Sexual abuse during childhood and all-cause mortality into middle adulthood: an Australian cohort study.

OBJECTIVE: To compare mortality from all causes, internal causes (eg, cancers, circulatory and respiratory system diseases), and external causes (eg, suicide, accidents, assault) among people who were sexually abused during childhood with mortality for the general population. DESIGN: Historical cohort study. SETTING, PARTICIPANTS: 2759 people (2201 women, 79.8%) who had experienced medically assessed contact sexual abuse in Victoria while aged 16 years or younger during 1964-1995, as recorded in Victorian Institute of Forensic Medicine records. MAIN OUTCOME MEASURES: Mortality rate, based on linked National Death Index data (1980-2020), by five-year age group; sex- and age-standardised mortality ratios; comparison of rates with age- and sex-adjusted rates for the general Victorian population (incident rate ratio [IRR]). RESULTS: We included 115 deaths of people under 50 years of age in our analysis (4.2% of people sexually abused as children; 79 women, 36 men); 56 deaths were attributed to external, 56 to internal causes (cause of death information missing in three cases). In each age group from 15-19 years, the mortality rates for people sexually abused as children were higher than for the general population; age- and sex-standardised all-cause mortality ratios were highest for people aged 25-29 years (men: 16.5; 95% confidence interval [CI], 11.0-22.0; women: 19.2; 95% CI, 14.3-24.2). The age- and sex-adjusted mortality rate for people sexually abused as children was higher than in the general population for all-cause (IRR, 8.25; 95% CI, 5.92-11.5), internal cause (IRR, 5.92; 95% CI, 3.89-9.01), and external cause deaths (IRR, 12.6; 95% CI, 9.61-16.6); the differences in external cause mortality were greater for people who had experienced penetrative (IRR, 14.9; 95% CI, 10.9-20.5) than for those who had experienced non-penetrative sexual abuse as children (IRR, 8.92; 95% CI, 5.35-14.9). CONCLUSIONS: Sexual abuse during childhood is associated with higher mortality rates into mid-adulthood. Preventing child sexual abuse and intervening early to reduce the damage it inflicts is not only essential for the welfare of the child, but could also help reduce avoidable deaths later in life.

Special considerations to the assessment of fitness to stand trial in Australia.

Australian criminal law presumes that defendants are fit to stand trial until proven otherwise on the balance of probabilities. Forensic mental health experts often provide opinions to the court about defendants' fitness, which requires them to understand the legal context within which the court decides the defendant's fitness status. This article outlines important case law considerations to the assessment of fitness in Australia, including the notions that fitness must be evaluated when there is a 'real and substantial question', assessments should be 'reasonable and common sense' and accommodations should be considered when impairments in capacity are evident. The essentially negligible impact of delusions, an unhelpful defence, unmanageable behaviour and poor defendant-lawyer relationship are also considered. Finally, precedent is reviewed for the use of the Presser standards in New Zealand and other pacific jurisdictions.

Psychiatric well-being among men leaving prison reporting a history of injecting drug use: A longitudinal analysis.

BACKGROUND: Community reintegration from prison is typically stressful, with several health and social outcomes impacting psychiatric well-being during this time, often exacerbated among individuals with histories of drug use. Longitudinal data was used to assess change in psychiatric well-being over 2 years following release from prison among men who reported a recent history of injecting drug use. METHODS: Data for this study come from the Prison and Transition Health cohort study of 400 men recruited in prison prior to release and followed up over three time points. Psychiatric well-being was assessed using the 12-item General Health Questionnaire. We calculated change in individual General Health Questionnaire scores between interviews and identified covariates associated with General Health Questionnaire score using linear mixed-effects regression. RESULTS: Data from 690 follow-up interviews among 326 participants were included in analyses. There was considerable variation in individuals' General Health Questionnaire scores. Moving accommodation frequently and frequent illicit drug injections were associated with an increase in General Health Questionnaire score (i.e. decline in psychiatric well-being). Two or more prior adult imprisonment episodes, social supports and past month primary healthcare attendance were associated with a decrease in General Health Questionnaire score. CONCLUSION: Our findings identify health, social and structural influences on psychiatric well-being after release from prison that can inform re-entry programmes to support community reintegration.

