Department of Population Health, New York University, 180 Madison Avenue, New York, NY 10016, United States.
Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California at Los Angeles, 11075 Santa Monica Blvd, Suite 200, Los Angeles, CA 90025, United States.
Psychiatry Res. 2019 Jun;276:191-195. doi: 10.1016/j.psychres.2019.05.018. Epub 2019 May 10.
The purpose of this study was to examine factors related to the delivery and effectiveness of psychiatric care prior to and following prison release. Particular attention was placed on patients' self-reported needs, psychiatric medication adherence, and perceived stigma related to mental health treatment, and how these factors related to post-release clinical and recidivism outcomes. Participants (N = 103) with serious psychiatric disorders (SPD; global assessment of functioning scores below 50) were recruited within 60 days of scheduled release from prison, and provided pre-release and six monthly follow-up interviews. Seventy eight percent of the released sample had at least one follow-up contact. Baseline interviews revealed low social stability prior to the current term of incarceration, and forty five percent of the sample had been returned to jail or prison within six months of release. Regression models revealed that perceived psychiatric stigma was a significant (negative) predictor of medication adherence in the community and even in prison. A path analysis showed that perceived stigma predicted responses on the K-6 psychological distress measure and recidivism both directly and indirectly via its influence on medication adherence. Mitigating the effects of this real or perceived stigma may significantly improve post-release outcomes for this high-risk population.
本研究旨在探讨监禁前后与精神科护理的提供和效果相关的因素。特别关注患者自我报告的需求、精神科药物的依从性以及与心理健康治疗相关的感知污名，以及这些因素如何与释放后的临床和累犯结果相关。在预定释放后 60 天内，从监狱中招募了患有严重精神障碍（SPD；全球功能评估得分低于 50）的参与者（N=103），并提供了释放前和六个月的随访访谈。释放样本中有 78%的人至少有一次随访联系。基线访谈显示，在当前监禁期之前社会稳定性较低，且 45%的样本在释放后六个月内被送回监狱或监狱。回归模型显示，感知到的精神科污名是社区中药物依从性的一个显著（负面）预测因素，甚至在监狱中也是如此。路径分析表明，感知到的污名将通过对药物依从性的影响直接和间接地预测 K-6 心理困扰量表的反应和累犯。减轻这种真实或感知到的污名将显著改善这一高风险人群的释放后结果。
