The Kirby Institute, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
The National Centre for Excellence in Intellectual Disability Health, Faculty of Medicine and Health, University of New South Wales Sydney, Sydney, New South Wales, Australia.
JAMA Netw Open. 2024 Oct 1;7(10):e2442146. doi: 10.1001/jamanetworkopen.2024.42146.
People living with psychosis experience excess premature mortality and are overrepresented in criminal legal systems, but little is known about mortality associated with criminal sanctions or diversion in this population.
To examine associations of different types of recent (past 2 years) criminal sanction, including court diversion, with mortality among people with psychosis.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, retrospective, data-linkage cohort study was conducted using 6 routinely collected administrative data collections from New South Wales, Australia, relating to health, court proceedings, imprisonment, and mortality. Participants (adults aged ≥18 years hospitalized for psychotic disorders) entered observation at the time of discharge from their first psychosis-related hospital admission (or their 18th birthday if aged <18 years) between July 2001 and November 2017 and were followed-up until May 2019. Data were analyzed between February 2023 and April 2024.
Recent (past 2 years) criminal sanction type, a time-varying variable with 5 categories: no recent criminal sanction, recent mental health court diversion, recent community sanction, current imprisonment, and recent prior imprisonment (ie, recent prison release).
Causes of death were described, and age- and sex-specific mortality rates by recent criminal sanction type were calculated. In those younger than 65 years, Cox regression was used to examine associations of all-cause and external-cause mortality with recent criminal sanction type, adjusting for sociodemographic, health-related, and offense-related confounders.
The cohort included 83 071 persons (35 791 female [43.1%]; 21 208 aged 25-34 years [25.5%]; median [IQR] follow-up, 9.5 [4.8-14.2] years), of whom 25 824 (31.1%) received a criminal sanction. There were 11 355 deaths. In those aged younger than 65 years, recent mental health court diversion, community sanctions, and prior imprisonment were associated with increased hazards of all-cause and external-cause mortality compared with no recent sanction, with the largest adjusted hazard ratios (aHRs) observed for recent prior imprisonment (all-cause mortality: aHR, 1.69; 95% CI, 1.50-1.91; external-cause mortality: aHR, 2.64; 95% CI, 2.27-3.06).
In this cohort study of people with psychosis, recent criminal sanctions were associated with increased mortality irrespective of sanction type. These findings suggest that future research should develop strategies to improve health and safety in people with psychosis who have criminal legal system contact.
精神疾病患者过早死亡的比例过高，且在刑事法律系统中比例过高，但对于此类人群中与刑事制裁或转处相关的死亡率知之甚少。
研究不同类型的近期（过去 2 年）刑事制裁，包括法庭转处，与精神疾病患者的死亡率之间的关联。
设计、地点和参与者：这是一项基于人群的回顾性数据链接队列研究，使用来自澳大利亚新南威尔士州的 6 项常规收集的行政数据，涉及健康、法庭程序、监禁和死亡率。参与者（年龄≥18 岁、因精神病住院的成年人）在 2001 年 7 月至 2017 年 11 月期间首次因精神疾病相关住院后出院时（或 18 岁生日时，如果年龄<18 岁）进入观察期，并在 2019 年 5 月之前进行随访。数据在 2023 年 2 月至 2024 年 4 月之间进行分析。
近期（过去 2 年）刑事制裁类型，这是一个随时间变化的变量，有 5 个类别：无近期刑事制裁、近期心理健康法庭转处、近期社区制裁、当前监禁和近期先前监禁（即近期监狱释放）。
描述了死因，并计算了按近期刑事制裁类型划分的年龄和性别特异性死亡率。在年龄<65 岁的人群中，使用 Cox 回归分析了全因和外部原因死亡率与近期刑事制裁类型之间的关联，同时调整了社会人口统计学、健康相关和犯罪相关的混杂因素。
该队列包括 83071 人（35791 名女性[43.1%]；21208 人年龄在 25-34 岁[25.5%]；中位[IQR]随访时间为 9.5[4.8-14.2]年），其中 25824 人（31.1%）受到刑事制裁。共有 11355 人死亡。在年龄<65 岁的人群中，与无近期制裁相比，近期心理健康法庭转处、社区制裁和先前监禁与全因和外部原因死亡率的增加风险相关，近期先前监禁的调整后危险比（aHR）最大（全因死亡率：aHR，1.69；95%CI，1.50-1.91；外部原因死亡率：aHR，2.64；95%CI，2.27-3.06）。
在这项针对精神疾病患者的队列研究中，近期刑事制裁与死亡率增加有关，无论制裁类型如何。这些发现表明，未来的研究应该制定策略，以改善与刑事法律系统有接触的精神疾病患者的健康和安全。