The cross-cultural fairness of the LS/RNR: An Australian analysis.

OBJECTIVE: Cross-cultural research into risk assessment instruments has often identified comparable levels of discrimination. However, cross-cultural fairness is rarely addressed. Therefore, this study explored the discrimination and fairness of the Level of Service/Risk, Need, Responsivity (LS/RNR) within a sample of Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander males. HYPOTHESES: We hypothesized that discrimination would not be significantly different for Aboriginal and Torres Strait Islander individuals and non-Aboriginal and Torres Strait Islander individuals. We further hypothesized that some fairness definitions would be unsatisfied. METHOD: The study included 380 males (Aboriginal and Torres Strait Islander, n = 180) from Australia. Discrimination was assessed with the area under the curve (AUC) and cross AUC (xAUC). To determine fairness, error rate balance, calibration, predictive parity, and statistical parity were used. RESULTS: The discrimination of the LS/RNR was not statistically different (p = .61) between groups. The xAUC identified disparities (p < .001), with the LS/RNR being unable to discriminate between Aboriginal and Torres Strait Islander nonreoffenders and non-Aboriginal and Torres Strait Islander reoffenders (xAUC = .46, 95% CI [.35, .57]). Disparities among certain fairness definitions were identified, with Aboriginal and Torres Strait Islander individuals scoring higher on the LS/RNR (d = 0.52) and nonreoffenders being classified as high risk more often. CONCLUSIONS: The findings suggest that the LS/RNR may not be a cross-culturally fair risk assessment instrument for Australian individuals, and standard discrimination indices with comparable levels do not imply that a risk assessment instrument is cross-culturally fair. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effects of judicial supervision on recidivism of offenders in Australia and New Zealand: a systematic review and meta-analysis.

This meta-analysis compares recidivism reduction in problem-solving courts employing judicial supervision in Australia and New Zealand to traditional processes. Using a four-phased search strategy, 16 studies totalling a treatment sample of 6588 individuals and 32,147 comparison participants were identified from 7161 unique records. Meta-analyses indicate that the problem-solving courts significantly reduced both the odds and incidences of recidivism compared with standard justice processes but that the heterogeneity observed within the latter analysis plus reliance on weak methodologies limits the strength of these conclusions. Studies at risk of bias may have had an undue influence on the odds of recidivism analysis. Additionally, the benefits of treatment on the incidence of recidivism are closely linked to the overlap of measurement and treatment periods. The findings suggest a positive impact from judicial supervision but further rigorous research is needed that closely matches experimental samples, strictly measures participants post-intervention and meticulously reports pertinent information.

Strategies to maximise study retention and limit attrition bias in a prospective cohort study of men reporting a history of injecting drug use released from prison: the prison and transition health study.

BACKGROUND: There are significant challenges associated with studies of people released from custodial settings, including loss to follow-up in the community. Interpretation of findings with consideration of differences between those followed up and those not followed up is critical in the development of evidence-informed policies and practices. We describe attrition bias in the Prison and Transition Health (PATH) prospective cohort study, and strategies employed to minimise attrition. METHODS: PATH involves 400 men with a history of injecting drug use recruited from three prisons in Victoria, Australia. Four interviews were conducted: one pre-release ('baseline') and three interviews at approximately 3, 12, and 24 months post-release ('follow-up'). We assessed differences in baseline characteristics between those retained and not retained in the study, reporting mean differences and 95% confidence intervals (95% CIs).  RESULTS: Most participants (85%) completed at least one follow-up interview and 162 (42%) completed all three follow-up interviews. Retained participants were younger than those lost to follow-up (mean diff - 3.1 years, 95% CI -5.3, - 0.9). There were no other statistically significant differences observed in baseline characteristics. CONCLUSION: The high proportion of participants retained in the PATH cohort study via comprehensive follow-up procedures, coupled with extensive record linkage to a range of administrative datasets, is a considerable strength of the study. Our findings highlight how strategic and comprehensive follow-up procedures, frequent contact with participants and secondary contacts, and established working relationships with the relevant government departments can improve study retention and potentially minimise attrition bias.

