参与美国刑事司法系统对精神分裂症治疗者的成本影响。
Involvement in the US criminal justice system and cost implications for persons treated for schizophrenia.
机构信息
Eli Lilly and Company, Indianapolis, IN, USA.
出版信息
BMC Psychiatry. 2010 Jan 28;10:11. doi: 10.1186/1471-244X-10-11.
BACKGROUND
Individuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population, but there are limited data on such encounters and their attendant costs. This study assessed the prevalence of encounters with the criminal justice system, encounter types, and the estimated cost attributable to these encounters in the one-year treatment of persons with schizophrenia.
METHODS
This post-hoc analysis used data from a prospective one-year cost-effectiveness study of persons treated with antipsychotics for schizophrenia and related disorders in the United States. Criminal justice system involvement was assessed using the Schizophrenia Patients Outcome Research Team (PORT) client survey and the victimization subscale of the Lehman Quality of Life Interview (QOLI). Direct cost of criminal justice system involvement was estimated using previously reported costs per type of encounter. Patients with and without involvement were compared on baseline characteristics and direct annual health care and criminal justice system-related costs.
RESULTS
Overall, 278 (46%) of 609 participants reported at least 1 criminal justice system encounter. They were more likely to be substance users and less adherent to antipsychotics compared to participants without involvement. The 2 most prevalent types of encounters were being a victim of a crime (67%) and being on parole or probation (26%). The mean annual per-patient cost of involvement was $1,429, translating to 6% of total annual direct health care costs for those with involvement (11% when excluding crime victims).
CONCLUSIONS
Criminal justice system involvement appears to be prevalent and costly for persons treated for schizophrenia in the United States. Findings highlight the need to better understand the interface between the mental health and the criminal justice systems and the related costs, in personal, societal, and economic terms.
背景
与普通人群相比，精神分裂症患者可能更有可能与刑事司法系统接触，但有关这种接触及其相关费用的数据有限。本研究评估了精神分裂症患者在一年治疗期间与刑事司法系统接触的发生率、接触类型以及这些接触的估计费用。
方法
本事后分析使用了美国一项针对接受抗精神病药物治疗的精神分裂症和相关障碍患者的为期一年的成本效益前瞻性研究的数据。使用 Schizophrenia Patients Outcome Research Team（PORT）患者调查和 Lehman 生活质量访谈（QOLI）的受害量表评估刑事司法系统的参与情况。使用之前报告的每种接触类型的成本来估算刑事司法系统参与的直接成本。比较了有和没有参与的患者在基线特征以及直接年度医疗保健和刑事司法系统相关费用方面的差异。
结果
总体而言，609 名参与者中有 278 名（46%）报告了至少一次刑事司法系统接触。与没有参与的参与者相比，他们更有可能是药物使用者且对抗精神病药物的依从性较差。最常见的两种接触类型是成为犯罪受害者（67%）和假释或缓刑（26%）。参与的患者每年人均费用为 1429 美元，占参与患者总年度直接医疗费用的 6%（排除犯罪受害者后占 11%）。
结论
在美国，接受精神分裂症治疗的患者刑事司法系统参与似乎很普遍且费用高昂。研究结果强调了需要更好地了解心理健康和刑事司法系统之间的接口以及相关费用，从个人、社会和经济角度来看。
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