The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study.

OBJECTIVE: Understand the relationship between criminal accusations, victimization, and mental disorders at a population level using administrative data from Manitoba, Canada. METHOD: Residents aged 18 to 64 between April 1, 2007, and March 31, 2012 (N = 793,024) with hospital- and physician-diagnosed mental disorders were compared to those without. Overall and per-person rates of criminal accusations and reported victimization in the 2011/2012 fiscal year were examined. Relative risks were calculated, adjusting for age, sex, income, and presence of a substance use disorder. The overlap between diagnosed mental disorders, accusations, and victimization with a χ2 test of independence was studied. RESULTS: Twenty-four percent (n = 188,693) of the population had a mental disorder over the 5-year time frame. Four to fifteen percent of those with a mental disorder had a criminal accusation, compared to 2.4% of the referent group. Individuals with mental disorders, especially psychotic or personality disorders, were often living in low-income, urban neighborhoods. The adjusted relative risk of accusations and victimization remained 2 to 5 times higher in those with mental disorders compared to the referent group. Criminal accusations and victimization were most prevalent among individuals with a history of attempted suicide (15.2% had an accusation and 8.1% were victims). The risk of victimization in the same year as a criminal accusation was significantly increased among those with mental disorders compared to those without (χ2 = 211.8, P < 0.001). CONCLUSIONS: Individuals with mental disorders are at elevated risk of both criminal involvement and victimization. The identification of these multiply-stigmatized individuals may lead to better intervention and support.

Prevalence of mental disorders among all justice-involved: A population-level study in Canada.

More than 10 million people are imprisoned around the world, with many more who encounter the justice system. However, most studies examining the mental health burden in the justice system have examined only incarcerated individuals, with few looking at both criminal offending and victimization at the population-level. This study aimed to describe the population-level prevalence of mental disorders among the entirety of justice-involved individuals in a Canadian sample. The study was conducted using linked health and justice administrative data for all residents of Manitoba, Canada ages 18-64 between April 1, 2007 and March 31, 2012. All justice involvement (crime accusations and victimizations) and inpatient and outpatient mental disorder diagnoses (mood/anxiety, substance use, psychotic, personality disorders and suicidal behavior) were retrieved. Five-year age- and sex-adjusted prevalence of mental disorders and suicidal behaviour among those with any crime accusation and any victimization were compared to the general population of Manitoba. The study found that age- and sex-adjusted prevalence of any mental disorder was significantly higher among both adults accused of a crime and those victimized (38.9% and 38.6%, respectively) compared to the general population (26.1%). Rate ratios for specific mental disorders and suicidal behaviour were 1.4-3.6 among those accused of a crime, and 1.4-3.7 among those who were victims, compared to the general population. These findings highlight the need for urgent and expanded attention to this intersection of vulnerability. Victimization is especially an area of justice-related health that requires more attention.

Evaluation of a Suicide Risk Assessment Tool in a Large Sample of Detained Youth.

OBJECTIVES: We evaluated the six-item Inmate Security Assessment (ISA) tool used among detained youth in Manitoba, Canada. METHOD: Two hundred and forty-one recorded self-harm incidents among all incarcerated youth occurred between January 1, 2005 and December 31, 2010 (N=5102). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) for three categories of suicide risk (high, medium, and low) as well as each of the six suicide risk evaluation indicators were determined. Receiver operating characteristic (ROC) curves and area under the curve (AUC) calculations for the three suicide risk levels and the six indicators were created. RESULTS: Having at least a low suicide risk level (93.8%) or at least one suicide risk factor (94.6%) provided high sensitivity. Specificity was high if an individual had at least a medium suicide risk level (94.2%) or at least three suicide risk indicators (96.7%). The PPV was low (8.9-16.2%) and the NPV was high (94.9-99.3%) for all suicide risk levels. The most sensitive risk factor for self-harm was a prior history of suicidal behavior or a family history of suicide (94.6%). All risk indicators had a low PPV (7.4-23.1%) and a high NPV (95.4-99.5%). A very low NLR was found for those without prior suicidal behavior or a family history of suicide (0.107). The AUC was 0.719 (95%CI = 0.692-0.746), indicating a fair test. CONCLUSION: The ISA is a moderately accurate tool for identifying risk for self-harm in detained youth.