Testing the Factor Structure of the Psychopathy Checklist: Screening Version (PCL:SV) in an Australian Violent Offender Population.

Although psychopathy is a correlate of recidivism, including violent offending, the inclusion of antisocial behavior items in the Psychopathy Checklist (PCL) assessment instruments has been debated. Further, the latent factor structure underpinning the PCL measures has not been comprehensively validated in Australia. This study examined the construct validity of the PCL:SV in a sample of 192 Australian male violent offenders using structural equation modeling. The incremental validity of including the antisocial behavior items for predicting recidivism was also assessed. Approximately one-third of the sample had high scores on the PCL:SV. Construct analyses indicated strongest support for two distinct three-factor models of PCL psychopathy, with the established two- and four-factor models demonstrating poorer fit. The Antisocial factor improved predictive accuracy incrementally relative to the other three factors (Interpersonal, Affective, and Lifestyle). Area under the curve analyses revealed predictive accuracy for recidivism only for factors containing the antisocial behavior items. Findings contribute to the construct and predictive validity of the PCL measures and are discussed relative to contemporary forensic risk assessment practice.

Investigating the predictive validity of Static-99/99R scores in a sample of older sexual offenders.

There is limited information regarding the use of risk assessment tools with aging offender populations. It is known that the likelihood of offending behaviour decreases with age, a small group of men either continue or begin to offend sexually in the later decades of life. The current study investigated the predictive validity of the Static-99 and the Static-99R, in a sample of convicted Australian sex offenders aged 50 and older. A sample of 118 participants was identified, of which 17 (14.4%) re-offended within a follow-up period ranging from four months to 20 years (M = 9.07 years). There were seven recidivists (13.46%) above the age of 60 years (n = 52) and 10 aged 40 to 59.9 years (n = 66). Both the Static-99 and Static-99R demonstrated moderate predictive validity with both age groups. The limitations of this study are discussed as well as recommendations for future research.

Predictive validity of the HCR-20V3 in a sample of Australian forensic psychiatric patients.

The Historical Clinical Risk Management-20 Version 3 is the latest iteration in the HCR-20 series, adopting novel changes such as the addition of Relevance ratings and non-requirement to include the Psychopathy Checklist-Revised. This study aimed to examine these changes and compare the predictive validity of the HCR-20V3 to the HCR-20V2. The sample comprised of 100 forensic psychiatric patients, retrospectively followed up for a maximum period of approximately 13 years post-discharge from the Thomas Embling Hospital. Recidivism data were sourced from official police records. Results indicated good to excellent inter-rater reliability. The HCR-20V3 significantly predicted violent recidivism (area under the curve = .70 to .77), levels of accuracy that were not significantly different from the HCR-20V2. HCR-20V3 Relevance ratings failed to add incremental validity above Presence ratings; however, the PCL-R improved upon the HCR-20V3's validity. The study represented one of the first evaluations of the HCR-20V3 in Australia.

Mental Health, Psychological Distress, and Coping in Australian Cross-Cultural Prison Populations.

The rates of mental illness are significantly higher in prison populations compared to the general community; however, little research has examined the rates of mental illness for cross-cultural groups of prisoners in Australia. This omission is concerning given the increasingly diverse nature of the Australian prison population. To address this gap in knowledge, the present study aimed to identify rates of key mental health factors and associated psychological processes in a cohort of 191 men from culturally and linguistically diverse, Indigenous Australian and English-speaking backgrounds who were incarcerated at a maximum-security prison in Victoria, Australia. We also explored differences in both psychological distress levels and predictors of psychological distress. Although no significant mental health differences were identified cross-culturally, the results revealed that several mental health factors predicted psychological distress for all prisoners, F(11, 147) = 33.23, p < .001, R2 = .71. The experiences of anxiety and sleep disturbance-related symptoms, ß = .34; depressive symptoms, ß = .19; posttraumatic stress disorder symptoms, ß = .25; and the use of psychological processes, such as avoidance coping, ß = .16; and engagement in cognitive fusion, ß = .15, all predicted psychological distress. The use of positive thinking as a coping strategy was found to predict a reduced level of psychological distress for prisoners, ß = -.13. The findings indicated that the mental health profiles of cross-cultural groups of prisoners are similar in nature, suggesting that justice involvement may be a more useful predictor than cultural differences concerning psychological health.

