Health, social and criminal justice factors associated with dual diagnosis among incarcerated adults in Brazil and Australia: a cross-national comparison

Mental health of prerelease incarcerated women

BACKGROUND

The mental health of incarcerated women is particularly poor, yet little is known about their condition during the prerelease period. This critical transition is shaped by stressors related to incarceration and the challenges of reintegration, raising important concerns. Notably, the release phase that follows is characterized by risks of rehospitalization, reincarceration and suicide among individuals with psychiatric disorders and/or substance use disorders (SUDs). The aim of this study was to estimate the prevalence of psychiatric disorders, SUDs and dual diagnoses (DDs, i.e., the combination of severe psychiatric disorder and SUD) among incarcerated women scheduled to be released soon.

METHODS

We conducted a cross-sectional survey from April 2021 to September 2022 across 4 women's correctional facilities in Northern France. This study included all adult women identified by the prison administration as having a scheduled release date within 30 days. Each participant was interviewed via a structured interviewer-administered questionnaire, which included the Mini International Neuropsychiatric Interview.

FINDINGS

Among the 248 women identified by the prison administration, 127 were ultimately enrolled in this study (mean age 36.3 years). We found high prevalences of psychiatric disorders (of the participants, 48.0% had current depressive episodes, 28.3% had current generalized anxiety disorder, and 26.8% had current posttraumatic stress disorder), SUDs (59.1%) and DDs (38.6%).

INTERPRETATION

The alarming prevalences of psychiatric disorders, SUDs, and DDs among our sample highlight the urgent need for integrated care that bridges incarceration and postrelease psychiatric settings for incarcerated women. Combining psychiatric, addiction, and social support services is essential for addressing the complex mental health needs and improving reintegration outcomes in this population.

FUNDING

This study was funded by the French Direction Générale la Santé - Directorate-General of Health (DGS) and Santé Publique France - Public Health France (SPF).

Substance use disorders, severe mental illness and risk of reoffending among women released from prison: a national cohort study

Women with a clinical history of a severe mental illness (SMI) or multiple mental disorders involving substance use disorder (SUD) might be at increased risk of re-offending after release from prison. This retrospective cohort study merged data from the Norwegian prison release study (nPRIS) with other registry sources. All women released from a Norwegian prison between 2011-2019 were followed for two years after date of release. Adjusting for several known risk factors, we used logistic regression to estimate risk of violent (VR), drug-related (DR) or other reoffending (ORE) after release among women with a history of SUD and severe mental illness (SUD-SMI), SMI, SUD and other mental illness (SUD-OMI) or a history of multiple SUDs (POLY-SUD) in comparison to a reference population with no history of such disorders or combination of disorders. Relative to the reference population, after adjusting for other relevant risk factors, women with a history of SUD-SMI (ORVR 2.27, 95% CI 1.37-3.76; ORDR 2.10, 95% CI 1.49-2.95), SUD-OMI (ORVR 1.81, 95% CI 1.11-2.47; ORDR 1.53, 95% CI 1.11-2.10) or POLY-SUD (ORVR 1.87, 95% CI 1.04-3.31; ORDR 2.51, 95% CI 1.80-3.49) were at significantly greater risk of violent and drug-related reoffending. Women with a history of SMI were at significantly greater risk of other reoffending (ORORE 2.64, 95% CI 1.21-5.30). Women with a clinical history of a severe mental illness (SMI) or multiple mental disorders involving substance use disorder (SUD) have an elevated risk reoffending.

The prevalence and correlates of dual diagnosis among adults in custody: A systematic review and meta-analysis

BACKGROUND

Incarcerated individuals experience mental illness (MI), substance use disorders (SUD), and their co-occurrence - dual diagnosis - at higher rates than the general population. By systematically reviewing the literature on dual diagnosis in custody, we aimed to (1) estimate the pooled prevalence of dual diagnosis among adults in custody, and (2) identify the psychosocial, health-related, and criminal justice correlates of dual diagnosis.

