Reduction of crime in first-onset psychosis: a secondary analysis of the OPUS randomized trial.

OBJECTIVE: Violence and criminality are adverse outcomes for some persons who develop psychotic illnesses. The extent to which treatment can reduce offending has rarely been studied. The aim of this study was to evaluate whether assertive specialized treatment would reduce the rate of crime in patients with a first episode of psychotic illness. METHOD: From January 1998 to December 2000, a total of 547 patients aged 18-45 years with a first episode of schizophrenia spectrum disorder (ICD-10 diagnostic code within F2) were randomized to assertive specialized treatment or standard treatment in an outpatient setting. In the current secondary analysis of the data, levels of criminality during the 2-year treatment period and the 3 years following were assessed using official records from Danish registers. Main outcome measures were any offending and violent offending. RESULTS: No significant reduction in violent offending or any offending was found in the assertive specialized treatment group (adjusted hazard ratio = 1.06; 95% CI, 0.72-1.56) compared with the control group. Prevalence of offending was low and had often commenced prior to inclusion in the trial. CONCLUSIONS: While assertive specialized treatment has shown good treatment effects, it had no impact on rates of offending, thereby calling into question the potential efficacy of universally applied improvements in outpatient services with respect to reducing crime and violence. More specific interventions that address criminogenic needs in a more narrowly defined group of high-risk patients may be considered.

Combined influence of serious mental illness and criminal offending on suicide risk in younger adults.

PURPOSE: We conducted a national epidemiological study to determine how mental illness and criminal offending combine to influence suicide risk in younger adults. METHODS: Using completely interlinked registers, we generated a nested case-control study from the cohort of all Danish people born 1965 and onwards. We identified 2,384 suicides aged 15-41 years during 1981-2006, and 56,016 age and sex-matched living controls. We examined all criminal charges from 1980, and all psychiatric admissions from 1969 and outpatient episodes from 1995. Exposure odds ratios were estimated using conditional logistic regression models. RESULTS: A quarter of male and 17 % of female suicides had histories of both criminal justice system contact and secondary care psychiatric treatment, with a marked elevation in risk seen compared with having neither risk factor: male odds ratio (OR) 34.0, 95 % confidence interval (CI) 29.1-39.6; female OR 72.7, CI 49.4-107.1. Among those treated for psychiatric illness, contact with the criminal justice system predicted higher risk: male OR 1.4, CI 1.1-1.7; female OR 1.7, CI 1.1-2.4, although these effects were attenuated and became non-significant with adjustment for socio-demographic risk factors. In men, risk was especially high if first criminal justice system contact occurred before first psychiatric treatment episode, and if these two challenging life events coalesced within a year of each other. CONCLUSION: These younger age adults should be monitored carefully for signs of suicidal behaviour. The need for well coordinated multiagency care is indicated, and a broad range of psychiatric illnesses should be considered carefully when assessing their suicide risk.

Suicide risk among violent and sexual criminal offenders.

Risk of suicide in people who have perpetrated specific forms of violent or sexual criminal offenses has not been quantified accurately or precisely. Also, gender comparisons have not been possible due to sparse data problems in the smaller studies that have been conducted to date. We therefore aimed to estimate these effects in the whole Danish population over a 26-year period. By completely interlinking national criminal, psychiatric, sociodemographic and cause-specific mortality registers, we conducted a nested case-control study of more than 27,000 adult suicides, during 1981-2006, and more than half a million age and gender-matched living controls. Elevated suicide risk was found in male sexual offenders. Risk was even higher among violent offenders, with greater effect sizes seen in females. It was markedly raised with serious violence, reaching a peak in relation to homicide or attempted homicide: male odds ratio (OR) 12.0, 95% confidence interval (CI) [8.3, 17.3]; female OR 30.9, CI [11.9, 80.6]. Following adjustment for psychiatric and social risk factors, relative risk in violent offenders was comparable to that seen among nonviolent offenders. These findings underline the importance of understanding why some people are violent toward themselves as well as other people, and why suicide risk is so much higher in people who have perpetrated serious acts of violence. They also indicate a clear need for developing effective multiagency interventions that effectively tackle both forms of destructive behavior.

Toxoplasma infection and later development of schizophrenia in mothers.

OBJECTIVE: Several studies based on clinical samples have found an association between Toxoplasma gondii infection and schizophrenia, and a case-control study among U.S. military personnel with specimens available from both before and after diagnosis found a positive association between T. gondii immunoglobulin G (IgG) antibody level and schizophrenia. These findings have never been replicated in a prospective cohort study. The purpose of this study was to determine whether mothers infected with T. gondii have an elevated risk of schizophrenia or related disorders and whether the risk depends on IgG antibody level. METHOD: In a register-based prospective cohort study of 45,609 women born in Denmark, the level of T. gondii-specific IgG antibodies was measured in connection with childbirth between 1992 and 1995. Women were followed up from the date of delivery until 2008. RESULTS: A significant positive association between T. gondii IgG antibody level and schizophrenia spectrum disorders was found. Mothers with the highest IgG level had a relative risk of 1.73 (95% confidence interval [CI]=1.12-2.62) compared with mothers with the lowest IgG level. For schizophrenia, the relative risk was 1.68 (95% CI=0.77-3.46). When the mothers were classified according to IgG level, only those with the highest IgG levels had a significantly higher risk of schizophrenia spectrum disorders. CONCLUSIONS: Women with high levels of T. gondii-specific IgG antibodies have a significantly elevated risk of developing schizophrenia spectrum disorders.