Disengagement from mental health treatment and re-offending in those with psychosis: a multi-state model of linked data.

BACKGROUND AND AIMS: Individuals with psychosis are over-represented in the criminal justice system and, as a group, are at elevated risk of re-offending. Recent studies have observed an association between increased contacts with mental health services and reduced re-offending, as well as reduced risk of re-offending in those who are ordered to mental health treatment rather than punitive sanctions. In furthering this work, this study examines the effect of disengagement from mental health treatment on probability of re-offence in offenders with psychosis over time. METHODS: Data linkage was conducted with judicial, health and mortality datasets from New South Wales, Australia (2001-2015). The study population included 4960 offenders with psychosis who received non-custodial sentences and engaged with community-based mental health treatment. Risk factors for leaving treatment and/or reconviction were examined using multivariate cox regression. Further, a multi-state model was used to observe the probabilities associated with individuals moving between three states: conviction, disengagement from mental health treatment and subsequent re-conviction. RESULTS: A threefold increase was observed in the risk of re-offending for those who disengaged from treatment compared to those who did not (aHR = 2.76, 95% CI 1.65-4.62, p < 0.001). The median time until re-offence was 195 days, with the majority (67%) being convicted within one year of leaving treatment. A higher risk of leaving treatment was found for those born outside of Australia, with substance-related psychosis, and a history of violent offence. CONCLUSIONS: The findings argue for an emphasis on continued engagement with mental health services following release for offenders with psychosis and identify subgroups within this population for whom concentrated efforts regarding treatment retention should be targeted.

The mental health of culturally and linguistically diverse offenders - what do we know?

OBJECTIVE: A key challenge facing justice health service providers is addressing and treating the high rates of mental illness among offenders. It is well documented that rates of mental illness are substantially higher within prison populations compared to the general population. As such, the need to provide ongoing treatment to prisoners experiencing mental health issues is of fundamental importance. Prisoners experiencing mental health disorders are more likely to have poorer social outcomes on release, including a greater likelihood of recidivism and poorer health outcomes. The growing numbers of justice-involved individuals from culturally and linguistically diverse (CALD) backgrounds signal the need for justice systems to adapt to the changing demographic. CONCLUSIONS: In this commentary, we argue that greater efforts to explore the nature and prevalence of mental illness among CALD groups in custody, where such concerns are often intertwined with additional complex personal, environmental and historical criminogenic risk factors, are desperately needed to improve system responses and reduce recidivism.

The Prison and Transition Health (PATH) Cohort Study: Study Protocol and Baseline Characteristics of a Cohort of Men with a History of Injecting Drug Use Leaving Prison in Australia.

People who inject drugs (PWID) are disproportionately represented among individuals who experience imprisonment and often have more complex physical and mental health needs than people in prison without injecting histories. The trajectories of PWID after prison release are poorly understood, hampering the development of effective strategies to address their distinct health needs. The Prison and Transition Health (PATH) Cohort Study is characterising the post-release trajectories of incarcerated male PWID in Victoria, Australia. We outline study methodology and baseline characteristics of participants prior to their release. Four hundred participants were recruited from three prisons and completed researcher-administered baseline interviews covering socio-demographics, social supports, physical health, mental health, alcohol and other drug use, and pre-release and transitional service utilisation. The median age among participants was 36 years (IQR 30-42), and they reported a median of five (IQR 3-9) previous adult incarcerations. Almost half (49%) were reliant on government payments prior to incarceration. One quarter (25%) of participants reported removal from their parents' care as children and 64% reported being a parent or primary caregiver to children. Most participants (81%) reported a previous mental health diagnosis and 44% reported three or more diagnoses. The most common drugs injected prior to incarceration were crystal methamphetamine (80%) and heroin (62%), and most (85%) reported being under the influence of drugs at the time of committing offences for which they were currently incarcerated. Injecting drug use during their current sentence was reported by 40% of participants, and 48% reported engaging with some form of drug treatment during their current sentence. Study participants are characterised by significant mental health and substance use morbidities, social disadvantage and criminogenic histories that present challenges for the provision of post-release support services. Data from the PATH Cohort Study will help inform strategies to improve the health and social outcomes of this population.