METHOD

We searched CINAHL, CINCH, Embase, Medline, PsycINFO, and Web of Science for studies investigating dual diagnosis among adults in custody. We also conducted backward citation chaining of a previous systematic review of dual diagnosis in Australian prisons. We used random-effects meta-analysis to generate a pooled prevalence estimate of dual diagnosis and conducted a narrative synthesis of the identified correlates of dual diagnosis in the literature.

RESULTS

Twenty-five studies met the inclusion criteria; 20 had sufficient data for meta-analysis. The pooled prevalence estimate of dual diagnosis among adults in custody was 25.3 % [95 %CI: 18.6, 32.7]. Correlates of dual diagnosis included illicit substance use before 15 years old, living with someone who used substances before incarceration, violence victimisation, increased suicide risk, and a lifetime history of multiple convictions.

CONCLUSIONS

Our findings suggest that approximately one out of every four adults in custody have a dual diagnosis, highlighting the need for coordinated mental health and alcohol and other drug services for justice-involved individuals. It is crucial that correctional healthcare providers have the capacity and resources necessary to address the complex needs of adults with dual diagnosis in custody.

Health and incarceration research in Australia: a scoping review

Background

People who experience incarceration often have complex healthcare needs and poorer health than the general population. Australia has the eighth-largest custodial population in the Western Pacific. Understanding the breadth and quality of research on this population's health is crucial for advancing health equity both in Australia and across the region. This scoping review synthesised health research involving people in contact with the criminal justice system in Australia.

Methods

We searched eight databases for primary, peer-reviewed research reporting on the health of people incarcerated or previously incarcerated in Australian prisons or youth detention settings.

Findings

Our search identified 11,731 unique records, and 508 met the inclusion criteria. Over half (51%) were published between 2015 and 2024. Relatively few studies provided evidence on cognitive disabilities (16%), non-communicable diseases (14%), or sexual and reproductive health (6%). Few focused on youth detention (15%) or post-release health (24%). Only 27 studies (5%) focused exclusively on the health of First Nations Australians. Most studies (86%) came from Australia's most populous states-New South Wales, Queensland, and Victoria-which account for 68% of people incarcerated each year, and 58% of incarcerated First Nations peoples.

Interpretation

Despite considerable growth in the number of peer-reviewed studies on the health of people who experience incarceration, critical health issues, key populations, and Australian jurisdictions with the highest incarceration rates require urgent attention. Further high-quality research is needed to fill these evidence gaps and translate research into evidence-based strategies that address the complex and diverse health needs of justice-involved people.

Funding

SP was supported by a Australian Government Research Training Program Scholarship.

Examining problem gambling, substance use disorders and cluster B personality traits among incarcerated individuals

Prison populations face heightened rates of addictive behaviors and significant stressors, including health challenges and social disparities. Although problem gambling is prevalent in criminal justice settings, its distinctiveness compared to other addictions among incarcerated individuals remains uncertain. This study examines risk factors associated with problem gambling in Finnish prisoners and explores differences compared to other forms of addiction. Covariates from a questionnaire (N = 527) included gender, age, education, offender status, involvement in theft or property crime, Trauma Screening Questionnaire (TSQ), Depression Scale (DEPS), and lifetime abuse experiences. Of the 527 participants, 330 were interviewed using the Structured Clinical Interview (SCID-II) to assess personality disorders. Multiple logistic regression models were utilized, with separate models for problem gambling (PG), lifetime substance use disorder, and lifetime alcohol disorder. Crime type was not significantly associated with alcohol or substance use problems, but PG was associated with property crime or theft convictions. Borderline personality traits were linked to probable PG, while antisocial traits were linked to drug use, and both traits predicted alcohol misuse. Age and gender were significant only in relation to alcohol use problems, with older age and male gender indicating higher risk. The association between problem gambling and criminal behavior underscores the vulnerability of incarcerated individuals across various domains. Detailed assessments, considering the nature of criminal activity and personality disorders, especially borderline traits and comorbid conditions, are crucial for tailoring rehabilitation and treatment strategies to prevent recidivism. These findings provide valuable insights for clinicians managing addiction and mental health issues within correctional settings.

