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Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population.

ABSTRACT: Preliminary evidence suggests that adherence to antipsychotic medication reduces criminal recidivism among patients diagnosed with schizophrenia. However, existing studies operationalize antipsychotic adherence as a binary variable (usually using a threshold of ?80%), which does not reflect the prevalence of suboptimal adherence in real-world settings. The purpose of the current analysis was to investigate the association between successive ordinal levels of antipsychotic adherence and criminal recidivism in a well-defined sample of offenders diagnosed with schizophrenia (n = 11462). Adherence was measured using the medication possession ratio (MPR) and analyzed as a time-dependent covariate in multivariable regression models. Data were drawn from linked, comprehensive diagnostic, pharmacy and justice system records, and individuals were followed for an average of 10 years. Adjusted rate ratios (ARR) and confidence intervals (CI) are reported. Overall mean MPR was 0.41. Increasing levels of antipsychotic adherence were not associated with progressively lower rates of offending. However, when compared to the reference group (MPR ? 80%) all lower adherence levels were significantly associated (P < .001) with increased risk of violent (ARR = 1.58; 95% CI = 1.46-1.71) and nonviolent (ARR = 1.41; 95% CI = 1.33-1.50) offenses. Significance was replicated in separate sensitivity analyses. Previously published studies reporting reductions in crime may have been influenced by antipsychotic adherence ?80%. Binary operationalization of adherence is an inaccurate predictor of recidivism. Future research addressing functional outcomes of antipsychotic adherence should conceptualize adherence as an incremental independent variable.

SUBMITTER: Rezansoff SN

PROVIDER: S-EPMC5581906 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population.

Rezansoff Stefanie N SN Moniruzzaman Akm A Fazel Seena S McCandless Lawrence L Somers Julian M JM

Schizophrenia bulletin 20170901 5

Preliminary evidence suggests that adherence to antipsychotic medication reduces criminal recidivism among patients diagnosed with schizophrenia. However, existing studies operationalize antipsychotic adherence as a binary variable (usually using a threshold of ≥80%), which does not reflect the prevalence of suboptimal adherence in real-world settings. The purpose of the current analysis was to investigate the association between successive ordinal levels of antipsychotic adherence and criminal ...[more]

PMID: 28637202

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Project description:IntroductionSmokers in the criminal justice system represent some of the most disadvantaged smokers in the U.S., as they have high rates of smoking (70%-80%) and are primarily uninsured, with low access to medical interventions. Few studies have examined smoking-cessation interventions in racially diverse smokers, and none have examined these characteristics among individuals supervised in the community. The purpose of this study is to determine if four sessions of standard behavioral counseling for smoking cessation would differentially aid smoking cessation for African American versus non-Hispanic white smokers under community corrections supervision.DesignAn RCT.Setting/participantsFive hundred smokers under community corrections supervision were recruited between 2009 and 2013 via flyers posted at the community corrections offices.InterventionAll participants received 12 weeks of bupropion plus brief physician advice to quit smoking. Half of the participants received four sessions of 20-30 minutes of smoking-cessation counseling following tobacco treatment guidelines, whereas half received no additional counseling.Main outcome measuresGeneralized estimating equations were used to determine factors associated with smoking abstinence across time. Analyses were conducted in 2014.ResultsThe end-of-treatment abstinence rate across groups was 9.4%, with no significant main effects indicating group differences. However, behavioral counseling had a differential effect on cessation: whites who received counseling had higher quit rates than whites who did not receive counseling. Conversely, African Americans who did not receive counseling had higher average cessation rates than African Americans who received counseling. Overall, medication-adherent African American smokers had higher abstinence rates relative to other smokers.ConclusionsRacial disparities in smoking cessation are not evident among those who are adherent to medication. More research is needed to better understand the differential effect that behavioral counseling might have on treatment outcomes between white and African American smokers under community corrections supervision.

Dataset Information

Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population.

Publications

Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population.

Similar Datasets

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