Thomas E G, Spittal M J, Heffernan E B, Taxman F S, Alati R, Kinner S A
Melbourne School of Population and Global Health,University of Melbourne,Parkville,VIC,Australia.
School of Medicine,University of Queensland,Herston,QLD,Australia.
Psychol Med. 2016 Feb;46(3):611-21. doi: 10.1017/S0033291715002123. Epub 2015 Nov 9.
Understanding individual-level changes in mental health status after prison release is crucial to providing targeted and effective mental health care to ex-prisoners. We aimed to describe trajectories of psychological distress following prison discharge and compare these trajectories with mental health service use in the community.
The Kessler Psychological Distress Scale (K10) was administered to 1216 sentenced adult prisoners in Queensland, Australia, before prison release and approximately 1, 3 and 6 months after release. We used group-based trajectory modeling to identify K10 trajectories after release. Contact with community mental health services in the year following release was assessed via data linkage.
We identified five trajectory groups, representing consistently low (51.1% of the cohort), consistently moderate (29.8%), high increasing (11.6%), high declining (5.5%) and consistently very high (1.9%) psychological distress. Mood disorder, anxiety disorder, history of self-harm and risky drug use were risk factors for the high increasing, very high and high declining trajectory groups. Women were over-represented in the high increasing and high declining groups, but men were at higher risk of very high psychological distress. Within the high increasing and very high groups, 25% of participants accessed community mental health services in the first year post-release, for a median of 4.4 contact hours.
For the majority of prisoners with high to very high psychological distress, distress persists after release. However, contact with mental health services in the community appears low. Further research is required to understand barriers to mental health service access among ex-prisoners.
了解出狱后个人心理健康状况的变化对于为刑满释放人员提供有针对性且有效的心理保健至关重要。我们旨在描述出狱后心理困扰的轨迹，并将这些轨迹与社区心理健康服务的使用情况进行比较。
对澳大利亚昆士兰州1216名被判刑的成年囚犯在出狱前以及出狱后约1个月、3个月和6个月进行了凯斯勒心理困扰量表（K10）测试。我们使用基于群体的轨迹模型来确定出狱后的K10轨迹。通过数据链接评估出狱后一年内与社区心理健康服务的接触情况。
我们确定了五个轨迹组，分别代表持续低水平（占队列的51.1%）、持续中等水平（29.8%）、高增长（11.6%）、高下降（5.5%）和持续非常高水平（1.9%）的心理困扰。情绪障碍、焦虑症、自残史和危险药物使用是高增长、非常高和高下降轨迹组的危险因素。在高增长和高下降组中女性比例过高，但男性出现非常高水平心理困扰的风险更高。在高增长和非常高的组中，25%的参与者在出狱后的第一年使用了社区心理健康服务，接触时间中位数为4.4小时。
对于大多数心理困扰程度高到非常高的囚犯来说，出狱后困扰依然存在。然而，在社区中与心理健康服务的接触似乎较少。需要进一步研究以了解刑满释放人员获得心理健康服务的障碍。
