Wilton Geoff, Stewart Lynn A
The authors are with Correctional Service Canada, Ottawa, Ontario. Send correspondence to Dr. Stewart (e-mail:
Psychiatr Serv. 2017 Jul 1;68(7):704-709. doi: 10.1176/appi.ps.201500391. Epub 2017 Mar 15.
Whether a diagnosis of a mental disorder contributes to the risk of poorer correctional outcomes is controversial. This study aimed to clarify the extent to which mental and substance use disorders individually and in combination contribute to correctional outcomes in order to determine optimal treatment and promote public safety.
Differences were examined between four groups of federal offenders in Canada (N=715): those with a mental disorder only, those with a substance use disorder only, those with co-occurring mental and substance use disorders, and those with no disorder. Groups were compared on profiles, criminal histories, charges while incarcerated (institutional charges), and reconvictions after release from incarceration by using chi-square tests and Cox regression analyses that controlled for risk factors.
Of the four groups, those with co-occurring disorders had the most substantial criminal histories and the highest rates of institutional charges, transfers to segregation while incarcerated, and reconvictions. The group with only mental disorders had outcomes intermediate between the groups with only substance use disorders and the group with neither type of disorder.
Having a substance use disorder appeared to be the key factor contributing to poorer correctional outcomes for offenders with mental disorders. Psychiatric services in correctional facilities must screen for substance use disorders and, if they are present, ensure provision of treatment to improve quality of life for this population and promote public safety.
精神障碍的诊断是否会增加惩教效果较差的风险存在争议。本研究旨在阐明精神障碍和物质使用障碍单独及合并存在时对惩教效果的影响程度，以确定最佳治疗方法并促进公共安全。
对加拿大四组联邦罪犯（N = 715）进行差异检验：仅患有精神障碍的罪犯、仅患有物质使用障碍的罪犯、同时患有精神障碍和物质使用障碍的罪犯以及无任何障碍的罪犯。通过卡方检验和控制风险因素的Cox回归分析，比较各组在个人资料、犯罪史、监禁期间的指控（机构指控）以及出狱后的再定罪情况。
在这四组中，同时患有两种障碍的罪犯犯罪史最为严重，机构指控率、监禁期间被转至隔离区的比例以及再定罪率最高。仅患有精神障碍的组的结果介于仅患有物质使用障碍的组和无任何一种障碍的组之间。
患有物质使用障碍似乎是导致患有精神障碍的罪犯惩教效果较差的关键因素。惩教机构的精神科服务必须筛查物质使用障碍，若存在此类障碍，则要确保提供治疗，以改善这一人群的生活质量并促进公共安全。
