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: 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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