[Treatment of mental disorders in prisons]. / Traitement des troubles mentaux en milieu pénitentiaire.

The practice of psychiatry and psychology in prisons is essential because of the high prevalence of mental disorders that is observed. Psychiatrists and psychologists, such as other health care professionals, should be affiliated to the health department and intervene in the therapeutic role, which must be distinguished from the role of the psychiatric expert mandated by the court. Therapy in prison is challenging because of the sometimes contradictory issues, at the interface of clinical, societal, security, legal and political fields. Health care professionals can thus be subject to important pressures or to ethical and deontological issues.

La pratique de la psychiatrie et de la psychologie en milieu pénitentiaire est essentielle du fait de la forte prévalence des troubles mentaux qui y est observée. Comme l'ensemble du personnel médicosoignant, les psychiatres et psychologues devraient être rattachés au département de la santé et interviennent dans un rôle de thérapeute qui doit être bien distinct du rôle de l'expert psychiatre mandaté par la justice. Les prises en charge thérapeutiques sont complexes en raison des enjeux parfois contradictoires, à l'interface des champs cliniques, sociétaux, sécuritaires, juridiques et politiques. Les thérapeutes peuvent ainsi être soumis à d'importantes pressions ou à des questionnements éthiques et déontologiques.

[The role of the lawyer of a convicted person to an institutional therapeutic measure]. / Rôle de l'avocat auprès des personnes condamnées à une mesure thérapeutique institutionnelle.

The intervention of the lawyer is of crucial importance after the sentencing of the institutional therapeutic measure for the treatment of mental disorders, especially in view of the concrete risk of never being released and the vulnerability of the convicted person due to his mental disorders. However, the intervention of the therapists in charge of the detainee's follow-up is essential in the context of the execution of the measure. In fact, it is on the basis of the evolution of the condition that led to the pronouncement of the measure that its extension can be considered. There is therefore a necessary interaction between the medical and the judicial authorities in the context of the execution of the measure, each of which must be concerned with enabling the detained person to complete the measure.

L'intervention de l'avocat revêt une importance cruciale après le prononcé de la mesure thérapeutique institutionnelle pénale de traitement des troubles mentaux, au regard en particulier du risque concret de ne jamais retrouver la liberté pour la personne condamnée et de sa vulnérabilité due à ses altérations psychiques. Dans un même temps, l'intervention des thérapeutes en charge du suivi de la personne détenue est essentielle dans le cadre de l'exécution de la mesure. En effet, c'est à l'aune de l'évolution de l'état à l'origine du prononcé de la mesure que son élargissement pourra être envisagé. Il y a donc une nécessaire interaction entre le médical et le judiciaire dans le cadre de l'exécution de la mesure, chacun devant avoir le souci de permettre à la personne détenue que la mesure prononcée puisse un jour prendre fin.

[Suicide attempts in detention during the pandemic: Lessons learned]. / Tentatives de suicide en détention durant la période pandémique : quels enseignements ?

People living in detention are at high risk of suicidal behaviour, with an incidence of suicides 3- to 9-fold higher compared to the general population. During the SARS-CoV-2 pandemic, suicidality among some disadvantaged populations increased and this trend was also observed in Swiss prisons. This article describes the clinical, psychosocial, institutional, criminological, and judicial factors associated with an increased risk of suicide attempt, as well as those that may lead to increased depression and other psychiatric disorders in the context of the pandemic in detention. Solutions are proposed to limit the incidence and consequences of these events in this vulnerable population.

Les personnes vivant en détention sont exposées à un risque élevé de comportements suicidaires, avec une incidence des suicides 3 à 9 fois plus élevée que dans la population générale. Durant la pandémie de SARS-CoV-2, la suicidalité au sein de certaines populations défavorisées s'est accrue et cette tendance a été observée dans certaines prisons, notamment en Suisse. Cet article décrit les facteurs cliniques, psychosociaux, institutionnels, criminologiques et judiciaires qui sont associés à un risque augmenté de passage à l'acte suicidaire, ainsi que ceux pouvant conduire à une exacerbation de la dépression et d'autres troubles psychiatriques dans le contexte pandémique en détention. Des solutions sont proposées pour limiter l'incidence et les conséquences de ces événements au sein de cette population vulnérable.