National study of suicide in all people with a criminal justice history.

CONTEXT: Previous research has focused on suicide among male prisoners and ex-prisoners, but little is known about risk in the wider offender population. OBJECTIVE: To examine suicide risk over 3 decades among all people processed by a national criminal justice system. DESIGN: Nested case-control study. SETTING: The whole Danish population. PARTICIPANTS: Interlinked national registers identified all adult suicides during 1981 to 2006 according to any criminal justice system contact since 1980. Exposure was defined according to history of criminal justice adjudication, up to and including each subject's last judicial verdict before suicide (or date of matching for controls). There were 27 219 suicides and 524 899 controls matched on age, sex, and time, ie, controls were alive when their matched case died. MAIN OUTCOME MEASURE: Suicide. RESULTS: More than a third of all male cases had a criminal justice history, but relative risk against the general population was higher for women than men. Independent effects linked with criminal justice exposure persisted with confounder adjustment. Suicide risk was markedly elevated with custodial sentencing, but the strongest effects were with sentencing to psychiatric treatment and with charges conditionally withdrawn. Risk was raised even in people with a criminal justice history but without custodial sentences or guilty verdicts. It was especially high with recent or frequent contact and in people charged with violent offenses. CONCLUSIONS: We examined a section of society in which major health and social problems frequently coexist including offending, psychopathology, and suicidal behavior. The need for developing more far-reaching national suicide prevention strategies is indicated. In particular, improved mental health service provision is needed for all people in contact with the criminal justice system, including those not found guilty and those not given custodial sentences. Our findings also suggest that public services should be better coordinated to tackle co-occurring health and social problems more effectively.

[Psychiatric treatment sentences]. / Dom til psykiatrisk behandling.

INTRODUCTION: Previous Danish studies of the increasing number of sentences to psychiatric treatment (SPT) have compared prevalent populations of persons undergoing treatment with incident measures of reported crimes. Examining the period 1990-2006, we studied incident sentences, taking the type and severity of crime into account. MATERIAL AND METHODS: Using data from Statistics Denmark's national crime statistics, we have compared time-trends of SPT with time-trends of suspended and custodial sentences stratified by type of crime. RESULTS: We found that the rise in SPT is primarily attributable to violent offending, and that particularly assaults against public servants have contributed to the development. CONCLUSION: Regarding violent offences against private persons, the time-trends for SPT are parallel to the time-trends for suspended and custodial sentences, which may indicate that the same societal factors, including propensity to report, police priorities and court practices, are involved both generally and amongst psychiatric patients. Conversely, the rise in violent offences against public servants is higher amongst SPTs. This can conceivably be connected to both conditions, leading to more confrontations and changes in practices, e.g., for reporting violence against staff. However, if a civil person is the victim of a violent offence, the probability of the perpetrator being a psychiatric patient is small and has remained virtually unchanged since 1990.

Full spectrum of psychiatric outcomes among offspring with parental history of mental disorder.

CONTEXT: While concordant parent/offspring risks for specific mental disorders are well established, knowledge of the broader range of psychiatric outcomes among offspring with parental history of mental disorder is lacking. OBJECTIVE: To examine the full range of mental health outcomes among offspring of parents with serious and other mental disorders compared with those whose parents had no such history. DESIGN: Population-based cohort study. Offspring were followed up from their 14th birthday for the development of mental disorders based on both outpatient and inpatient hospital data. SETTING: Danish population. PARTICIPANTS: All offspring born in Denmark between 1980 and 1994 (N = 865 078) with follow-up to December 2008. MAIN OUTCOME MEASURES: Incidence rates, incidence rate ratios, and cumulative incidences for offspring psychiatric outcomes. RESULTS: Parental serious mental disorder (SMD) (nonaffective or affective psychosis) was found to be positively associated with virtually all offspring psychiatric outcomes, including those not hitherto regarded as clinically related. Offspring of parents without SMD but with a history of "other mental disorder" were also found to be at increased risk of developing a range of mental disorders. The strongest associations were found where both parents had a history of mental disorder (eg, offspring of 2 parents with SMD were 13 times more likely to develop schizophrenia). Elevated risks were not confined to concordant parent/offspring disorders (eg, offspring of 2 parents with SMD were 8 times more likely to develop substance misuse disorders). CONCLUSIONS: The impact of parental history of mental disorder was not confined to elevated offspring risk of concordant disorders but rather offspring are at increased risk of a wide range of mental disorders, particularly those with 2 affected parents. Our results imply an important role for etiological factors giving rise to broad, as well as specific, familial vulnerabilities. These findings also have potential implications for diagnostic classification.