入狱前精神疾病、物质使用、伤害及性传播感染方面的性别差异与医疗服务利用情况：安大略省联邦服刑人员的纵向关联研究
Sex differences in pre-incarceration mental illness, substance use, injury and sexually transmitted infections and health service utilization: a longitudinal linkage study of people serving federal sentences in Ontario.
作者信息
Butsang Tenzin, McLuhan Arthur, Keown Leslie A, Fung Kinwah, Matheson Flora I
机构信息
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.
出版信息
Health Justice. 2023 Apr 1;11(1):19. doi: 10.1186/s40352-023-00218-9.
BACKGROUND
People who experience incarceration have poorer health than the general population. Yet, we know little about the health and health service utilization of people during the critical period prior to their incarceration, relative to during incarceration and post-release. In this study, we conducted a longitudinal cohort study of 39,498 adults in Ontario, Canada between January 1, 2002, and December 31, 2011 using linked administrative health and correctional data to describe mental illness, substance use, injury, sexually transmitted infections and health service utilization of men and women in federal prisons in the 3 years prior to their incarceration, compared to a matched group.
RESULTS
We found that, in the 3-year period prior to their incarceration, men (n = 6,134) and women (n = 449) experiencing their first federal sentence had poorer health across all indicators examined (e.g., psychosis, drug/alcohol use, and self-harm) and higher outpatient psychiatric and emergency department visits, compared with the matched group. Women in the pre-incarceration group exhibited a higher prevalence of self-harm and substance use, relative to women in the matched comparison group and higher relative prevalence to that of men in the pre-incarceration group, compared to their matched counterparts.
CONCLUSIONS
Disparities in health and health service utilization are gendered and exist prior to incarceration. The gendered nature of these findings, specifically the significantly higher prevalence of poor health among women across several indicators, necessitates a focus on the social and systemic factors that contribute to these disparities. Gender-responsive and trauma-informed primary, secondary, and tertiary prevention strategies, alongside transformative approaches to justice should be considered in addressing the health needs of men and women who experience incarceration.
背景
经历过监禁的人群健康状况比普通人群更差。然而，相对于监禁期间和释放后，我们对人们在监禁前的关键时期的健康状况和医疗服务利用情况知之甚少。在本研究中，我们对2002年1月1日至2011年12月31日期间加拿大安大略省的39498名成年人进行了一项纵向队列研究，使用关联的行政健康和惩教数据来描述联邦监狱中男性和女性在监禁前3年的精神疾病、物质使用、伤害、性传播感染以及医疗服务利用情况，并与匹配组进行比较。
结果
我们发现，在首次被判处联邦监禁前的3年期间，与匹配组相比，首次被判处联邦监禁的男性（n = 6134）和女性（n = 449）在所有检查指标（如精神病、药物/酒精使用和自我伤害）方面的健康状况更差，门诊精神科就诊和急诊科就诊次数更高。与匹配的对照组中的女性相比，监禁前组中的女性自我伤害和物质使用的患病率更高，并且与监禁前组中的男性相比，相对于其匹配对象，患病率也更高。
结论
健康状况和医疗服务利用方面的差异存在性别之分，且在监禁前就已存在。这些研究结果的性别特征，特别是在多个指标上女性健康状况较差的患病率显著更高，这就需要关注导致这些差异的社会和系统因素。在满足经历过监禁的男性和女性的健康需求时，应考虑采用对性别问题有敏感认识和了解创伤情况的一级、二级和三级预防策略，以及变革性的司法方法。
Zotero 插件