Relationship between benzodiazepine prescription, aggressive behavior, and behavioral disinhibition: a retrospective study in a Swiss prison.

BACKGROUND: Benzodiazepines are commonly prescribed in prisons amidst the controversies surrounding their potential role in causing behavioral disinhibition and aggressive behavior and their association with use and trafficking of illicit and addictive substances. The present study aimed to (1) ascertain the relationship between benzodiazepine prescription (including their dosage and duration of use) and aggressive behavior and behavioral disinhibition in prison and (2) investigate whether there was an association between benzodiazepine prescription, (including their dosage and duration of use) and using and trafficking illicit and addictive substances during imprisonment. METHODS: Data were extracted from the electronic database of an "open" Swiss prison (n = 1206, 1379 measures) over a 5-year period (2010-2015). Measures included benzodiazepine prescription, duration of benzodiazepine use and mean dosage, and punishable behaviors (physical and verbal aggression, disinhibited but not directly aggressive behaviors, property damage or theft, substance-related offenses, and rule transgression). We assessed the relationship between benzodiazepine prescription and punishable behaviors after propensity score matching. Logistic regressions were also used to test the relationship of benzodiazepine use duration and dosage with punishable behaviors among participants who received benzodiazepines. RESULTS: After propensity score matching, benzodiazepine prescription was not significantly associated with any punishable behavior. Among detained persons who took benzodiazepines, there was no significant association of dosage and duration of use with offenses involving illicit or addictive substance use or trafficking. CONCLUSIONS: Our study did not empirically support the occurrence of increased aggressive or disinhibited behaviors or increased risk of substance abuse in detained persons who received benzodiazepines in prison. This suggests a need to reconsider restrictions in prescribing benzodiazepines in the prison setting.

[Child or adult†? Transdisciplinary reflections on forensic age-assessments]. / Enfant ou adulte†? Réflexions ­transdisciplinaires sur les expertises d'âge.

Forensic age assessments are carried out in Switzerland at the request of the administrative or judicial authorities, with the aim of determining whether an individual is a minor or an adult. This -article first recalls the context in which these assessments are -produced, and the challenges that arise from them. Then it details the current procedure for age assessments and summarizes some of the criticisms that can be made, along with the answers proposed by experts of the «â€…Centre Universitaire Romand de Médecine -Légale ¼. Finally, the article presents various medical and political position statements regarding forensic age assessments and provides some suggestions for improvements.

Les expertises d'âge sont réalisées en Suisse à la requête des ­autorités administratives ou judiciaires, dans le but de déterminer si un individu est mineur ou majeur. Cet article rappelle tout d'abord dans quel contexte sont réalisées ces expertises et quels enjeux en découlent. Ensuite il détaille le déroulement d'une ­expertise d'âge, puis résume dans un tableau les critiques qui peuvent être formulées par rapport aux différentes étapes de la procédure et comment les experts du Centre universitaire ­romand de médecine légale y répondent. Finalement, l'article ­expose différentes prises de position de sociétés médicales et politiques face à ces expertises d'âge et propose en conclusion quelques pistes d'amélioration.

[Clinical situations in detention settings]. / Situations cliniques en milieu ­pénitentiaire.

Infectious diseases, substance use disorders, and psychiatric conditions are more prevalent in prisons than in the general population. There is relatively limited evidence regarding the medical management of non communicable diseases in prison settings. The clinical cases described in this article highlight specific dimensions to be considered when practicing medicine in detention settings : multidisciplinary work ; regular voluntary screening for infectious diseases that are prevalent in this population ; management of non communicable diseases ; availability of medical protocols for specific clinical situations (for example, body-packing) ; or proactive screening for mental health disorders.

La prévalence des maladies infectieuses, des troubles de la dépendance et des pathologies psychiatriques est plus importante en prison que dans la population générale. Il existe encore peu d'évidences quant à la prise en charge optimale des maladies non transmissibles dans ces contextes. Les vignettes cliniques discutées dans cet article mettent en lumière certaines dimensions liées à l'exercice de la médecine en milieu carcéral : travailler en interdisciplinarité ; proposer le dépistage régulier de certaines maladies infectieuses fréquentes dans cette population ; être d­avantage attentif à la prise en charge des maladies non transmissibles ; élaborer des directives propres à des situations particulières (telles que la dissimulation intracorporelle de substances illicites) ou dépister de manière proactive les troubles de la ­santé mentale.

