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Risk Factors for Criminal Recidivism Among Persons With Serious Psychiatric Diagnoses: Disentangling What Matters for Whom.

ABSTRACT: Reducing criminal legal system involvement requires an understanding of the factors that promote repeat offending (i. e., recidivism), and the dissemination of relevant interventions to those most likely to benefit. A growing body of research has established common recidivism risk factors for persons with serious psychiatric disorder diagnoses. However, research to date has not examined the degree to which these risks apply to those with serious psychiatric disorders with and without co-occurring substance use disorders. To clarify what risk and need factors are greatest and for whom, this cross-sectional study drew from an original dataset containing data on 14 social and economic, psychological, and criminal risk areas for a cohort of people on probation (n = 4,809). Linear regression models indicated that, compared to those without a serious psychiatric disorder, people on probation with a serious psychiatric disorder are at greater risk in a minority of areas and those areas are mostly social and economic in nature. Meanwhile, those withco-occurring disorders are at relatively high risk across almost all areas. The results from this study suggest that justice involved persons with serious psychiatric disorders will benefit from interventions that increase social support and economic well-being and that interventions that broadly reduce risk among people with co-occurring serious psychiatric and substance use disorders will likely yield meaningful reductions in system involvement. Ultimately, understanding and intervening upon risk for recidivism among persons with serious psychiatric disorders requires differentiating between those with and without co-occurring substance use disorders.

SUBMITTER: Jacobs LA

PROVIDER: S-EPMC8716805 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe duration of forensic psychiatric care is in Sweden not determined at the time of sentencing; instead, offenders are regularly evaluated, often with regard to risk of criminal recidivism. The length and justifiability of such a sanction have been greatly debated; however, previous estimates of treatment duration based on datasets delimited to discharged patients-have provided an uncertain groundwork for these deliberations. The aim of this study was to use a more suitable approach to calculate average duration of forensic psychiatric care and to examine the relationship between length of treatment and subsequent recidivism after discharge.MethodsThis retrospective cohort study focused on offenders sentenced to forensic psychiatric care in Sweden between 2009 and 2019 and registered in the Swedish National Forensic Psychiatric Register (n = 2064), with a follow-up period until May 2020. We used Kaplan-Meier estimator to calculate and visualize treatment duration including analyses comparing levels of relevant variables, and then evaluated criminal recidivism in patients discharged from treatment between 2009 and 2019 (n = 640), after stratification for the same variables and dichotomization by treatment duration.ResultsThe median duration of forensic psychiatric care was estimated to 89.7 months (95% CI 83.2-95.8). Treatment was longer in offenders who committed violent crimes, suffered from psychosis, or had a history of substance use disorder, and in offenders whose sentences included special court supervision. The cumulative incidence of recidivism in patients discharged from treatment was estimated to 13.5% at 12 months (95% CI 10.6-16.2) and 19.5% at 24 months (95% CI 16.0-22.8). Corresponding cumulative incidence of violent crime post discharge was 6.3% at 12 months (95% CI 4.3-8.3) and 9.9% at 24 months (95% CI 7.3-12.4). Among other findings, in patients without a history of substance use disorder and patients whose sentences did not include special court supervision, recidivism was significantly higher in those with a shorter treatment duration.ConclusionUsing the entirety of a suitable, contemporary, prospectively enrolled cohort of mentally ill offenders, we were able to estimate-with greater accuracy than previous studies-the average duration of Swedish forensic psychiatric care and rate of subsequent criminal recidivism.

Project description:BackgroundOffenders with intellectual disability (ID) constitute a distinct subgroup of offenders with mental disorders. Regarding criminal recidivism, it is unclear whether or not offenders with ID in forensic psychiatric settings differ from offenders without ID. Factors associated with criminal recidivism among offenders with ID have been scarcely investigated.AimTo investigate the association between ID and criminal recidivism among offenders sentenced to forensic psychiatric care and to explore the impact of clinical, sociodemographic and offense variables.Materials and methodsWe conducted a retrospective cohort study based on Swedish nationwide registers. A total of 3,365 individuals being sentenced to forensic psychiatric care in Sweden in 1997-2013 were followed from the forensic psychiatric assessment until first reconviction, death, emigration, or 31 December 2013, whichever occurred first. Cox regression models compared rates of recidivism in individuals with and without ID. Impact of clinical, sociodemographic, and offense variables on risk of criminal recidivism was presented as hazard ratios (HRs) with 95% confidence intervals (CIs).ResultsOut of 3,365 offenders sentenced to forensic psychiatric care, 259 (7.7%) were diagnosed with ID. During follow-up (0-17 years, median 6 years), one third (n = 1,099) of the study population relapsed into criminality, giving a recidivism rate of 50.5 per 1,000 person-years. We observed an association between ID and a decreased risk of recidivism (HR 0.8, 95% CI 0.6-1.0, p = 0.063), although this reached statistical significance only for the subgroup of male offenders (HR 0.8, 95% CI 0.6-1.0, p = 0.040) and not females (HR 1.0, 95% CI 0.6-1.8). ID offenders with concurrent ADHD tended to have a higher rate of recidivism (73.9 per 1,000 person-years, HR 1.2, 95% CI 0.6-2.4) than ID offenders without ADHD (42.5 per 1,000 person-years, HR 0.8, 95% CI 0.6-1.1). Amongst ID offenders, concurrent autism spectrum disorder, young age or male sex were not associated with recidivism, while previous criminal convictions were strongly associated with recidivism.ConclusionA diagnosis of ID was associated with a lower risk of criminal recidivism among male offenders sentenced to forensic psychiatric care. The association between ADHD and recidivism among ID offenders highlights eligible focus areas in the management of offenders with ID.

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Risk Factors for Criminal Recidivism Among Persons With Serious Psychiatric Diagnoses: Disentangling What Matters for Whom.

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