Somers Research Group, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
School of Social Welfare, University of California-Berkeley, Berkeley, CA.
Schizophr Bull. 2017 Sep 1;43(5):1002-1010. doi: 10.1093/schbul/sbx084.
Preliminary evidence suggests that adherence to antipsychotic medication reduces criminal recidivism among patients diagnosed with schizophrenia. However, existing studies operationalize antipsychotic adherence as a binary variable (usually using a threshold of ≥80%), which does not reflect the prevalence of suboptimal adherence in real-world settings. The purpose of the current analysis was to investigate the association between successive ordinal levels of antipsychotic adherence and criminal recidivism in a well-defined sample of offenders diagnosed with schizophrenia (n = 11462). Adherence was measured using the medication possession ratio (MPR) and analyzed as a time-dependent covariate in multivariable regression models. Data were drawn from linked, comprehensive diagnostic, pharmacy and justice system records, and individuals were followed for an average of 10 years. Adjusted rate ratios (ARR) and confidence intervals (CI) are reported. Overall mean MPR was 0.41. Increasing levels of antipsychotic adherence were not associated with progressively lower rates of offending. However, when compared to the reference group (MPR ≥ 80%) all lower adherence levels were significantly associated (P < .001) with increased risk of violent (ARR = 1.58; 95% CI = 1.46-1.71) and nonviolent (ARR = 1.41; 95% CI = 1.33-1.50) offenses. Significance was replicated in separate sensitivity analyses. Previously published studies reporting reductions in crime may have been influenced by antipsychotic adherence ≥80%. Binary operationalization of adherence is an inaccurate predictor of recidivism. Future research addressing functional outcomes of antipsychotic adherence should conceptualize adherence as an incremental independent variable.
初步证据表明，抗精神病药物的依从性降低了精神分裂症患者的犯罪复发率。然而，现有研究将抗精神病药物的依从性操作化为二分类变量（通常使用≥80%的阈值），这不能反映现实环境中依从性不佳的普遍程度。本分析的目的是在一个明确诊断为精神分裂症的罪犯样本（n=11462）中，研究抗精神病药物依从性的连续有序水平与犯罪复发之间的关联。使用药物持有率（MPR）来衡量依从性，并作为多变量回归模型中的时间依赖性协变量进行分析。数据来自于关联的、全面的诊断、药房和司法系统记录，个体的平均随访时间为 10 年。报告了调整后的比率比（ARR）和置信区间（CI）。总体平均 MPR 为 0.41。抗精神病药物依从性水平的升高与犯罪率的降低没有相关性。然而，与参考组（MPR≥80%）相比，所有较低的依从性水平与暴力（ARR=1.58；95%CI=1.46-1.71）和非暴力（ARR=1.41；95%CI=1.33-1.50）犯罪的风险增加显著相关（P<0.001）。在单独的敏感性分析中也得到了验证。之前报道的减少犯罪的研究可能受到抗精神病药物依从性≥80%的影响。依从性的二分法操作是复发的不准确预测指标。未来研究应将抗精神病药物依从性的功能结果作为一个递增的独立变量进行研究。