Patterns of source monitoring bias in incarcerated youths with and without conduct problems.

INTRODUCTION: Antisocial individuals present behaviours that violate the social norms and the rights of others. In the present study, we examine whether biases in monitoring the self-generated cognitive material might be linked to antisocial manifestations during adolescence. We further examine the association with psychopathic traits and conduct problems (CPs). METHODS: Sixty-five incarcerated adolescents (IAs; M age = 15.85, SD = 1.30) and 88 community adolescents (CAs; M age = 15.78, SD = 1.60) participated in our study. In the IA group, 28 adolescents presented CPs (M age = 16.06, SD = 1.41) and 19 did not meet the diagnostic criteria for CPs (M age = 15.97, SD = 1.20). Source monitoring was assessed through a speech-monitoring task, using items requiring different levels of cognitive effort; recognition and source-monitoring bias scores (internalising and externalising biases) were calculated. RESULTS: Between-group comparisons indicate greater overall biases and different patterns of biases in the source monitoring. IA participants manifest a greater externalising bias, whereas CA participants present a greater internalising bias. In addition, IA with CPs present different patterns of item recognition. CONCLUSIONS: These results indicate that the two groups of adolescents present different types of source-monitoring bias for self-generated speech. In addition, the IAs with CPs present impairments in item recognition. Future studies may examine the developmental implications of self-monitoring biases in the perseverance of antisocial behaviours from adolescence to adulthood.

Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR).

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is characterized by difficulty paying attention, poor impulse control, and hyperactive behavior. It is associated with several adverse health and social outcomes and leads to an increased risk of criminality and recidivism. Worldwide, ADHD is thus highly prevalent in prisons. However, ADHD treatment has been neglected in such environments. Stimulant medications such as osmotic-release oral system methylphenidate (OROS-MPH) are first-line treatments in the general population, but they are under-prescribed in prisons due to concerns about abuse, even though such claims are not empirically supported. This project aims to compare the efficacy of a 3-month in-prison OROS-MPH vs. placebo treatment on the severity of core ADHD symptoms and relevant in- and post-prison outcomes. METHODS: This study is a phase III, double-blinded, randomized, superiority, controlled trial of OROS-MPH vs. placebo. After randomization, the participants will receive 3 months of treatment with OROS-MPH or placebo (1:1 ratio) while incarcerated. Upon release, all participants will be offered the treatment (OROS-MPH) for 1 year but will remain blinded to their initial study group. The study will be conducted at the Division of Prison Health, Geneva, Switzerland, among incarcerated men (n = 150). Measures will include (1) investigator-rated ADHD symptoms, (2) acute events collected by the medical and prison teams, (3) assessment of the risk of recidivism, (4) medication side effects, (5) medication adherence, (6) study retention, (7) health care/prison costs, and (8) 1-year recidivism. Analyses will include bivariable and multivariable modeling (e.g., regression models, mixed-effects models, survival analyses) and an economic evaluation (cost-benefit analysis). DISCUSSION: We expect that early identification and treatment of ADHD in prison will be an important public health opportunity and a cost-effective approach that is likely to reduce the vulnerability of incarcerated individuals and promote pathways out of criminal involvement. The study will also promote standards of care for people with ADHD in prison and provide recommendations for continuity of care after release. TRIAL REGISTRATION: ClinicalTrials.gov NCT05842330 . Registered on June 5, 2023. Kofam.ch SNCTP000005388. Registered on July 17, 2023.

Mental Health Consultations in Immigration Detention: What Can We Learn From Clinical Records?

Objectives: Knowledge on mental health consultations in immigration detention and characteristics of people receiving consultations is scarce. Based on a sample of 230 adult men in immigration detention in Switzerland, we aimed to: (1) Quantify the proportion of persons receiving mental health consultations during detention; and (2) Identify socio-demographic and clinical characteristics associated with mental health consultations. Methods: Retrospective observational study with a cross-sectional design. Prevalence estimates, logistic regressions, and contingency tables were used to analyse the data. Results: A total of 30% of the sample received mental health consultations during detention. Time spent in immigration detention, mental health problems during detention, use of psychotropic medication, and self-harm were associated with mental health consultations. Although mental health consultations are provided to people with more severe mental health problems, 41% of persons with assessed mental health needs during the initial screening and 26% of those who self-harmed during detention did not receive mental health consultations. Conclusion: Mental health resources and screening procedures could be improved to ensure that mental health consultations are matched to clinical need in immigration detention settings.

