Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.
Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, Australia.
J Intellect Disabil Res. 2017 Oct;61(10):939-956. doi: 10.1111/jir.12349. Epub 2017 Jan 16.
Intellectual disability and patient activation may be important drivers of inequities in health service access and health outcomes for people with intellectual disability transitioning from prison to the community. We assessed the association between intellectual disability and patient activation after prison release and examined whether this association varied, depending on whether intellectual disability was identified prior to prison release.
Overall, 936 prisoners were screened for intellectual disability by using the Hayes Ability Screening Index and completed the Patient Activation Measure (PAM) within 6 weeks of prison release and again at 1, 3 and 6 months post-release. We estimated the association between intellectual disability status and PAM scores by using a multilevel linear model, adjusting for sociodemographic, behavioural, health and criminogenic factors. We used propensity score matching to estimate the impact of being identified with intellectual disability prior to release from prison on the change in mean PAM score after prison release.
Compared with those who screened negative for intellectual disability, ex-prisoners who screened positive, both with and without prior identification of intellectual disability, had significantly decreased mean PAM scores [(B = -4.3; 95% CI: -6.3, -2.4) and (B = -4.5; 95% CI: -6.8, -2.3), respectively] over 6 months of follow-up. Among those who reported being identified with intellectual disability prior to release from prison, a significant increase in PAM score at the 6-month follow-up interview (B = 5.89; 95% CI: 2.35, 9.42; P = 0.001) was attributable to being identified with intellectual disability prior to release.
Ex-prisoners screening positive for possible intellectual disability have decreased patient activation for at least 6 months after release from prison. However, individuals whose possible intellectual disability is unidentified appear to be particularly vulnerable. Incarceration is a pivotal opportunity for the identification of intellectual disability and for initiating transitional linkages to health and intellectual disability-specific community services for this marginalised population.
智力障碍和患者激活可能是影响智障人群在从监狱过渡到社区后获得卫生服务和健康结果公平性的重要因素。我们评估了智力障碍与监狱释放后患者激活之间的关联，并研究了这种关联是否因在监狱释放前是否确定智力障碍而有所不同。
共有 936 名囚犯使用 Hayes 能力筛查指数进行了智力障碍筛查，并在监狱释放后 6 周内以及释放后 1、3 和 6 个月内完成了患者激活量表（PAM）。我们使用多水平线性模型来估计智力障碍状况与 PAM 分数之间的关联，调整了社会人口统计学、行为、健康和犯罪因素。我们使用倾向评分匹配来估计在监狱释放前确定有智力障碍对监狱释放后 PAM 评分变化的影响。
与智力障碍筛查阴性的前囚犯相比，无论是否事先确定有智力障碍，智力障碍筛查阳性的前囚犯的平均 PAM 分数均显著降低[（B=-4.3；95%CI：-6.3，-2.4）和（B=-4.5；95%CI：-6.8，-2.3）]，随访 6 个月。在那些报告在监狱释放前被确定为智力障碍的人中，在 6 个月的随访访谈中 PAM 评分显著增加（B=5.89；95%CI：2.35，9.42；P=0.001），这归因于在监狱释放前被确定为智力障碍。
对可能的智力障碍进行筛查呈阳性的前囚犯在从监狱释放后的至少 6 个月内，患者的积极性降低。然而，未确定可能的智力障碍的个体似乎尤其脆弱。监禁是确定智力障碍并为这个边缘化群体启动过渡性联系到卫生和智力障碍特定社区服务的关键机会。