Crime and victimization among people with intellectual disability with and without comorbid mental illness.

BACKGROUND: Accumulating evidence internationally points to an increased risk of crime perpetration and victimization among people with an intellectual disability (ID). This study aimed to examine the impact that comorbid mental illness had on the association between intellectual disability, crime perpetration and criminal victimization. METHOD: A case linkage methodology involving 2,220 individuals with an intellectual disability from an Australian State. RESULTS: One in four (27%) had contacts with public mental health services; 8.2% had a comorbid mental illness. This "dual disability" group was between 2.97 and 3.22 times more likely than those with intellectual disability alone to have a history of criminal charges, and between 2.76 and 2.97 times more likely to have been a victim of crime. CONCLUSIONS: The extent of criminality and victimization found among people with dual disability indicates a potentially multiply stigmatized group for whom the need for a coordinated cross-agency service response remains paramount.

Asking the Right Questions: Examining the Efficacy of Question Trails as a Method of Improving Lay Comprehension and Application of Legal Concepts.

The present study examines the 'fact based' approach to jury instructions, which embeds legal concepts in a series of logically ordered written factual questions that the jury must answer to reach a verdict. The study utilised a sample of 1007 adults called for jury service in Victoria, Australia. Four instructional types (standard, plain language, checklist, fact based) were compared on paraphrase and application measures across three time points. Results indicated that paraphrase performance was significantly lower for standard instructions compared to all other instructional types at the pre-deliberation stage. Findings around application of law were mixed. At the pre-deliberation stage, participants receiving fact based instructions had significantly higher scores on true/false application questions compared with participants in other conditions, whereas there were no significant differences between conditions for multiple-choice application. However, testing following deliberation revealed that participants in the fact-based condition had significantly higher scores on multiple-choice application items.

Psychological wellbeing, distress and coping in Australian Indigenous and multicultural prisoners: a mixed methods analysis.

The Australian prison population is growing and becoming increasingly diverse. Yet very little research has investigated mental health concerns for multi-cultural prisoners. This mixed methods study aimed to identify the prevalence of mental health factors (wellbeing, distress and coping) in a cohort of 530 prisoners from Indigenous, culturally and linguistically diverse (CALD) and English-speaking backgrounds (ESB) at a maximum-security prison in Victoria, Australia. Focus group interviews were also conducted with an additional 40 prisoners. It was found that Indigenous prisoners had significantly higher levels of distress and more symptoms of anxiety and depression than CALD and ESB prisoners. CALD prisoners had a greater sense of 'feeling in control' in prison than ESB prisoners. The focus group interviews also identified several factors that contributed to mental health differences between the groups. Findings reinforce the need for a more individualised approach in addressing mental health issues for prisoners cross-culturally.

Violent offending in schizophrenia spectrum disorders preceding and following diagnosis.

