Robertson Allison G, Swanson Jeffrey W, Frisman Linda K, Lin Hsiuju, Swartz Marvin S
Dr. Robertson, Dr. Swanson, and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail:
Psychiatr Serv. 2014 Jul;65(7):931-8. doi: 10.1176/appi.ps.201300044.
Adults with serious mental illness have a relatively high risk of criminal justice involvement. Some risk factors for justice involvement are known, but the specific interaction of these risk factors has not been examined. This study explored the interaction of gender, substance use disorder, and psychiatric diagnosis among patients with schizophrenia or bipolar disorder to identify subgroups at higher risk of justice involvement.
Administrative service records of 25,133 adults with schizophrenia or bipolar disorder who were clients of Connecticut's public behavioral health system during 2005-2007 were merged with state records of criminal convictions, incarceration, and other measures of justice involvement. The main effects and the effects of interactions of gender, substance use disorder, and psychiatric diagnosis on risk of justice involvement ("offending") were estimated by using multivariable logistic regression.
Men with bipolar disorder and co-occurring substance use disorder had the highest absolute risk of offending in every category of justice involvement. For both men and women, bipolar disorder was associated with an increased risk of offending versus schizophrenia, but the increase was significantly greater for women. Substance use disorder also increased risk of offending more among women than men, especially among those with schizophrenia.
Men and women with bipolar disorder and substance use disorders have much higher risk of justice involvement than those with schizophrenia, especially those without a substance use disorder. Research is needed to validate these effects in other populations and specify risk factors for justice involvement among adults with mental illness.
患有严重精神疾病的成年人涉及刑事司法的风险相对较高。一些导致涉及司法问题的风险因素是已知的，但这些风险因素之间的具体相互作用尚未得到研究。本研究探讨了精神分裂症或双相情感障碍患者中性别、物质使用障碍和精神科诊断之间的相互作用，以确定涉及司法风险较高的亚组。
将2005 - 2007年期间作为康涅狄格州公共行为健康系统服务对象的25133名患有精神分裂症或双相情感障碍的成年人的行政服务记录与该州的刑事定罪、监禁及其他涉及司法问题的衡量记录进行合并。通过多变量逻辑回归估计性别、物质使用障碍和精神科诊断对涉及司法风险（“犯罪”）的主效应及相互作用效应。
患有双相情感障碍且同时存在物质使用障碍的男性在各类司法涉入中犯罪的绝对风险最高。对于男性和女性而言，与精神分裂症相比，双相情感障碍与犯罪风险增加相关，但女性的增加幅度显著更大。物质使用障碍在女性中比在男性中增加犯罪风险的程度更高，尤其是在患有精神分裂症的女性中。
患有双相情感障碍和物质使用障碍的男性和女性比患有精神分裂症的人涉及司法的风险要高得多，尤其是那些没有物质使用障碍的精神分裂症患者。需要开展研究以在其他人群中验证这些效应，并明确患有精神疾病的成年人涉及司法问题的风险因素。
