Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.
Soc Psychiatry Psychiatr Epidemiol. 2022 Sep;57(9):1839-1847. doi: 10.1007/s00127-021-02158-x. Epub 2021 Aug 28.
High rates of psychiatric disorders in correctional facilities have fueled widespread concern about the "criminalization of mental illness." While the link between incarceration, substance abuse, and antisocial-personality disorder is well established, the relationship between non-substance-related psychiatric disorders and incarceration has not been thoroughly investigated. This study examines the association of mental illness, excluding substance use disorders, with risk for incarceration in US adults.
Nationally representative data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) were used to compare the proportions of respondents with lifetime incarceration among those with no lifetime history of DSM-5 disorders, or with lifetime history of mental illness, substance use disorders, dual diagnosis, and antisocial personality/conduct disorder. Logistic regression analysis was used to examine the independent association of incarceration with mental illness alone, both in comparison to and net of associations with sociodemographic and behavioral characteristics.
Among adults with mental illness alone, 6.7% reported past incarceration, compared to 4.8% with no history of DSM-5 disorders, and 20-40% in other DSM-5 diagnostic groups. Sociodemographic and behavioral risk factors were more strongly associated with incarceration (c-statistics = 0.74 and 0.77, respectively), than mental illness (c-statistic = 0.56). Schizophrenia or other psychoses and borderline personality disorder were independently associated with incarceration, but with effect sizes no greater than eight other sociodemographic or behavioral risk factors.
A weak association of mental illness alone with incarceration was found, despite high level of public attention to "criminalization of mental illness."
惩教设施中精神疾病发病率高，引发了人们对“精神疾病犯罪化”的广泛关注。虽然监禁、药物滥用和反社会人格障碍之间的联系已得到充分证实，但非药物相关精神疾病与监禁之间的关系尚未得到彻底研究。本研究考察了排除物质使用障碍的精神疾病与美国成年人监禁风险之间的关系。
使用全国酒精相关情况和精神障碍流行病学调查第三期（NESARC-III）的全国代表性数据，比较了终生无 DSM-5 障碍史、有终生精神疾病史、物质使用障碍史、双重诊断和反社会/品行障碍史的受访者中，有过监禁经历的比例。采用逻辑回归分析，考察了监禁与单纯精神疾病之间的独立关联，以及与社会人口学和行为特征关联的比较和净关联。
在仅有精神疾病的成年人中，有 6.7%报告过去有过监禁经历，而无 DSM-5 障碍史的成年人中这一比例为 4.8%，其他 DSM-5 诊断组的比例为 20-40%。社会人口学和行为风险因素与监禁的关联更强（C 统计量分别为 0.74 和 0.77），而精神疾病的关联较弱（C 统计量为 0.56）。精神分裂症或其他精神病和边缘型人格障碍与监禁独立相关，但效应大小不超过其他 8 个社会人口学或行为风险因素。
尽管公众高度关注“精神疾病犯罪化”，但仅发现精神疾病与监禁之间存在微弱关联。