Refusal to participate in research among hard-to-reach populations: The case of detained persons.

Providing insights on refusal to participate in research is critical to achieve a better understanding of the non-response bias. Little is known on people who refused to participate, especially in hard-to-reach populations such as detained persons. This study investigated the potential non-response bias among detained persons, comparing participants who accepted or refused to sign a one-time general informed consent. We used data collected in a cross-sectional study primary designed to evaluate a one-time general informed consent for research. A total of 190 participants were included in the study (response rate = 84.7%). The main outcome was the acceptance to sign the informed consent, used as a proxy to evaluate non-response. We collected sociodemographic variables, health literacy, and self-reported clinical information. A total of 83.2% of the participants signed the informed consent. In the multivariable model after lasso selection and according to the relative bias, the most important predictors were the level of education (OR = 2.13, bias = 20.7%), health insurance status (OR = 2.04, bias = 7.8%), need of another study language (OR = 0.21, bias = 39.4%), health literacy (OR = 2.20, bias = 10.0%), and region of origin (not included in the lasso regression model, bias = 9.2%). Clinical characteristics were not significantly associated with the main outcome and had low relative biases (≤ 2.7%). Refusers were more likely to have social vulnerabilities than consenters, but clinical vulnerabilities were similar in both groups. The non-response bias probably occurred in this prison population. Therefore, efforts should be made to reach this vulnerable population, improve participation in research, and ensure a fair and equitable distribution of research benefits.

The role of civil society organizations (CSOs) in the COVID-19 response across the Global South: A multinational, qualitative study.

Despite receiving less attention than high-income countries, low- and middle-income countries (LMICs) experienced more than 85% of global excess deaths during the first two years of the COVID-19 pandemic. Due to the unprecedented speed and scale of the COVID-19 pandemic, which placed large demands on government capacity, many LMICs relied on civil society organizations (CSOs) to assist in implementing COVID-19 response programs. Yet few studies have examined the critical role CSOs played in mitigating the effects of the COVID-19 pandemic in low resource settings. This study explored the CSO response to COVID-19 in five of the most heavily impacted LMICs in the Global South. Interviews were conducted from May to August 2021 with a purposive sample of CSO key informants within each of the five countries. A total of 52 CSOs were selected from which 53 key informants were interviewed either via Zoom or by phone. Interviews were coded and analyzed using NVivo or MAXQDA2020. Out of the 52 CSOs selected, 24 were national organizations, 8 were regional, and 20 were local. CSOs fell into six categories: community-based organizations, non-governmental organizations, unions/professional organizations, campaigns/social movements, research organizations/think tanks, and networks/coalitions. CSOs across all five countries adapted their missions, stretched their resources, and performed a wide range of activities that fit into five programmatic areas: food security and livelihood support, public health and medical care, cash transfer programs, risk communication and community education, and needs assessment. This qualitative analysis demonstrates the critical role CSOs played in supplementing government emergency aid response by delivering necessary resources and supporting highly vulnerable populations during the COVID-19 pandemic, as well as the primary challenges they faced in doing so. Given the generally weak state of public capacity in the LMICs studied, this role was vital to responding to the pandemic.

Comparison of Audiovisual and Paper-Based Materials for 1-Time Informed Consent for Research in Prison: A Randomized Clinical Trial.