Psychiatric morbidity among women in Norwegian prisons, 2010-2019: a register-based study

PURPOSE

Research suggests that women in prison have more mental health problems than men and are prone to suffer from more severe psychiatric disorders. This study utilizes national registry data to describe demographic and psychiatric gender differences in Norwegian prisons, and to investigate comorbid psychiatric disorders and time trends in psychiatric morbidity among women.

METHODS

Longitudinal data from the Norwegian Prison Release Study linked with the Norwegian Patient Registry and data from Statistics Norway provided information on health care utilization, socioeconomic status, and history of psychiatric disorders among all individuals (nwomen = 5,429; nmen = 45,432) who were incarcerated in a Norwegian prison between 2010 and 2019.

RESULTS

Women were more likely than men to have a history of any psychiatric disorder (75% vs. 59%). Substance use disorders and dual disorders were highly prevalent in both genders, yet highest among women (56 and 38% respectively, versus 43 and 24% among men). From 2010 to 2019, we found a considerable increase in the 12-month prevalence of most diagnostic categories among women entering prison.

CONCLUSION

Psychiatric and dual disorders are highly prevalent in Norwegian prisons, and especially among women. The proportion of women entering prison with a recent history of mental health problems has increased rapidly over the last decade. Women's prison institutions need to adjust health and social services, and awareness about substance use and other psychiatric disorders in order to meet the increasing proportion of women facing these challenges.

Association between contact with mental health and substance use services and reincarceration after release from prison

Objective

People released from prison who experience mental health and substance use problems are at high risk of reincarceration. This study aimed to examine the association between contact with mental health and substance use treatment services, and reincarceration, among adults released from prison.

Methods

Pre-release survey data from 1,115 adults released from prisons in Queensland, Australia were linked with administrative health and correctional records covering a median of 787 days post-release. We constructed marginal structural Cox proportional hazards models, adjusting for pre-release variables and time-varying indicators of emergent mental health and substance use problems, to examine the association between contact with mental health and substance use treatment services, and reincarceration.

Results

The adjusted hazard ratio (AHR) for reincarceration associated with mental health service contact was 1.76 (95%CI 1.23,2.51). Among those not on parole following release, the AHR for reincarceration associated with substance use treatment service contact was 3.16 (95%CI 2.09,4.77); we found no evidence for an association among those who were released on parole (AHR = 1.07; 95%CI 0.80,1.43).

Conclusions

Although we cannot eliminate the possibility of residual confounding, our findings suggest that infrequent or unsustained contact with community-based mental health and substance use treatment services is not protective against reincarceration, and may even be iatrogenic. Increased investment in high-quality and timely behavioural health services for people released from prison may simultaneously improve health outcomes, and reduce reincarceration.

The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis

BACKGROUND

Comorbid mental illnesses and substance use disorders are associated with adverse criminal, social, and health outcomes. Yet, their burden is not reliably known among prison populations. We therefore aimed to estimate the prevalence of comorbid serious mental illnesses and substance use disorders (dual disorders) among people in prison worldwide.

METHODS

In this systematic review and meta-analysis, we searched 15 electronic databases (ASSIA, CAB Abstracts, Criminal Justice Database, Embase, Global Health, Global Index Medicus, IBSS, MEDLINE, NCJRS, PAIS Index, PsycINFO, Russian Science Citation Index, Scielo, Social Services Abstracts, and Web of Science) and the grey literature (Open Grey and ProQuest Dissertations & Theses Global) for studies reporting the prevalence of serious mental illnesses and substance use disorders in prison populations published between Jan 1, 1980, and Sept 25, 2021, and contacted the authors of relevant studies. Empirical studies among unselected adult prison populations that applied representative sampling strategies and validated diagnostic instruments, and either reported the prevalence of dual disorders or had authors who could provide prevalence data in correspondence, were included. Two reviewers (GB and SDL) independently extracted data from the eligible studies; both current (up to 1 year) and lifetime prevalence were extracted, if available. We sought summary estimates. Our primary outcomes were comorbid non-affective psychosis with substance use disorders and comorbid major depression with substance use disorders. We conducted a random-effects meta-analysis, explored between-sample heterogeneity with meta-regression, and calculated odds ratios (ORs) to assess bidirectional relationships between mental and substance use disorders. Risk of bias was assessed by use of a standard tool. The study protocol was registered with PROSPERO, CRD42020207301.

