Justice Health Unit, Centre for Health Equity; Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3052, Australia.
Programa de Pós-graduação Em Saúde Coletiva, Universidade Católica de Santos-São Paulo, Santos, Brazil.
Soc Psychiatry Psychiatr Epidemiol. 2020 Oct;55(10):1355-1362. doi: 10.1007/s00127-020-01832-w. Epub 2020 Feb 11.
To estimate the prevalence of dual diagnosis and identify health, social and criminal justice factors associated with dual diagnosis among incarcerated adults in Australia and Brazil.
We compared data from cross-sectional surveys of incarcerated adults (aged ≥ 18 years) in Australia and Brazil. Using data from linked emergency department, hospital, and in-prison medical records in the Australian sample, and from the Composite International Diagnostic Interview (CIDI) in the Brazilian sample, participants were categorised as having: (1) no mental disorder; (2) substance use disorder only; (3) mental illness only; or (4) dual diagnosis. A multivariate multinomial logistic regression model was fitted to identify factors associated with dual diagnosis in each country.
Approximately one quarter of participants in both Australia (22%) and Brazil (25%) met the diagnostic criteria for dual diagnosis. In both countries, dual diagnosis was associated with being female [relative risk (RR) = 2.25 (95% CI 1.47-3.43) Australia; RR = 2.59 (95% CI 1.79-3.74) Brazil], having a history of prior incarceration [RR = 2.99 (95% CI 1.99-4.48) Australia; RR = 2.27 (95% CI 1.57-3.29) Brazil], and having comorbid physical health problems [RR = 1.54 (95% CI 1.08-2.19) Australia; RR = 2.53 (95% CI 1.75-3.65) Brazil].
Despite differences in health, social, and criminal justice systems between Australia and Brazil, the prevalence of and factors associated with dual diagnosis in incarcerated adults appear to be similar in the two countries. A number of generalisable principles can be inferred and should be considered in health and criminal justice policy making.
评估澳大利亚和巴西被监禁成年人双重诊断的流行情况，并确定与双重诊断相关的健康、社会和刑事司法因素。
我们比较了澳大利亚和巴西的横断面调查中被监禁成年人（年龄≥18 岁）的数据。使用澳大利亚样本中急诊室、医院和监狱内医疗记录的链接数据，以及巴西样本中的复合国际诊断访谈（CIDI），参与者被分为：（1）无精神障碍；（2）仅物质使用障碍；（3）仅有精神疾病；或（4）双重诊断。在每个国家，使用多元多项逻辑回归模型来确定与双重诊断相关的因素。
澳大利亚（22%）和巴西（25%）的参与者中，大约四分之一符合双重诊断的诊断标准。在两个国家中，双重诊断都与女性有关[澳大利亚的相对风险（RR）=2.25（95%可信区间 1.47-3.43）；RR=2.59（95%可信区间 1.79-3.74）巴西]、有先前被监禁的历史[RR=2.99（95%可信区间 1.99-4.48）澳大利亚；RR=2.27（95%可信区间 1.57-3.29）巴西]和合并身体健康问题[RR=1.54（95%可信区间 1.08-2.19）澳大利亚；RR=2.53（95%可信区间 1.75-3.65）巴西]。
尽管澳大利亚和巴西的卫生、社会和刑事司法系统存在差异，但被监禁成年人双重诊断的流行率和相关因素在这两个国家似乎相似。可以推断出一些可推广的原则，在制定卫生和刑事司法政策时应予以考虑。