OBJECTIVE: People affected by schizophrenia spectrum disorders are at a higher risk of offending violently. This study aims to investigate risk factors in relation to the peri-diagnostic period and possible predictors of post-diagnostic violence of people diagnosed for the first time in the public mental health system. METHODS: The study compared various risk factors for post-diagnostic violence in patients ( n = 1453) diagnosed with a schizophrenia spectrum disorder. Patients were grouped according to the occurrence of peri-diagnostic violence. Of the 246 violent offenders, 164 committed their first offence pre-diagnosis. Mental health and criminological variables were evaluated across the lifespan (median age at end of follow-up = 34.22 years, range = 17.02-55.80 years). RESULTS: Gender, employment, non-violent offending, family incidents, violent and non-violent victimisation, substance use, personality disorder, number of in-patient admissions and history of non-compliance differed significantly across violent and non-violent subgroups (all p ⩽ 0.01 and at least small effect size). More frequent and longer inpatient admissions were found in the violent subgroups (all p ⩽ 0.01). For the whole sample, sex, number of violent offences, non-violent offences, violent victimisation, substance use and number of inpatient admissions predicted post-diagnostic violence (χ2 (6) = 188.13, p < 0.001). Among patients with a history of pre-diagnostic violence, a history of non-violent offending in the 18-month period pre-diagnosis was the strongest predictor of future violence (odds ratio = 3.08, 95% confidence interval [1.32, 7.21]). CONCLUSION: At triage, violence risk assessment should consider the presence of antisocial behaviour and violent victimisation, substance use, male gender and frequency of inpatient admissions. Common treatment targets for the prevention of post-diagnostic violence include criminality and victimisation. Treatment of positive symptoms should be of greater emphasis for individuals without a history of pre-diagnostic violence.

Demographic, mental health, and offending characteristics of online child exploitation material offenders: A comparison with contact-only and dual sexual offenders.

Technological advances have dramatically increased the ability to access, distribute and produce child exploitation material (CEM) online, resulting in increased numbers of individuals being charged with CEM offences. This study examined the demographic, mental health, and offending characteristics of CEM offenders (n = 456) in comparison to child contact sexual offenders (n = 493) and offenders with a history of both CEM and contact offences (dual offenders, n = 256). A robust data linkage methodology was employed to link records from statewide corrections services with policing and mental health records in Victoria, Australia. The results indicated that CEM offenders differed from both contact and dual offenders, and that the groups were primarily differentiated based on two factors: antisocial orientation and sexual deviance. CEM offenders demonstrated high rates of sexual deviance but low rates of antisociality, contact offenders exhibited the opposite pattern, and dual offenders had both high sexual deviance and antisociality. The findings suggest that existing sexual offender assessment and treatment frameworks are unlikely to be suitable for exclusive CEM offenders. The implications for future research are discussed.

The Predictive Validity of the Static-99, Static-99R, and Static-2002/R: Which One to Use?

The use of Static tools (Static-99, Static-99R, Static-2002, and Static-2002R) in risk decision making involving sexual offenders is widespread internationally. This study compared the predictive accuracy and incremental validity of four Static risk measures in a sample of 621 Australian sexual offenders. Results indicated that approximately 45% of the sample recidivated (with 18.8% committing sexual offenses). All of the Static measures investigated yielded moderate predictive validity for sexual recidivism, which was comparable with other Australian and overseas studies. Area under the curve (AUC) values for the four measures across the 5-, 10-, and 15-year intervals ranged from .67 to .69. All of the Static measures discriminated quite well between low-risk and high-risk sexual offenders but less well for the moderate risk categories. When pitted together, none of the tools accounted for additional variance in sexual recidivism, above and beyond what the other measures accounted for. The overall results provide support for the use of Static measures as a component of risk assessment and decision making with Australian sexual offending populations. The limitations of this study and recommendations for further research are also discussed.

The Utility of the HCR-20 in an Australian Sample of Forensic Psychiatric Patients.

The Historical Clinical Risk Management-20 (HCR-20) is utilised internationally to assess an individual's risk for violence. Despite being widely administered in Australian correctional and forensic populations, the predictive validity of the HCR-20 instrument has never been explored in Australian settings. This retrospective study investigated the predictive validity of the HCR-20 for an Australian cohort of 136 forensic psychiatric patients. Findings support the relationship between the HCR-20 and violent offending post hospital discharge. The HCR-20 Total, Historical, and Risk Management scales shared moderate to large positive correlations with several reconviction categories.