Drug-related disorders and the criminal and clinical background of the prison population of São Paulo State, Brazil

Recidivism among prisoners with severe mental disorders

Introduction

Mental disorders are common among prison inmates, with a high rate of recidivism found among those with severe mental disorders. In Japan, the number of inmates with mental disorders has been increasing with the increasing rate of recidivism. Prisoners need an uninterrupted connection to post-release support to prevent them from being incarcerated again. This study identified inmates diagnosed with mental disorders whose recidivism had recently increased to investigate recidivism among inmates with severe mental disorders and the risk factors for reincarceration.

Methods

This study included 148 prisoners released from the Medical Correction Center in East Japan. Clinical diagnoses were coded using the World Health Organization's International Classification of Diseases, Tenth Revision. Risk factors focusing on the central eight items were categorized, and recidivism within 3 years of release was investigated.

Result

Overall, the recidivism rate was 29.7%, with the risk of recidivism increasing by 170% in inmates with multiple incarcerations. A diagnosis of intellectual disability increased the risk of recidivism by 176%. Patients with schizophrenia were consistently less likely to recidivate than patients with other disorders.

Conclusion

Intellectual disability was identified as a risk factor for recidivism, as was multiple incarcerations. These prisoners may not be connected to medical and social services and thus may not be receiving appropriate assistance. Patients with schizophrenia might be more likely to be connected to medical care and receive support after release. Further research should be conducted using these findings to prevent recidivism among inmates with mental disorders.

Alcohol use disorder among prisoners in Debre Berhan prison, Ethiopia: a cross-sectional study

BACKGROUND

Several studies reported that history of alcohol use among prisoners is higher than the prevalence in the general population. Criminality is found to be associated with alcohol use disorder (AUD) in previous studies. In Ethiopia, there is limited information on the prevalence and associated factors of AUD among prisoners. Therefore, this study aimed to assess the prevalence and associated factors of AUD among prisoners of Debre Berhan Prison.

METHODS

A cross-sectional survey was conducted to assess history of AUD among prisoners at Debre Berhan Prison, before imprisonment. We selected 347 prisoners with a systematic sampling technique and interviewed using Alcohol Use Disorder Identification Test (AUDIT) to screen for AUD in May 2017. Data entry was done using Epi-Data version 3.1 software, and bivariate and multivariate analyses were done using Stata version 13 software. Crude and adjusted odds ratios, with 95% confidence intervals and p-values are reported.

RESULTS

About six out of ten prisoners (59.1%) had AUD before imprisonment. Factors associated with increased odds of AUD were perception that the current offence is related to using substances (AOR = 4.2; 95% CI = 2.3, 7.8), and family history of substance use (AOR = 8.7; 95% CI = 1.7, 44.9). Being married had lower odds of AUD compared to the unmarried (AOR = 0.5; 95% CI = 0.2, 0.9).

CONCLUSION

We found that the prevalence of AUD 1 year before imprisonment in this population is high. AUD is found to be associated with a family history of substance use and perception that the current offence is related to using a substance. We recommend community-based study with different kind of study designs to see the relationship between AUD and crime for planning interventions.

Correlated factors of depression among male and female inmates

INTRODUCTION

The prevalence of depression is high in the prison system, and the differences between sex regarding associated risk factors are still not clear. We analyzed the correlated factors of depression among incarcerated men and women in the state of São Paulo, Brazil.

METHODOLOGY

A cross-sectional study with stratified and multi-stage probabilistic sample was performed. Composite International Diagnostic Interview (CIDI) was applied for psychiatric diagnostic classification, as well as a questionnaire on criminal history with 1,192 men and 617 women. Lifetime prevalence of mental disorder was calculated, and association analysis performed by multinomial logistic regression stratified by sex. A dependent variable was categorized into depression, any other mental disorder and no mental disorder (reference).

RESULTS

The prevalence of depression was of 33.3% -(30.3 - 36.5) in women and 12.9% (11.1 - 15.0) in men. Depression was associated with disciplinary penalty, being in a stable relationship, physical health problems and history of infringement in adolescence in men. Regarding other mental illnesses, the correlated factors were historical transgression during adolescence and re-offense. Among women, depression was associated with physical health problems, drug crimes, violent crimes and being imprisoned.

DISCUSSION

Results confirmed the differences between associated factors with depression regarding sex.

CONCLUSION

Differences in the profile between men and women require effective specialized programs, considering the need for coping strategies for incarcerated men and health-related rehabilitation for women with depression.

Health morbidity in Brazilian prisons: a time trends study from national databases

OBJECTIVE

The goal of this study was to explore the surveillance data about mandatory reporting diseases, included in the official information systems, and evaluate the historical trend analysis in prisoners in Brazil.

DESIGN

A time trends study was performed using secondary data from prisons' health units.

SETTING

Nationwide representative data of Brazilian prisoners obtained from 2007 to 2014 health and prison information systems database were analysed. These data are carried out by units identified as prison health facilities.

PRIMARY OUTCOME MEASURES

Diseases diagnosis and individual data were available at the National System of Disease Notification (in Portuguese SINAN), Mortality Information System (in Portuguese SIM) and Prison Registration Systems (in Portuguese INFOPEN and GEO prisons). Analyses of the notification data performed in the SINAN at the national level. SINAN was consolidated with SIM, INFOPEN and GEO prison data.

RESULTS

A total of 23 235 cases of compulsory disease notification causing morbidity were reported in prison units in Brazil; of these cases, 20 003 (85.6%) were men and 3362 (14.4%) were women. Over time, the proportion of prisoners increased from 1.92 per 1000 inhabitants in 2007 to 2.77 per 1000 inhabitants in 2014 (rising trend). From a total of 27 states, 12 of them presented a growth in disease notifications, 14 were stable and in only one state was there a decrease in notifications. There was an increase in notifications in the country as a whole. Tuberculosis (64.4%), dengue (9.1%), AIDS (9.0%) and viral hepatitis (5.9%) were among the most frequently reported diseases during the study period.

CONCLUSION

Despite showing stable tendencies, our results show high rates of diseases in Brazilian prisons. Prison health services should not be isolated but integrated into regional and national health and justice systems.

Introducing care management to Brazil's alcohol and substance use disorder population

Brazil has a sizable alcohol and substance use disorder (ASUD) population, yet there are considerable gaps in treatment access and retention. ASUD, a chronic medical condition, is highly comorbid with medical and behavioral health disorders. This indicates a need for more targeted interventions in order to achieve health care integration (a major goal of Brazil's health care system). Care management - that is, the organization of patient care by an institution - is a viable strategy to engage individuals with ASUD who might benefit from treatment but are not aware of or do not use the available resources, as well as to help maintain patients in treatment. Care management is considered an essential supplement to the treatment of chronic disease. The objective of this article is to discuss the applicability of care management for the treatment of ASUD within the public health care system in Brazil. We describe models of care management that have been adopted internationally and identify the feasibility and advantages for its adoption in Brazil.