Substance use disorders, psychiatric disorders, and mortality after release from prison: a nationwide longitudinal cohort study
Substance use disorders, psychiatric disorders, and mortality after release from prison: a nationwide longitudinal cohort study
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DOI：
10.1016/s2215-0366(15)00088-7
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发表时间：
2015-05-01
影响因子：
64.3
通讯作者：
Fazel, Seena
中科院分区：
文献类型：
--
作者：
Chang, Zheng;Lichtenstein, Paul;Fazel, Seena
据报道，与一般人群相比，从监狱释放的人的死亡率很高。然而，很少有研究调查与这些高发病率相关的潜在风险因素，特别是精神因素。我们的目的是调查精神疾病和死亡率之间的关联，从监狱中释放的人在Sweden.Methods我们研究了所有的人谁被监禁自2000年1月1日，并在2009年12月31日之前，在瑞典释放的风险，所有原因和外部原因（事故，自杀，杀人）的死亡率监狱释放后。我们从基于人口的登记册中获得了物质使用障碍和其他精神疾病的数据，以及犯罪学和社会人口学因素。我们通过考克斯回归计算风险比（HR），然后使用它们计算释放后死亡率的人群归因分数。为了控制潜在的家族混杂因素，我们将研究中的个体与同样从监狱释放但没有精神疾病的兄弟姐妹进行了比较。我们测试了是否有任何独立的危险因素提高了预测死亡率超越年龄，性别和犯罪history.Findings我们确定了47326人被监禁。在5.1年的中位随访时间（IQR 2.6-7.5）中，我们记录了2874例（6%）从监狱释放后死亡。总的全因死亡率为1205例死亡/10万人年。物质使用障碍显着增加了全因死亡率（酒精用途：调整后HR 1. 62，95% CI 1.48-1.77;药物用途：1. 67，1.53-1.83），该协会是独立的社会人口，犯罪学和家庭因素。在我们控制了潜在的混杂因素后，我们没有发现其他精神疾病增加死亡率的有力证据。在从监狱释放的人中，925名（34%）男性和85名（50%）女性的全因死亡可能归因于物质使用障碍。物质使用障碍也是外部原因死亡率的独立决定因素，人群归因分数估计为男性42%，女性70%。物质使用障碍显着改善预测的外部原因死亡率，除了社会人口和犯罪学factors.Interpretation干预，以解决物质使用障碍，可以大大减少从监狱释放的人的过度死亡率的负担，但可能需要提供后立即释放。
Background High mortality rates have been reported in people released from prison compared with the general population. However, few studies have investigated potential risk factors associated with these high rates, especially psychiatric determinants. We aimed to investigate the association between psychiatric disorders and mortality in people released from prison in Sweden.Methods We studied all people who were imprisoned since Jan 1, 2000, and released before Dec 31, 2009, in Sweden for risks of all-cause and external-cause (accidents, suicide, homicide) mortality after prison release. We obtained data for substance use disorders and other psychiatric disorders, and criminological and sociodemographic factors from population-based registers. We calculated hazard ratios (HRs) by Cox regression, and then used them to calculate population attributable fractions for post-release mortality. To control for potential familial confounding, we compared individuals in the study with siblings who were also released from prison, but without psychiatric disorders. We tested whether any independent risk factors improved the prediction of mortality beyond age, sex, and criminal history.Findings We identified 47326 individuals who were imprisoned. During a median follow-up time of 5.1 years (IQR 2.6-7.5), we recorded 2874 (6%) deaths after release from prison. The overall all-cause mortality rate was 1205 deaths per 100 000 person-years. Substance use disorders significantly increased the rate of all-cause mortality (alcohol use: adjusted HR 1. 62, 95% CI 1.48-1.77; drug use: 1. 67, 1.53-1.83), and the association was independent of sociodemographic, criminological, and familial factors. We identified no strong evidence that other psychiatric disorders increased mortality after we controlled for potential confounders. In people released from prison, 925 (34%) of all-cause deaths in men and 85 (50%) in women were potentially attributable to substance use disorders. Substance use disorders were also an independent determinant of external-cause mortality, with population attributable fraction estimates at 42% in men and 70% in women. Substance use disorders significantly improved the prediction of external-cause mortality, in addition to sociodemographic and criminological factors.Interpretation Interventions to address substance use disorders could substantially decrease the burden of excess mortality in people released from prison, but might need to be provided beyond the immediate period after release.