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Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England..
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ Orebro, Sch Med Sci, Orebro, Sweden..
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2016 (English)In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 316, no 17, p. 1798-1807Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk. OBJECTIVE To investigate the associations between major classes of psychotropic medications and violent reoffending. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013. EXPOSURES Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure. MAIN OUTCOMES AND MEASURES Violent crime after release from prison. RESULTS The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years. CONCLUSIONS AND RELEVANCE Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.

Place, publisher, year, edition, pages
2016. Vol. 316, no 17, p. 1798-1807
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:uu:diva-308906DOI: 10.1001/jama.2016.15380ISI: 000386569300019PubMedID: 27802545OAI: oai:DiVA.org:uu-308906DiVA, id: diva2:1051229
Funder
Wellcome trust, 095806Swedish Research Council, 2011-2492 2013-2280Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-1678 2014-2780EU, European Research Council, 602768Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-11-29Bibliographically approved

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