Law and Psychiatry Division, Yale School of Medicine, New Haven, Connecticut06519, USA.
VA Connecticut Health Care System, West Haven, Connecticut06516, USA.
Eur Psychiatry. 2021 Dec 3;64(1):e75. doi: 10.1192/j.eurpsy.2021.2250.
The correlates of legally significant outcomes that have been identified in people with mental disorders are of limited value in understanding the mechanisms by which these outcomes occur.
To describe the relationships between mental disorder, impaired psychosocial function, and three legally significant outcomes in a representative sample of the US population.
We used a population survey, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III, sample size 36,309), to identify people who self-reported serious trouble with the police or the law over the past 12 months and two lifetime outcomes, being incarcerated and engaging in violence to others. DSM-5 categories were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Psychosocial function was assessed using social and role-emotional function scores of the 12-Item Short-Form Health Survey Version 2.
Participants with mental disorder, but not people with no diagnosis, who reported serious trouble with the police or with the law during the previous 12 months reported significantly worse psychosocial function than those who did not report such trouble. The size of the statistical effect varied by diagnosis, moderate for some forms of mental illness and for alcohol abuse and nonsignificant for drug abuse and the personality disorders. Effect sizes were largest for diagnoses where legally significant outcomes were least common.
The effect of impaired psychosocial function, for instance in disrupting family and social networks that would otherwise protect against these legally significant outcomes, warrants further investigation in studies with longitudinal designs.
在精神障碍患者中确定的与法律相关的结果的相关性，对于理解这些结果发生的机制的价值有限。
描述美国代表性人群中精神障碍、社会心理功能受损与三种法律相关结果之间的关系。
我们使用了一项人群调查，即国家酒精和相关条件流行病学调查（NESARC-III，样本量为 36309 人），以确定在过去 12 个月内自我报告有严重警察或法律问题的人群，以及两种终生结果，即监禁和对他人实施暴力。DSM-5 类别是使用酒精使用障碍和相关障碍访谈表-5 生成的。社会心理功能使用 12 项简短健康调查版本 2 的社会和角色情感功能评分进行评估。
与没有诊断的人相比，报告过去 12 个月内有警察或法律问题的有精神障碍的参与者的社会心理功能明显更差，而没有报告这些问题的参与者则没有这种情况。统计效应的大小因诊断而异，某些形式的精神疾病和酒精滥用的效应较大，而药物滥用和人格障碍的效应则不显著。在法律相关结果最不常见的诊断中，效应大小最大。
社会心理功能受损的影响，例如破坏本可以防止这些法律相关结果的家庭和社交网络，值得在具有纵向设计的研究中进一步调查。
