Young S, Sedgwick O, Fridman M, Gudjonsson G, Hodgkins P, Lantigua M, González R A
Centre for Mental Health,Division of Brain Sciences,Department of Medicine,Imperial College,London,UK.
Broadmoor Hospital,West London Mental Health Trust,London,UK.
Psychol Med. 2015;45(12):2499-510. doi: 10.1017/S0033291715000598. Epub 2015 Apr 10.
Rates of psychiatric disorders are highly prevalent among prison inmates, and recent evidence confirms over-representation of youths and adults with attention deficit hyperactivity disorder (ADHD). The risk for psychiatric co-morbidity may be greater among offenders with ADHD. We undertook a systematic review and meta-analysis of reported rates of co-existing psychiatric morbidity with ADHD in prison samples.
Studies published from 1980 to 2015 were identified using five bibliographic indexes, review articles and reference lists. Included studies had a defined ADHD group and provided additional prevalence on at least one of the following: conduct disorder, substance use disorder, mood disorder, anxiety disorder, or personality disorder. We performed meta-analytical estimates of the prevalence of each co-morbid disorder within ADHD, and estimated the risk for co-existing disorders among prisoners with ADHD by pooling odds ratios (OR) with 95% confidence intervals.
Eighteen studies with data for 1615 with ADHD and 3128 without ADHD were included. The risk (OR) of all psychiatric morbidity is increased among adult inmates with ADHD. Associations in youths with ADHD were restricted to mood disorder (OR 1.89, 95% confidence interval 1.09-3.28).
This study quantifies the extent of co-morbidity presented by offenders with ADHD, especially adults. The differences between risk estimates for youths and adults indicate an incremental effect in both frequency and severity for the development of further co-morbid pathology through adulthood. The findings have implications for clinical intervention and for criminal justice policy.
精神疾病在监狱囚犯中极为普遍，最近的证据证实患有注意力缺陷多动障碍（ADHD）的青少年和成年人比例过高。患有ADHD的罪犯出现精神疾病共病的风险可能更高。我们对监狱样本中报告的ADHD与精神疾病共病率进行了系统评价和荟萃分析。
使用五个书目索引、综述文章和参考文献列表，确定1980年至2015年发表的研究。纳入的研究有明确的ADHD组，并提供了以下至少一项的额外患病率：品行障碍、物质使用障碍、情绪障碍、焦虑障碍或人格障碍。我们对ADHD中每种共病障碍的患病率进行了荟萃分析估计，并通过合并比值比（OR）和95%置信区间，估计了患有ADHD的囚犯中存在共病障碍的风险。
纳入了18项研究，其中1615名患有ADHD的数据和3128名未患有ADHD的数据。患有ADHD的成年囚犯中所有精神疾病的风险（OR）增加。患有ADHD的青少年中的关联仅限于情绪障碍（OR 1.89，95%置信区间1.09 - 3.28）。
本研究量化了患有ADHD的罪犯，尤其是成年人的共病程度。青少年和成年人风险估计的差异表明，在成年期进一步发展共病病理的频率和严重程度都有递增效应。这些发现对临床干预和刑事司法政策具有启示意义。
