Error bars are 95% CIs.
Read more at: http://ht.ly/S88T2
By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.
- 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
Error bars are 95% CIs.
Read more at: http://ht.ly/S88T2
By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.
- 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
Reoffending
and presence of psychiatric disorders are common in prisoners worldwide. However,
whether psychiatric disorders are risk factors for reoffending is still
unknown. We aimed to examine the association between psychiatric disorders,
including substance use disorder, and violent reoffending.
We did a
longitudinal cohort study of 47 326 prisoners who were imprisoned since Jan 1,
2000, and released before Dec 31, 2009, in Sweden. We obtained data for
diagnosed psychiatric disorders from both inpatient and outpatient registers,
and sociodemographic and criminological factors from other population-based
registers...
Diagnosed
psychiatric disorders were associated with an increased hazard of violent
reoffending in male and female prisoners, and these associations were independent of measured
sociodemographic and criminological factors, and, in men, remained substantial
after adjustment for unmeasured familial factors. However,
findings differed between individual diagnoses and sex. We found some evidence
of stronger effects on violent reoffending of alcohol and drug use disorders
and bipolar disorder than of other psychiatric disorders. Alcohol use disorder
seemed to have a greater effect in women than in men. The overall effects of psychiatric disorders did not differ
with severity of crime. The hazard of violent reoffending increased
in a stepwise way with the number of diagnosed psychiatric disorders. Assuming
causality, up to 20% of violent reoffending in men and 40%
in women was attributable to the diagnosed psychiatric disorders that
we investigated.
Certain
psychiatric disorders are associated with a substantially increased hazard of
violent reoffending. Because these disorders are prevalent and mostly
treatable, improvements to prison mental health services could counteract the
cycle of reoffending and improve both public health and safety. National
violence prevention strategies should consider the role of prison health.
Read more at: http://ht.ly/S88T2
By: Chang Z1, Larsson H2, Lichtenstein P2, Fazel S3.
- 1Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
- 3Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
INTRODUCTION:
Borderline
personality disorder (BPD) is a severely disabling condition, associated with
substantially increased risk of deliberate self-harm and, particularly in men,
also with interpersonal violence and other criminal behavior. Although BPD
might be common among prison inmates, little is known about prevalence and
psychiatric comorbidity in probationers and parolees.
RESULTS:
We
ascertained a final DSM-5 BPD prevalence rate of 19.8%.
The most common current comorbid disorders among subjects with BPD were
antisocial personality disorder (91%), major depressive disorder (82%),
substance dependence (73%), attention deficit hyperactivity disorder (ADHD)
(70%), and alcohol dependence (64%). Individuals diagnosed with BPD had
significantly more current psychiatric comorbidity than
interviewed participants not fulfilling BPD criteria. Participants with
BPD also reported substantially more symptoms of ADHD, anxiety and depression
compared to all subjects without BPD.
CONCLUSIONS:
BPD
affected one fifth of probationers and was related to serious mental ill-health
known to affect recidivism risk. The findings suggest further study of possible
benefits of improved identification and treatment of BPD in offender
populations.
- 1Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden. Electronic address: dan.wetterborg@ki.se.
- 2Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden; Swedish Prison and Probation Services R&D Unit, 601 80 Norrköping, Sweden. Electronic address: niklas.langstrom@ki.se.
- 3Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; Department of Behavioural Sciences and Learning, Linköping University, 581 83 Linköping, Sweden. Electronic address: gerhard.andersson@liu.se.
- 4Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden. Electronic address: pia.enebrink@ki.se.
Below: Plot showing the relationship between psychological health and duration of detention
The mean QOL domain scores (out of 100) were 47.0, 57.5, 41.9, and 60.5 for the environmental, physical, psychological, and social domains, respectively. The level of support detainees received from detention staff was significantly positively associated with detainees’ physical (βadjusted 3.93, confidence interval [CI] 0.06–7.80) and psychological (βadjusted 5.72, CI 1.77–9.66) domain scores. There was also significant positive association between detainees’ satisfaction with the care they received from detention staff and the domain scores. The general health score in the WHOQOL-BREF was significantly associated with the detainees’ ability to understand the Swedish or English languages. Although not statistically significant, a longer duration of detention was negatively correlated with QOL scores.
Immigrant detainees report low QOL. Services provided at the centres, especially the support received from detention staff, is positively associated with their QOL. A review of detention guidelines addressing language barriers, staff training, and duration of detention is highly recommended.
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Below: Number of suicides (total N=127) among released prisoners in Sweden 2005-2009 by month of release. The fifth year is not shown since no suicide occurred.
We identified 38,995 releases among 26,953 prisoners (7.6% females) during 2005-2009. Overall, 127 suicides occurred, accounting for 14% of all deaths after release (n=920). The mean suicide rate was 204 per 100,000 person years yielding an incidence rate ratio of 18.2 (95% CI 13.9-23.8) compared with general population controls. Previous substance use disorder (Hazard Ratio [HR]=2.1, 1.4-3.2), suicide attempt (HR=2.5, 1.7-3.7), and being born in Sweden vs. abroad (HR=2.1, 1.2-3.6) were independent risk factors for suicide after release.
Released prisoners are at high suicide risk and with a slightly different pattern of psychiatric risk factors for suicide compared with the general population. Results suggest appropriate allocation of resources to facilitate transition to life outside prison and increased attention to prisoners with both a previous suicide attempt and substance use disorder.
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