OBJECTIFS: Nous avons évalué l'instrument en 6 items évaluant la sécurité des détenus (ESD) en usage chez les adolescents détenus au Manitoba, Canada. MÉTHODE: Deux cent quarante et un incidents d'automutilation enregistrés parmi les adolescents incarcérés ont eu lieu entre le 1er janvier 2005 et le 31 décembre 2010 (N = 5102). La sensibilité, la spécificité, la valeur prédictive positive (VPP), la valeur prédictive négative (VPN), le rapport de vraisemblance positif (RVP) et le rapport de vraisemblance négatif (RVN) pour trois catégories de risque de suicide (élevé, moyen et faible) de même que chacun des six indicateurs de l'évaluation du risque de suicide ont été déterminés. Les calculs des courbes caractéristiques du fonctionnement du receveur (ROC) et de la zone située sous la courbe (ZSC) ont été créés pour les trois niveaux de risque de suicide et les six indicateurs. RÉSULTATS: Avoir au moins un faible niveau de risque de suicide (93,8 %) ou au moins un facteur de risque de suicide (94,6 %) procurait une sensibilité élevée. La spécificité était élevée si une personne avait au moins un niveau moyen de risque de suicide (94,2 %) ou au moins trois indicateurs de risque de suicide (96,7 %). La VPP était faible (8,9­16,2 %) et la VPN était élevée (94,9­99,3 %) pour tous les niveaux de risque de suicide. Le facteur de risque le plus sensible pour l'automutilation était des antécédents de comportement suicidaire ou des antécédents de suicide familiaux (94,6 %). Tous les indicateurs de risque avaient une faible VPP (7,4­23,1 %) et une VPN élevée (95,4­99,5 %). Un RVN très faible a été constaté chez ceux n'ayant pas de comportement suicidaire antérieur ni des antécédents de suicide familiaux (0,107). La ZSC était de 0,719 (IC à 95 % 0,692 à 0,746), indiquant un bon test. CONCLUSION: L'ISA est un instrument modérément exact pour identifier le risque d'automutilation chez les adolescents détenus.

A Population-Based Study of the Prevalence and Correlates of Self-Harm in Juvenile Detention.

BACKGROUND: Suicide is the number one cause of death among incarcerated youth. We examined the demographic and forensic risk factors for self-harm in youth in juvenile detention using a Canadian provincial correctional database. METHOD: We analyzed data from de-identified youth aged 12 to 18 at the time of their offense who were in custody in a Manitoba youth correctional facility between January 1, 2005 and December 30, 2010 (N = 5,102). Univariate and multivariate logistic regression analyses determined the association between staff-identified self-harm events in custody and demographic and custodial variables. Time to the event was examined based on the admission date and date of event. RESULTS: Demographic variables associated with self-harm included female sex, lower educational achievement, older age, and child welfare involvement. Custodial variables associated with self-harm included higher criminal severity profiles, younger age at first incarceration, longer sentence length, disruptive institutional behavior, and a history of attempting escape. Youth identified at entry as being at risk for suicide were more likely to self-harm. Events tended to occur earlier in the custodial admission. INTERPRETATION: Self-harm events tended to occur within the first 3 months of an admission stay. Youth with more serious offenses and disruptive behaviors were more likely to self-harm. Individuals with problematic custodial profiles were more likely to self-harm. Suicide screening identified youth at risk for self-harm. Strategies to identify and help youth at risk are needed.

Suicide and Deliberate Self-injurious Behavior in Juvenile Correctional Facilities: A Review.

OBJECTIVE: Describe the rates of suicidal ideation, self-injury, and suicide among detained youth as well as risk factors and preventive measures that have been attempted. METHOD: Literature searches in PubMed, PsycINFO, and the Social Science Citation Index were undertaken to identify published studies written in English. Governmental data was also included from English-speaking nations. RESULTS: The adjusted risk of suicide was 3 to 18 times higher than age-matched controls. The prevalence of lifetime suicidal ideation ranged from 16.9% to 59% while lifetime self-injury ranged from 6.2% to 44%. Affective disorders, borderline personality traits, substance use disorders, impulse control disorders, and anxiety disorders were associated with suicidal thoughts and self-injury. Screening for suicidal ideation upon entry was associated with a decreased rate of suicide. CONCLUSIONS: All youth should be screened upon admission. Identified co-morbid disorders should also be treated.

