Reliability of prisoners' survey responses: comparison of self-reported health and biomedical data from an australian prisoner cohort.

OBJECTIVE: Prisoner health surveys primarily rely on self-report data. However, it is unclear whether prisoners are reliable health survey respondents. This paper aimed to determine the level of agreement between self-report and biomedical tests for a number of chronic health conditions. METHOD: This study was a secondary analysis of existing data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey. The health surveys were cross-sectional in nature and included a stratified random sample of men (n=2,114) from all NSW prisons. Self-reported histories of hepatitis, sexually transmissible infections, and diabetes were compared to objective biomedical measures of these conditions. RESULTS: Overall, the sensitivity (i.e., the respondents who self-reported having the condition also had markers indicative of the condition using biomedical tests) was high for hepatitis C (96%) and hepatitis B (83%), but low for all other assessed conditions (ranging from 9.1% for syphilis using RPR to 64% for diabetes). However, Kappa scores indicated substantial agreement only for hepatitis C. That is, there were false positives and false negatives which occurred outside of chance leading to poor agreement for all other assessed conditions. CONCLUSIONS: Prisoners may have been exposed to serious health conditions while failing to report a history of infection. It may be possible that prisoners do not get tested given the asymptomatic presentation of some conditions, were unaware of their health status, have limited health-service usage preventing the opportunity for detection, or are subject to forgetting or misunderstanding prior test results. These findings demonstrate the importance of the custodial environment in screening for health conditions and referral for treatment should this be needed. Testing on entry, periodically during incarceration, and prior to release is recommended.

Implications of sex offender classification on reporting demographic characteristics, health, and criminal careers: results from an Australian jurisdiction.

BACKGROUND: Cross-sectional and retrospective offence data are often used to classify sex offenders in epidemiological and survey research, but little empirical evidence exists regarding the practical implications of this for applied research. This study describes the classification of sex offenders from a cohort of prisoners recruited as part of an Australian inmate health survey and the implications for reporting results. METHODS: Data-linkage was used to join the New South Wales (NSW) Inmate Health Surveys to the states re-offending database to identify men with histories of sexual offending. Sex offenders were classified into men who sexually offended against children only (ChildSOs), against adults only (AdultSOs), and men who sexually offended against both children and adults (Age-PolySOs). RESULTS: Using historical offending data rather than the current offence information only, an additional 35.4% of men with histories of sexual offences were identified. Differences were found between the three sex offender subgroups in terms of demographic characteristics, health, and criminal careers. Age-PolySOs reported higher educational attainment, were less likely to report being self-employed, single marital status, and having children. Half the ChildSOs self-reported a mental health issue and half of the ChildSOs and Age-PolySOs reported four or more chronic health conditions. Age-PolySOs were older than the other sex offender groups when committing their first non-sexual, non-violent crime (M = 43.2 years, SD = 13.8); violent crime (M = 39.5 years, SD = 11.1); and sexual crime (M = 47.8 years, SD = 11.2). Age-PolySOs also committed more sexual offences (M = 5.91, SD = 11.2) compared to those who only offended against one victim age group. CONCLUSION: These findings suggested that historical offending records should be used to more accurately identify sex offender subgroups and that differences in demographic, health, and criminal careers exist for the different sex offender subgroups.

Physical health status of individuals convicted of sexual offences: Results from an Australian prisoner cohort.

Although the poor health of prisoners poses a serious public health problem, very little is known about the health of specific offender groups. Three waves of an Australian Inmate Health Survey were used to describe the self-reported and objectively tested health of men incarcerated for sexual offences against children only (ISOC), adults only (ISOA), and against both (age-polymorphous; ISOP) compared to men incarcerated without sexual offences. ISOC and ISOP were found to have the poorest self-reported health of all groups, with higher rates of eyesight and cardiovascular problems; however, lower rates of Hepatitis B and Hepatitis C as objectively measured. There are important implications for the correctional and public health systems for addressing the health needs of specific offenders.

Predicting attrition of men with a history of violence from randomised clinical trials.

Preventing dropout (attrition) from clinical trials is vital for improving study validity. Dropout is particularly important in justice-involved populations as they can be very challenging to engage and recruit in the first instance. This study identifies factors associated with dropout in a double-blind, placebo-controlled randomised control trial of a selective serotonin reuptake inhibitor (SSRI) aimed at reducing reoffending in highly impulsive men with histories of violent offending. Age, education, social support, psychiatric history, and length of previous incarceration were identified as factors that predict attrition. These findings are consistent with previous research examining variables associated with attrition in clinical trials for community and offender populations. We also explored referral source and treatment allocation as attrition predictors. Although neither significantly predicted attrition, we identified that there are discernible differences in the median time to attrition among the referral source subgroups. Understanding factors that predict treatment completion and attrition will allow researchers to identify participants for whom additional provisions may optimise retention and inform development of targeted interventions.

Self-harm and suicidality among three subgroups of male sex offenders: results from an Australian prisoner cohort.

OBJECTIVE: Prisoners complete suicide and self-harm more frequently than members of the community. Sex offenders have been found to be at greater risk of engaging in these behaviours. This study examines the characteristics, prevalence, and predictors of self-harm and suicide attempts among: sex offenders that only victimise children (ChildSOs); adults (AdultSOs); or both (age-crossover polymorphous; PolySOs). METHODS: Data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey was linked to the State's re-offending database to identify men with histories of sexual offending. The health surveys captured self-report data on self-harm and suicidality. RESULTS: Non-sexual violent offenders (15%) and AdultSOs (14%) had the highest rate of self-harm, significantly more than ChildSOs (11%), non-sexual non-violent offenders (10%), and PolySOs (0%). Several factors significantly predicted self-harm at the bivariate level for both ChildSOs and AdultSOs, with unique predictors for each group. At the multivariate level, manic-depression trended towards significance for ChildSOs and any mental health condition remained a significant predictor for AdultSOs who self-harmed relative to AdultSOs who had not (aOR = 11.989, 95%CI [1.14, 126.66]). Approximately 23% of AdultSOs, 22% of PolySOs, and 19% of ChildSOs reported a suicide attempt throughout their lifetime, whereas only 15% of non-sexual non-violent offenders reported an attempt. At the bivariate level, few factors were significant for ChildSOs while several factors were significant for AdultSOs. At the multivariate level, a diagnosis of depression and treatment with psychiatric medication trended towards being significant predictors of suicide attempts for ChildSOs. In contrast, treatment with psychiatric medication (aOR = 25.732, 95%CI [1.91, 347.19])] remained a significant predictor for AdultSOs who attempted suicide relative to AdultSOs who had not, as well as historical psychiatric hospitalisation (aOR = 6.818, 95%CI [1.04, 44.82]) and self-harm (aOR = 5.825, 95%CI [1.31, 25.99]). CONCLUSION: Sex offenders are at significantly higher risk of attempting and completing suicide relative to non-sexual non-violent offenders and warrant special attention. The prevalence rates and predictors of self-harm and suicidality suggest differences between sex offender subgroups may exist. These hold implications for the criminal justice and public health systems for addressing needs and identifying those most at risk of self-harm and suicide.