目标:尽管有监禁和暴力史的持续犯罪者患精神疾病的比例过高,对他们的精神病医疗保健利用(HCU)和HCU相关因素知之甚少。本研究旨在探索精神科的HCU,精神病发病率,以及有监禁史的暴力罪犯的精神药物。
方法:2010-2012年对因暴力和/或身体性犯罪而被监禁的18-25岁男性罪犯(n=266)进行了临床评估,并在瑞典国家登记处进行了前瞻性随访,直至2017年。关于HCU的基于注册的信息,精神病发病率,和精神药物被追踪并与普通人群组(n=10,000)和所有违规轨迹组进行比较.使用基线风险因素来解释暴力罪犯中的前瞻性精神病HCU。
结果:暴力罪犯使用较少一般医疗保健和精神科门诊护理,但与普通人群相比,更多的精神病住院护理和更频繁地接受精神病诊断和精神药物治疗。先前被分配到持续违规轨迹组的参与者的精神病HCU比率高于被分配到停止轨迹组的参与者。在多变量回归模型中,精神病HCU与焦虑症有关,之前的精神病接触,安置在寄养家庭,精神病特征,智力功能低下,和持续的冒犯。
结论:暴力犯罪者承受着广泛而严重的精神病发病率,并且通常以住院患者而不是门诊患者的身份与精神病医疗保健进行互动。了解他们的背景,犯罪行为,精神病状况可以帮助为这个麻烦的群体规划精神病服务。
OBJECTIVE: Although persistent offenders with histories of imprisonment and violence have disproportionate high rates of psychiatric disorders, little is known of their psychiatric healthcare utilization (HCU) and HCU-associated factors. This
study aimed to explore psychiatric HCU, psychiatric morbidity, and psychotropic prescription drugs in violent offenders with a history of incarceration.
METHODS: Male offenders aged 18-25 (n = 266) imprisoned for violent and/or physical sexual offenses were clinically assessed in 2010-2012 and prospectively followed in Swedish national registries through 2017. Register-based information regarding HCU, psychiatric morbidity, and psychotropic drugs was tracked and compared with a general population group (n = 10,000) and across offending trajectory groups. Baseline risk factors were used to explain prospective psychiatric HCU in violent offenders.
RESULTS: Violent offenders used less general healthcare and psychiatric outpatient care, but more psychiatric inpatient care and were more often given psychiatric diagnoses and psychotropic drugs than the general population. Participants previously assigned to persisting offending trajectory groups had higher rates of psychiatric HCU than those assigned to a desisting trajectory. In multivariable regression models, psychiatric HCU was associated with anxiety disorders, prior psychiatric contact, placement in a foster home, psychopathic traits, low intellectual functioning, and persistent offending.
CONCLUSIONS: Violent offenders are burdened by extensive and serious psychiatric morbidity and typically interact with psychiatric healthcare as inpatients rather than outpatients. Knowledge about their backgrounds, criminal behaviors, and psychiatric statuses can aid the planning of psychiatric services for this troublesome group.