Importance: Few studies are available on informed consent (IC) among detained persons, even with ethics being a critical aspect of prison research. In IC research, audiovisual material seems to improve understanding and satisfaction compared with conventional paper-based material, but findings remain unclear. Objective: To compare audiovisual and paper-based materials for 1-time general IC for research in prisons. Design, Setting, and Participants: This cross-sectional randomized clinical trial was conducted in 2 corrections facilities in Switzerland (an adult prison and a juvenile detention center). The study was conducted from December 14, 2019, to December 2, 2020, in the adult prison and from January 15, 2020, to September 9, 2021, in the juvenile detention center. In the adult prison, study participation was offered to detained persons visiting the medical unit (response rate, 84.7%). In the juvenile detention center, all newly incarcerated adolescents were invited to participate (response rate, 98.0%). Interventions: Participants were randomized to receive paper-based conventional material or to watch a 4-minute video. Materials included the same legal information, as required by the Swiss Federal Act on Research Involving Human Beings. Main Outcomes and Measures: The main outcome was acceptance to sign the IC form. Secondary outcomes included understanding, evaluation, and time to read or watch the IC material. Results: The study included 190 adults (mean [SD] age, 35.0 [11.8] years; 190 [100%] male) and 100 adolescents (mean [SD] age, 16.0 [1.1] years; 83 [83.0%] male). In the adult prison, no significant differences were found between groups in acceptance to sign the IC form (77 [81.1%] for paper-based material and 81 [85.3%] for audiovisual material; P = .39) and to evaluate it (mean [SD] correct responses, 5.09 [1.13] for paper-based material and 5.01 [1.07] for audiovisual material; P = .81). Understanding was significantly higher in the audiovisual material group (mean [SD] correct responses, 5.09 [1.84]) compared with the paper-based material group (mean [SD] correct responses, 4.61 [1.70]; P = .04). In the juvenile detention center, individuals in the audiovisual material group were more likely to sign the IC form (44 [89.8%]) than the paper-based material group (35 [68.6%], P = .006). No significant difference was found between groups for understanding and evaluation. Adults took a mean (SD) of 5 (2) minutes to read the paper material, and adolescents took 7 (3) minutes. Conclusions and Relevance: Given the small benefit of audiovisual material, these findings suggest that giving detained adults and prison health care staff a choice regarding IC material is best. For adolescents, audiovisual material should be provided. Future studies should focus on increasing understanding of the IC process. Trial Registration: ClinicalTrials.gov Identifier: NCT05505058.

Suicide attempts and Covid-19 in prison: Empirical findings from 2016 to 2020 in a Swiss prison.

Disadvantaged populations have an increased risk of suicide and suicide attempts because of the Covid-19 pandemic. To date, few studies focused on people living in detention, who have a high burden of mental health problems and are exposed to severe control measures. Our study investigated whether there was an increase in suicide attempts in prison. Data were collected in the largest Swiss pre-trial prison (Champ-Dollon) for the pre-pandemic and the pandemic periods. We identified a statistically significant 57%-increase of suicide attempts. Mitigation measures, access to mental health care, and access to vaccination are needed to protect this vulnerable population.

Prevalence Rates and Evolution of Psychiatric Disorders Among Incarcerated Youths in Comparison With Non-incarcerated Youths.

Background: Our main objective was to provide estimates of the prevalence rates of psychiatric disorders and comorbidities among youths in a juvenile detention center in Geneva, Switzerland. We also aimed to investigate potential positive effects of intensive psychotherapeutic and educational services this center provides. Finally, we examined psychiatric care prior to and after custody as well as the evolution of the youths' mental health during detention. Methods: We conducted a longitudinal study including a group of incarcerated (n = 86) and a group of non-incarcerated (n = 169) youths (12-18 years old). Measures included diagnoses of psychiatric disorders, cognitive functions, trauma, psychopathic traits and the Youth Self-Report (aggressive behavior, attentional disorders, criminal behavior, social withdrawal, anxiety, depression and somatic complaints) collected at baseline and at discharge for the incarcerated group. Data were analyzed using mixed-effect models. Results: Psychiatric disorders were prevalent in the incarcerated group (82.6, 95% CI: 71.6-90.7%), but young people also often suffered from several disorders simultaneously. Two-thirds of the incarcerated participants had a diagnosis of two or more psychiatric disorders. Regarding health care, most incarcerated participants (79.1%) had psychiatric care prior to detention. The planned care after detention was associated with psychiatric comorbidities, care being more likely planned for those with comorbidities (p = 0.030). Compared to the non-incarcerated group, the incarcerated group had lower scores on cognitive functioning (p < 0.001) and higher scores on trauma (p < 0.021) and psychopathic traits (p < 0.034). The youths' stay in the detention center was associated with a positive change of mental health, with externalized problems being significantly reduced at the end of their stay (p = 0.017). Conclusion: Our findings showed that youths in conflict with the law are characterized by (1) their internal vulnerabilities: a high prevalence of psychiatric disorders and psychiatric comorbidities, lower cognitive functions, externalized problems and psychopathic traits; (2) environmental factors: victims of violence and sexual abuse; and (3) their psychiatric history. Besides, the evolution of the most prevalent issues was favorable over time, which puts into question the usual perspective about the deleterious effect of detention.