OBJECTIF: Décrire les taux d'idéation suicidaire, d'automutilation et de suicide chez les jeunes détenus ainsi que les facteurs de risque et les mesures préventives adoptées à l'essai. MÉTHODE: Des recherches de la littérature ont été entreprises dans PubMed, PsycINFO, et le Social Science Citation Index afin d'identifier les études publiées en anglais. Des données du gouvernement de nations anglophones ont également été incluses. RÉSULTATS: Le risque corrigé de suicide était de 3 à 18 fois plus élevé que chez les témoins du même âge. La prévalence de durée de vie de l'idéation suicidaire allait de 16,9% à 59% tandis que l'automutilation de durée de vie se situait entre 6,2% et 44%. Les troubles affectifs, les traits de la personnalité limite, les troubles liés à l'utilisation d'une substance, les troubles de contrôle des impulsions, et les troubles anxieux étaient associés aux pensées suicidaires et à l'automutilation. Le dépistage de l'idéation suicidaire à l'admission était associé à un risque moindre de suicide. CONCLUSIONS: Tous les jeunes devraient subir un dépistage à l'admission. Les troubles comorbides identifiés devraient aussi être traités.

Media use and health outcomes in adolescents: findings from a nationally representative survey.

OBJECTIVE: Examine the association between quantity of media use and health outcomes in adolescents. METHOD: Multiple logistic regression analyses were conducted with the Canadian Community Health Survey 1.1 (youth aged 12-19 (n=9137)) to determine the association between hours of use of television/videos, video games, and computers/Internet, and health outcomes including depression, alcohol dependence, binge drinking, suicidal ideation, help-seeking behaviour, risky sexual activity, and obesity. RESULTS: Obesity was associated with frequent television/video use (Adjusted Odds Ratio (AOR) 1.10). Depression and risky sexual behaviour were less likely in frequent video game users (AOR 0.87 and 0.73). Binge drinking was less likely in frequent users of video games (AOR 0.92) and computers/Internet (AOR 0.90). Alcohol dependence was less likely in frequent computer/Internet users (AOR 0.89). CONCLUSIONS: Most health outcomes, except for obesity, were not associated with using media in youth. Further research into the appropriate role of media will help harness its full potential.

Childhood maltreatment and threats with weapons.

The relationship between childhood maltreatment and future threats with weapons is unknown. We examined data from the nationally representative National Comorbidity Survey Replication (n = 5692) and conducted multiple logistic regression analyses to determine the association between childhood maltreatment and lifetime behavior of threatening others with a gun or other weapon. After adjusting for sociodemographic variables, physical abuse, sexual abuse, and witnessing domestic violence were significantly associated with threats made with a gun (adjusted odds ratios [AOR] ranging between 3.38 and 4.07) and other weapons (AOR ranging between 2.16 and 2.83). The greater the number of types of maltreatment experienced, the stronger the association with lifetime threats made to others with guns and any weapons. Over 94% of respondents who experienced maltreatment and made threats reported that the maltreatment occurred prior to threatening others with weapons. Prevention efforts that reduce exposure to maltreatment may reduce violent behavior in later life.

Mental disorder and threats made by noninstitutionalized people with weapons in the national comorbidity survey replication.

Controversy exists as to whether mental disorders are associated with a higher risk of violent behavior. Data from the nationally-representative National Comorbidity Survey Replication was examined. Multiple logistic regression was used to determine whether mood, anxiety, impulse control, and substance use disorders were associated with a higher rate of potentially violent behavior as assessed by threatening others with a gun or other weapon. After adjusting for sociodemographic factors, an association was found between mood, anxiety, impulse control, and substance use disorders and the rate of threatening others. A significant association was found between threats made against others with a gun and both substance use disorders (adjusted odds ratio [AOR] 2.27; 95% confidence interval [CI] 1.62-3.20) and impulse control disorders (AOR 2.67; 95% CI 1.95-3.66). Threats made against others with any other type of weapon were significantly associated with any anxiety (AOR 1.76; 95% CI 1.34-2.31), substance (AOR 2.63; 95% CI 1.87-3.71), or impulse control disorder (AOR 2.49; 95% CI 1.96-3.18). Of the disorders studied, social phobia, specific phobia, and impulse control disorders seemed to have their onset before the act of threatening others with weapons. This finding was also true for those who had attempted suicide. Further research is needed to determine whether treatment of mental disorders decreases the risk of violence in this population.

Recurrent priapism during treatment with clozapine, quetiapine and haloperidol.

The following is a letter to the editor that represents a case of recurrent priapism. The patient received clozapine, quetiapine and haloperidol and had the adverse reaction of priapism, one episode of which required surgical intervention. This case highlights the need for physicians to be aware of the potential for this serious adverse effect and to be especially mindful to carefully monitor those patients who have already had one episode of priapism as they may be at risk for recurrence.