FINDINGS

Of 11 346 records screened, we identified 34 studies reporting the prevalence of dual disorders among individuals in prison and received unpublished prevalence data for 16 studies, totalling 50 eligible studies and 24 915 people. The mean quality score of included studies was 7·8 (SD 1·2). We found that 3·5% (95% CI 2·2-5·0) had current non-affective psychosis with any comorbid substance use disorder, representing 443 (49·2%) of 900 people with non-affective psychosis, and 9·1% (5·6-13·3) had current major depression and comorbid substance use disorders, representing 1105 (51·6%) of 2143 people with major depression. Between-sample heterogeneity was high (I2>80%). People in prison with current non-affective psychosis were significantly more likely to have substance use disorders compared with those without (OR 1·7, 95% CI 1·4-2·2). People with major depression had higher odds of substance use disorders than those without (1·6, 1·3-2·0).

INTERPRETATION

Around half of the prison population with non-affective psychosis or major depression have a comorbid substance use disorder. Consideration should be given to screening for dual disorders and implementing integrated and scalable treatments.

FUNDING

Economic and Social Research Council, Agencia Nacional de Investigación y Desarrollo (Chile), and the Wellcome Trust.

Prevalence of co-occurring mental illness and substance use disorder and association with overdose: a linked data cohort study among residents of British Columbia, Canada

AIMS

To estimate the treated prevalence of mental illness, substance use disorder (SUD) and dual diagnosis and the association between dual diagnosis and fatal and non-fatal overdose among residents of British Columbia (BC), Canada.

DESIGN

A retrospective cohort study using linked health, income assistance, corrections and death records.

SETTING

British Columbia (BC), Canada.

PARTICIPANTS

A total of 921 346 BC residents (455 549 males and 465 797 females) aged 10 years and older.

MEASUREMENTS

Hospital and primary-care administrative data were used to identify a history of mental illness only, SUD only, dual diagnosis or no history of SUD or mental illness (2010-14) and overdoses resulting in medical care (2015-17). We calculated crude incidence rates of non-fatal and fatal overdose by dual diagnosis history. Andersen-Gill and competing risks regression were used to examine the association between dual diagnosis and non-fatal and fatal overdose, respectively, adjusting for age, sex, comorbidities, incarceration history, social assistance, history of prescription opioid and benzodiazepine dispensing and region of residence.

FINDINGS

Of the 921 346 people in the cohort, 176 780 (19.2%), 6147 (0.7%) and 15 269 (1.7%) had a history of mental illness only, SUD only and dual diagnosis, respectively; 4696 (0.5%) people experienced 688 fatal and 6938 non-fatal overdoses. In multivariable analyses, mental illness only, SUD only and dual diagnosis were associated with increased rate of non-fatal [hazard ratio (HR) = 1.8, 95% confidence interval (CI) = 1.6-2.1; HR = 9.0, 95% CI = 7.0-11.5, HR = 8.7, 95% CI = 6.9-10.9, respectively] and fatal overdose (HR = 1.6, 95% CI = 1.3-2.0, HR = 4.3, 95% CI = 2.8-6.5, HR = 4.1, 95% CI = 2.8-6.0, respectively) compared with no history.

CONCLUSIONS

In a large sample of residents of British Columbia (Canada), approximately one in five people had sought care for a substance use disorder or mental illness in the past 5 years. The rate of overdose was elevated in people with a mental illness alone, higher again in people with a substance use disorder alone and highest in people with a dual diagnosis. The adjusted hazard rates were similar for people with substance use disorder only and people with a dual diagnosis.