Department of Psychology, University of Calgary, Calgary, Alberta, Canada.
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Can J Psychiatry. 2024 Mar;69(3):196-206. doi: 10.1177/07067437231189468. Epub 2023 Jul 28.
Individuals with chronic psychotic disorders are overrepresented in correctional facilities, but little is known about factors that increase the risk of correctional involvement. The objective of this study was to compare individuals with chronic psychotic disorders who were released from correctional facilities in Ontario to individuals with chronic psychotic disorders but no correctional involvement on sociodemographic, clinical, and prior mental health-related health service utilization characteristics.
All individuals with chronic psychotic disorders who were released from a provincial correctional facility in Ontario in 2010 were matched (1:2) by age and sex to Ontario residents with chronic psychotic disorders and no correctional involvement. Covariates included sociodemographic (rural residence, marginalization such as residential instability quintile, material deprivation quintile, dependency quintile, and ethnic concentration quintile) and clinical (duration of chronic psychotic disorder and comorbidities) characteristics, and mental health-related health service utilization characteristics (primary care physician, psychiatrist and emergency department visits, and hospitalizations) 1 and 3 years prior to correctional involvement. The association between correctional involvement and prior health service utilization was measured by estimating incidence rate ratios using Poisson and negative-binomial regressions.
Individuals with correctional involvement ( = 3,197) lived in neighbourhoods with higher material deprivation and residential instability, and had a shorter duration of illness, and more psychosocial comorbidities (e.g., behavioural issues and depression) than individuals without correctional involvement ( = 6,393). Adjusting for sociodemographic and clinical variables, individuals with correctional involvement had a higher rate of mental health-related primary care physician visits, emergency department visits, and hospitalizations but a lower rate of psychiatrist visits prior to correctional involvement, compared to individuals without correctional involvement.
Despite higher mental health-related comorbidities and higher rates of accessing acute mental health services among individuals with chronic psychotic disorders and correctional involvement, visits to psychiatrists prior to involvement were low.
患有慢性精神病的个体在惩戒设施中所占比例过高，但对于增加其被惩戒机构收容的风险因素却知之甚少。本研究的目的是比较在安大略省从惩戒设施中获释的患有慢性精神病的个体与无惩戒收容经历的患有慢性精神病的个体，在人口统计学、临床和先前心理健康相关医疗服务使用特征方面的差异。
所有在 2010 年从安大略省一所省级惩戒机构获释的患有慢性精神病的个体均按年龄和性别与无惩戒收容经历的安大略省慢性精神病患者进行 1:2 匹配。协变量包括人口统计学因素（农村居住、居住不稳定五分位数、物质剥夺五分位数、依赖五分位数和种族集中五分位数）和临床特征（慢性精神病的持续时间和合并症），以及在获得惩戒收容前 1 年和 3 年的心理健康相关医疗服务使用特征（初级保健医生、精神病医生就诊、急诊就诊和住院）。使用泊松和负二项回归估计发病率比值来衡量惩戒收容与先前医疗服务使用之间的关联。
有惩戒收容经历的个体（n=3197）居住在物质剥夺和居住不稳定程度更高的社区，且发病时间更短，伴有更多的心理社会合并症（例如，行为问题和抑郁）。与无惩戒收容经历的个体（n=6393）相比，有惩戒收容经历的个体在获得惩戒收容前，心理健康相关的初级保健医生就诊、急诊就诊和住院的次数更多，而精神病医生就诊的次数更少。
尽管患有慢性精神病且有惩戒收容经历的个体有更高的心理健康相关合并症和更高的急性心理健康服务利用率，但在获得惩戒收容前，他们看精神病医生的次数却较少。