Associations of executive and functional outcomes with full-score intellectual quotient among ADHD adults.

Associations between executive and functional impairment, intelligence, and attention deficit hyperactivity disorder (ADHD) have been scarcely investigated among adult populations and lead to inconsistent results. This study tested the impact of intellectual level on executive and functional impairment in a clinical sample of adults diagnosed with ADHD. Participants were recruited in a specialized center for the diagnosis and treatment of ADHD (n=66, mean age=27.9 ± 10.8). Measures included intellectual quotient (IQ, Wechsler Adult Intelligence Scale) categorized as ≤110 or >110, the continuous performance test (CPT3TM), grade retention, educational attainment, and having an activity (job or studies). Participants with a higher IQ had significantly better functional outcomes than participants with a standard IQ: higher educational attainment, lower grade retention, and often having an activity. Participants with higher IQ performed significantly better on all CPT variables assessing executive functioning. Intelligence seemed to work as a protective factor for executive and functional outcomes in a clinical population of ADHD adults and might reduce long-lasting detrimental consequences in life.

Reducing recidivism using the Reasoning and Rehabilitation program: a pilot multi-site-controlled trial among prisoners in Switzerland.

OBJECTIVES: This study evaluated whether the Reasoning and Rehabilitation (R&R2) program was effective in reducing recidivism, minimizing dropout rates, and improving outcomes related to attitudes, behaviors, and personality among people living in detention. METHODS: Data were collected in eight Swiss German-speaking prisons among males detained for violent offenses using a quasi-experimental controlled design (R&R2: n = 129, treatment as usual [TAU]: n = 84). Measures included recidivism, dropout rate, and self-report questionnaires (hostile attribution bias, aggressiveness, interpersonal problems, and willingness to accept responsibility). Data were analyzed using mixed-effect models. RESULTS: Participants in the R&R2 group were less likely to reoffend in comparison with the TAU group in the intention-to-treat (n = 51, odds ratio = 0.75, p = .060) and the per-protocol (excluding dropouts; n = 38, odds ratio = 0.65, p = .068) analyses. They also had lower self-reported scores of spontaneous and reactive aggressiveness (p = .047 and p = .070) and excitability (p = .086). CONCLUSIONS: The findings of this pilot project were promising, with the R&R2 program leading to reduced recidivism and dropout rate. Even though these results should be considered preliminary, the R&R2 program appeared to be a relevant approach in reducing recidivism after prison.

Screening for alcohol use disorder among individuals with comorbid psychiatric disorders: Diagnostic accuracy in a sample of young Swiss men.

Alcohol use disorder (AUD) is frequently comorbid with other psychiatric disorders. However, few studies investigated the psychometric properties of AUD screening tools in presence of co-occurring disorders. This study examined the diagnostic accuracy of a short AUD screening tool among young adults, in the presence of high vs. low or moderate symptomatology of other common psychiatric disorders. Data were collected among young Swiss men (n = 233) between 2016 and 2018. Measures included a diagnostic interview for AUD and screening tools for AUD and other psychiatric disorders (attention deficit hyperactivity disorder, antisocial personality disorder, bipolar disorder, borderline personality disorder, major depressive disorder, and social anxiety disorder). We computed receiver operating characteristic curves to test whether the AUD screening tool was an accurate indicator of AUD for groups with high vs. low or moderate symptomatology of each psychiatric disorder. The results showed that the optimal cut-off score was ≥3 (the original cut-off of the scale) for participants with a low or moderate symptomatology and ≥4 for participants with a high symptomatology. Our findings highlighted the urgent need for an integrated approach to screening. Psychiatric comorbidities should be included in the screen for AUD to obtain accurate results.

Identifying an accurate self-reported screening tool for alcohol use disorder: evidence from a Swiss, male population-based assessment.

