disorders often associated with deficits in impulse control, such as antisocial personality disorder (ASPD) (odds ratio [OR] = 21.8; CI, 6.6–28.5), drug dependence (OR = 7.6; 95% CI, 5.2–10.9), bipolar disorder (OR = 5.6; 95% CI, 4.0–7.9), and pathological gambling (OR = 4.8; 95% CI, 2.4–9.5). Associations between fire-setting and all antisocial behaviors were positive and significant. A lifetime history of fire-setting, even in the absence of an ASPD diagnosis, was strongly associated with substantial rates of Axis I comorbidity, a history of antisocial behavior, a family history of other antisocial behaviors, decreased functioning, and higher treatment-seeking rates.
Conclusions: Our findings suggest that fire-setting may be better understood as a behavioral manifestation of a broader impaired control syndrome and part of the externalizing spectrum. Fire-setting and other antisocial behaviors tend to be strongly associated with each other and increase the risk of lifetime and current psychiatric disorders, even in the absence of a DSM-IV diagnosis of ASPD.
J Clin Psychiatry
Submitted: October 20, 2008; accepted April 21, 2009.
Online ahead of print: February 23, 2010 (doi:10.4088/JCP.08m04812gry).
Corresponding author: Carlos Blanco, MD, PhD, New York State Psychiatric Institute, 1051 Riverside Drive, Box 69, New York, NY 10032 (firstname.lastname@example.org).