Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release
Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release
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DOI：
10.1001/jama.2016.15380
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发表时间：
2016-11-01
影响因子：
120.7
通讯作者：
Fazel, Seena
中科院分区：
文献类型：
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作者：
Chang, Zheng;Lichtenstein, Paul;Fazel, Seena
从监狱释放的人有很高的暴力再犯罪率，药物治疗是否能降低再犯罪风险还不确定。目的调查主要类别的精神药物与暴力再犯罪之间的关系。设计、设置和参与者这项队列研究包括2005年7月1日至2010年12月31日瑞典所有被释放的囚犯，通过基于人口的登记联系。服药期间的暴力再犯罪率与非服药期间的比率进行了个体内分析比较。截至2013年12月31日的随访。在有或没有精神药物(抗精神病药物、抗抑郁药物、精神刺激剂、用于成瘾障碍的药物和抗癫痫药物)处方的情况下，监狱获释后的一段时间。以监狱为基础的心理治疗作为二次暴露进行了调查。主要结果和衡量出狱后暴力犯罪的指标。结果队列包括22 275名释囚(平均年龄38[13]岁；男性91.9%)。在随访期间(中位数4.6年；四分位数范围3.0-6.4年)，4031人(18.1%)有5653次暴力再犯罪。根据服药期间1596个人年的100个事件和非服药期间11026个人年的1044个事件，与处方抗精神病药物相关的个人风险比(HR)为0.58(95%CI，0.39-0.88)，相当于每1000人年暴力复发的风险差异39.7(95%CI，11.3-57.7)。基于服药期间1648人年的94起事件和非服药期间4553人年的513起事件，与分配的精神刺激剂相关的个体内HR为0.62(95%CI，0.40-0.98)，相当于每1000人年暴力再犯罪的风险差异为42.8(95%CI，2.2-67.6)。基于服药期间1168人年的46个事件和非服药期间15725人年的1103个事件，与成瘾障碍配药相关的个体内HR为0.48(95%CI，0.23-0.97)，相当于每1000人年暴力再犯罪的风险差异为36.4(95%CI，2.1-54.0)。相反，抗抑郁药物和抗癫痫药物与暴力再发率无显著相关性(HR=1.09[95%CI，0.83~1.43]和1.14[95%CI，0.79~1.65])。最常见的监狱计划是药物滥用的心理治疗，相关的HR为0.75(95%CI，0.63-0.89)，这相当于每1000人年暴力再犯罪的风险差异减少23.2(95%CI，10.3-34.1)。结论与瑞典释放的囚犯中的相关性相比，在给个人发放抗精神病药物、精神刺激剂和治疗成瘾障碍的药物期间，暴力再犯罪率较低。需要进一步的研究来理解这种联系的因果性质。
IMPORTANCE Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk.OBJECTIVE To investigate the associations between major classes of psychotropic medications and violent reoffending.DESIGN, SETTING, AND PARTICIPANTS This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013.EXPOSURES Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure.MAIN OUTCOMES AND MEASURES Violent crime after release from prison.RESULTS The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years.CONCLUSIONS AND RELEVANCE Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.