BACKGROUND AND AIMS: Short screenings for alcohol use disorder (AUD) are crucial for public health purposes, but current self-reported measures have several pitfalls and may be unreliable. The main aim of our study was to provide empirical evidence on the psychometric performance of self-reports currently used. Our research questions were: compared with a gold standard clinical interview, how accurate are (1) self-reported AUD, (2) self-reported alcohol use over time and (3) biomarkers of alcohol use among Swiss men? Finally, we aimed to identify an alternative screening tool. DESIGN: A single-center study with a cross-sectional design and a stratified sample selection. SETTING: Lausanne University Hospital (Switzerland) from October 2017 to June 2018. PARTICIPANTS: We selected participants from the French-speaking participants of the ongoing Cohort Study on Substance Use and Risk Factors (n = 233). The sample included young men aged on average 27.0 years. MEASUREMENTS: We used the Diagnostic Interview for Genetic Studies as the gold standard for DSM-5 AUD. The self-reported measures included 11 criteria for AUD, nine alcohol-related consequences, and previous 12 months' alcohol use. We also assessed biomarkers of chronic excessive drinking (ethyl glucuronide and phosphatidylethanol). FINDINGS: None of the self-reported measures/biomarkers taken alone displayed both sensitivity and specificity close to 100% with respect to the gold standard (e.g. self-reported AUD: sensitivity = 92.3%, specificity = 45.8%). The best model combined eight self-reported criteria of AUD and four alcohol-related consequences. Using a cut-off of three, this screening tool yielded acceptable sensitivity (83.3%) and specificity (78.7%). CONCLUSIONS: Neither self-reported alcohol use disorder nor heavy alcohol use appear to be adequate to screen for alcohol use disorder among young men from the Swiss population. The best screening alternative for alcohol use disorder among young Swiss men appears to be a combination of eight symptoms of alcohol use disorder and four alcohol-related consequences.

Do Overcrowding and Turnover Cause Violence in Prison?

Violence is common in prison and its individual risk factors are well documented. However, there is a mixed evidence on the relationship between prison violence and institutional factors, such as overcrowding and turnover, and recent research suggested that these factors may not be important or relevant. This study investigated the association between prison violence and institutional factors in a Swiss pre-trial prison between 2013 and 2018. Measures included violence (assaults requiring immediate medical attention) as well as the annual overcrowding and turnover rates. Using a meta-regression, the results showed that prison violence was higher when overcrowding and turnover increased. Overall, our study highlighted that institutional prison factors might have notable detrimental effects on prison life. Reduction of prison overcrowding and turnover appear critical to reduce prisoners' vulnerability. Turning prison into safe places designed to promote desistance would probably not be achievable without considering these crucial factors.

Body pack in sick bodies: a retrospective study of somatic and psychiatric comorbidities among body-packers.

PURPOSE: Body-packing means concealing packets of illicit psychoactive substances in the digestive or genital system. The purpose of this paper is to investigate profiles of body-packers and comorbidities associated with body-packing. DESIGN/METHODOLOGY/APPROACH: A retrospective study (2005-2016) was conducted among all patients hospitalized for suspicion of body-packing in the Geneva hospital prison unit (n=287). Data were extracted from medical records and included demographics, somatic/psychiatric diseases, suicidal ideation and psychological distress. FINDINGS: Body-packers were mostly young men (mean age=33.4). A total of 42.2 percent of the participants had at least one psychiatric or somatic comorbidity reported during incarceration (somatic: 28.2 percent, psychiatric: 18.8 percent). The most frequent somatic diseases were infectious (10.5 percent), cardiovascular (10.1 percent), and endocrinological (4.2 percent) diseases, and more precisely HIV (4.5 percent), hepatitis B (3.5 percent), hepatitis C (1.4 percent), high blood pressure (8.0 percent) and diabetes (4.2 percent). The most frequent psychiatric conditions were substance use disorders (10.5 percent) and mood disorders (8.0 percent). Depressed mood/psychological distress and suicidal ideation were frequently reported during hospitalization (27.2/6.6 percent). Comorbidities were associated with demographics: Females were more likely to have somatic and psychiatric diseases detected during hospitalization in detention and participants from Western, educated, industrialized, rich and democratic countries were more likely to report diseases known before detention. ORIGINALITY/VALUE: Body-packers bear a heavy burden of disease and psychological distress. This vulnerable subgroup of incarcerated people has been overlooked in previous research and their health needs are not correctly understood. This study was a first step to improve their health care and reintegration.