Psychology Services Limited, PO Box 1735, Croydon, CR97AE, UK.
Reykjavik University, Reykjavik, Iceland.
BMC Psychiatry. 2018 Jun 22;18(1):209. doi: 10.1186/s12888-018-1785-9.
Attention-deficit hyperactivity disorder (ADHD) and head injury (including traumatic brain injury (TBI)) manifest in high levels across prison samples and guidance from the National Institute for Health and Care Excellence notes that people with acquired brain injury may have increased prevalence of ADHD. We aimed to examine the association of ADHD with TBI and the impact of the association upon health-related quality of life (HRQoL) and service use among imprisoned adults.
An observational study was performed in 2011-2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Head injury was measured with a series of self-reported questions, addressing history of hits to the head: frequency, severity, loss of consciousness (LOC), and sequelae. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 was used to measure health status, and to calculate attribute specific HRQoL and Quality-Adjusted Life Year (QALY) scores.
72% of prisoners sampled reported at least one head injury in their lifetime. Among those, 70% of head injuries occurred before age 16 and 70% experienced LOC. Prisoners with ADHD were nearly twice more likely to have TBI. Prisoners with ADHD-only and ADHD with co-morbid TBI had significantly lower scores in several HRQoL attributes, compared with TBI only or the absence of either condition. Adjusted logistic regression models indicated an average reduction of 0.20 QALYs in inmates with ADHD-only and 0.30 QALY loss in those with ADHD with co-morbid TBI compared with inmates with neither condition.
There is a robust association between ADHD and TBI, and ADHD with co-morbid TBI confers significantly greater impairment in terms of HRQoL. Managing the short and long-term consequences of TBI is essential to improving care for prisoners and to addressing the criminogenic factors related to them.
注意力缺陷多动障碍（ADHD）和头部损伤（包括创伤性脑损伤（TBI））在监狱样本中表现出较高的水平，国家卫生与保健卓越研究所的指导意见指出，脑损伤患者可能会增加 ADHD 的患病率。我们旨在研究 ADHD 与 TBI 的关联，以及这种关联对监禁成年人的健康相关生活质量（HRQoL）和服务利用的影响。
本研究于 2011 年至 2013 年在英国因弗内斯波特菲尔德监狱进行了一项观察性研究。所有男性样本包括 390 名有能力同意且无中度或重度智力残疾史的成年监狱囚犯。头部损伤通过一系列自我报告的问题来衡量，包括头部受伤的历史：频率、严重程度、意识丧失（LOC）和后遗症。参与者使用成人 ADHD 诊断访谈 2.0 进行访谈。健康效用指数标记 3 用于衡量健康状况，并计算特定属性的 HRQoL 和质量调整生命年（QALY）评分。
72%的抽样囚犯报告一生中至少有一次头部受伤。其中，70%的头部损伤发生在 16 岁之前，70%的人出现了 LOC。患有 ADHD 的囚犯发生 TBI 的可能性几乎是两倍。仅患有 ADHD 和 ADHD 合并 TBI 的囚犯在几个 HRQoL 属性上的得分明显较低，而 TBI 仅或没有任何一种疾病的囚犯得分则较高。调整后的逻辑回归模型表明，仅患有 ADHD 的囚犯的平均 QALY 损失减少了 0.20，而 ADHD 合并 TBI 的囚犯的 QALY 损失减少了 0.30，与没有任何一种疾病的囚犯相比。
ADHD 和 TBI 之间存在着密切的关联，而 ADHD 合并 TBI 则会导致 HRQoL 显著受损。管理 TBI 的短期和长期后果对于改善囚犯的护理和解决与之相关的犯罪因素至关重要。
