Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia; Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; National Drug Research Institute, Curtin University, Perth, WA, Australia.
School of Medicine, University of Queensland, Brisbane, QLD, Australia.
Lancet Public Health. 2018 May;3(5):e237-e248. doi: 10.1016/S2468-2667(18)30052-5. Epub 2018 Apr 18.
People with mental illness and substance use disorder are over-represented in prisons. Injury-related mortality is elevated in people released from prison, and both mental illness and substance use disorder are risk factors for injury. Effective care coordination during the transition between criminal justice and community service providers improves health outcomes for people released from prison. However, the health outcomes and support needs of people with dual diagnosis (co-occurring mental illness and substance use disorder) released from prison are poorly understood. Here we aim to examine the association between dual diagnosis and non-fatal injury in adults released from prison.
Pre-release interview data collected between Aug 1, 2008, and July 31, 2010, from a representative sample of sentenced adults (≥18 years) in Queensland, Australia, were linked, retrospectively and prospectively, to person-level, state-wide emergency department and hospital records. We identified dual diagnoses from inpatient, emergency department, and prison medical records. We modelled the association between mental health status and all injury resulting in hospital contact by fitting a multivariate Cox regression, adjusting for sociodemographic, health, and criminogenic covariates, and replacing missing covariate data by multiple imputation.
In 1307 adults released from prison, there were 2056 person-years of follow-up (median 495 days, IQR 163-958). The crude injury rates were 996 (95% CI 893-1112) per 1000 person-years for the dual diagnosis group, 538 (441-657) per 1000 person-years for the mental illness only group, 413 (354-482) per 1000 person-years for the substance use disorder only group, and 275 (247-307) per 1000 person-years for the no mental disorder group. After adjusting for model covariates, the dual diagnosis (adjusted hazard rate ratio 3·27, 95% CI 2·30-4·64; p<0·0001) and mental illness only (1·87, 1·19-2·95; p=0·0071) groups were at increased risk of injury after release from prison compared with the group with no mental health disorders.
People released from prison experience high rates of injury compared with the general population. Among people released from prison, dual diagnosis is associated with an increased risk of injury. Contact with the criminal justice system is a key opportunity to prevent subsequent injury morbidity in people with co-occurring mental health disorders. Engagement with integrated psychiatric and addiction treatment delivered without interruption during the transition from prison into the community might prevent the injury-related disparities experienced by this vulnerable group. The development of targeted injury prevention strategies for people with dual diagnosis released from prison is warranted.
National Health and Medical Research Council.
患有精神疾病和物质使用障碍的人群在监狱中比例过高。从监狱获释的人群中，与伤害相关的死亡率较高，而精神疾病和物质使用障碍都是伤害的风险因素。在刑事司法和社区服务提供者之间进行有效的医疗协调，可以改善从监狱获释人员的健康状况。然而，患有双重诊断（同时存在精神疾病和物质使用障碍）的从监狱获释人员的健康结果和支持需求仍了解甚少。在这里，我们旨在研究双重诊断与从监狱获释成年人的非致命性伤害之间的关联。
2008 年 8 月 1 日至 2010 年 7 月 31 日期间，从澳大利亚昆士兰州具有代表性的被判成年人（≥18 岁）样本中收集了预先释放的访谈数据，对个人层面、全州范围内的急诊部和医院记录进行了回顾性和前瞻性的链接。我们从住院、急诊和监狱医疗记录中确定了双重诊断。通过拟合多变量 Cox 回归，调整了社会人口统计学、健康和犯罪学协变量，并通过多次插补替换缺失的协变量数据，我们对心理健康状况与所有导致住院的伤害之间的关联进行了建模。
在 1307 名从监狱获释的成年人中，有 2056 人年的随访（中位数为 495 天，IQR 163-958）。在双重诊断组中，未校正的伤害发生率为 996（95%CI 893-1112）/1000 人年，在仅精神疾病组中为 538（441-657）/1000 人年，在仅物质使用障碍组中为 413（354-482）/1000 人年，在无精神障碍组中为 275（247-307）/1000 人年。在调整了模型协变量后，与没有精神健康障碍的组相比，双重诊断（调整后的危险比 3.27，95%CI 2.30-4.64；p<0.0001）和仅精神疾病（1.87，1.19-2.95；p=0.0071）组在从监狱获释后受伤的风险增加。
与一般人群相比，从监狱获释的人群中受伤的发生率较高。在从监狱获释的人群中，双重诊断与受伤风险增加有关。与刑事司法系统的接触是预防具有共同精神健康障碍人群随后出现伤害发病率的关键机会。在从监狱过渡到社区期间，提供不间断的精神病学和成瘾治疗的综合治疗服务，可能会防止这一弱势群体遭受与伤害相关的差异。需要为从监狱获释的双重诊断人群制定有针对性的伤害预防策略。
澳大利亚国家卫生与医学研究理事会。
