Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release
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Importance: Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk. Objective: To investigate the associations between major classes of psychotropic medications and violent reoffending. Design, Setting, and Participants: This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013. Exposures: Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure. Main Outcomes and Measures: Violent crime after release from prison. Results: The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years. Conclusions and Relevance: Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.
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Treatment discontinuation places individuals with ADHD at higher risk for catastrophic outcomes, such as motor vehicle crashes, criminality, including drug-related crimes and violent reoffending, depression, interpersonal issues, and other injuries.
“Treatment discontinuation also places individuals with ADHD at higher risk for catastrophic outcomes, such as motor vehicle crashes78,79; criminality, including drug-related crimes77 and violent reoffending76; depression71; interpersonal issues80; and other injuries.81,82”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [76]
The Results and Sensitivity Analyses (page unavailable) associate psychostimulant treatment with lower violent reoffending rates, including among released prisoners diagnosed with ADHD. The claim overstates this as a causal effect of treatment discontinuation in individuals with ADHD generally; the Discussion explicitly says the observational study cannot prove causality. This citation is attached to violent reoffending, not the other listed outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThey have increased rates of incarceration.
“They also have lower educational achievement than those without ADHD73,74 and increased rates of incarceration.75–77”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [76]
The Discussion (page unavailable) mentions ADHD among prisoners, and the Results examine violent reoffending in prisoners with ADHD. Neither compares incarceration rates for people with and without ADHD. Searches for ADHD, imprisonment, and incarceration risk found no passage making that comparison. (LLM, conf=0.76)
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Cites
Leucht, S., Tardy, M., Komossa, K., Heres, S., Kissling, W., Salanti, G., & Davis, J. M. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60239-6 · Cited by 931 · see citing works
Substance abuse and dependence in prisoners: a systematic review
Fazel, S., Bains, P., & Doll, H. (2006) · Addiction · doi:10.1111/j.1360-0443.2006.01316.x · Cited by 839 · see citing works
Self-citationSchizophrenia, substance abuse, and violent crime
Fazel, S. (2009) · JAMA · doi:10.1001/jama.2009.675 · Cited by 726 · see citing works
Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety
Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009) · JAMA · doi:10.1001/jama.2008.976 · Cited by 583 · see citing works
Major Mental Disorders and Criminal Violence in a Danish Birth Cohort
Brennan, P. A., Mednick, S. A., & Hodgins, S. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.5.494 · Cited by 518 · see citing works
Huhn, M., Tardy, M., Spineli, L. M., Kissling, W., Förstl, H., Pitschel-Walz, G., Leucht, C., Samara, M., Dold, M., Davis, J. M., et al. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.112 · Cited by 333 · see citing works
Ginsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H. P. (2014) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.13r01600 · Cited by 274 · see citing works
Flagged first, then by citations
Research works printed but not linked: 25
- [4]Lamb HR Weinberger LE Decarceration of US jails and prisons: where will persons with serious mental illness go? J Am Acad Psychiatry Law 2014 42 4 489 494 25492076
- [5]McGuire J A review of effective interventions for reducing aggression and violence Philos Trans R Soc Lond B Biol Sci 2008 363 1503 2577 2597 18467276 PMC2606715
- [6]Chang Z Larsson H Lichtenstein P Fazel S Psychiatric disorders and violent reoffending: a national cohort study of convicted prisoners in Sweden Lancet Psychiatry 2015 2 10 891 900 26342957 PMC4629414
- [7]Fazel S Seewald K Severe mental illness in 33,588 prisoners worldwide: systematic review and meta-regression analysis Br J Psychiatry 2012 200 5 364 373 22550330
- [9]Fazel S Zetterqvist J Larsson H Långström N Lichtenstein P Antipsychotics, mood stabilisers, and risk of violent crime Lancet 2014 384 9949 1206 1214 24816046 PMC4165625
- [10]Lichtenstein P Halldner L Zetterqvist J Medication for attention deficit-hyperactivity disorder and criminality N Engl J Med 2012 367 21 2006 2014 23171097 PMC3664186
- [11]Frankle W Shera D Berger-Hershkowitz H Clozapine-associated reduction in arrest rates of psychotic patients with criminal histories Am J Psychiatry 2001 158 2 270 274 11156810
- [12]Dailey LF Townsend SW Dysken MW Kuskowski MA Recidivism in medication-noncompliant serious juvenile offenders with bipolar disorder J Clin Psychiatry 2005 66 4 477 484 15816790
- [13]McMurran M What works in substance misuse treatments for offenders? Crim Behav Ment Health 2007 17 4 225 233 17902119
- [14]Gibbons RD Amatya AK Brown CH Post-approval drug safety surveillance Annu Rev Public Health 2010 31 419 437 20070192 PMC2841706
- [15]Bulloch AG Patten SB Non-adherence with psychotropic medications in the general population Soc Psychiatry Psychiatr Epidemiol 2010 45 1 47 56 19347238
- [16]Ludvigsson JF Otterblad-Olausson P Pettersson BU Ekbom A The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research Eur J Epidemiol 2009 24 11 659 667 19504049 PMC2773709
- [18]Wettermark B Hammar N Fored CM The new Swedish Prescribed Drug Register–opportunities for pharmacoepidemiological research and experience from the first six months Pharmacoepidemiol Drug Saf 2007 16 7 726 735 16897791
- [20]Andrews DA Bonta J The Psychology of Criminal Conduct 5th ed London, England Routledge 2010
- [23]Chang Z Lichtenstein P D’Onofrio BM Sjölander A Larsson H Serious transport accidents in adults with attention-deficit/hyperactivity disorder and the effect of medication: a population-based study JAMA Psychiatry 2014 71 3 319 325 24477798 PMC3949159
- [24]Webb RT Lichtenstein P Larsson H Geddes JR Fazel S Suicide, hospital-presenting suicide attempts, and criminality in bipolar disorder: examination of risk for multiple adverse outcomes J Clin Psychiatry 2014 75 8 e809 e816 25191918 PMC4226039
- [26]Skeem JL Manchak S Peterson JK Correctional policy for offenders with mental illness: creating a new paradigm for recidivism reduction Law Hum Behav 2011 35 2 110 126 20390443
- [27]Coid JW Ullrich S Kallis C The relationship between delusions and violence: findings from the East London First Episode Psychosis Study JAMA Psychiatry 2013 70 5 465 471 23467760
- [28]Keers R Ullrich S Destavola BL Coid JW Association of violence with emergence of persecutory delusions in untreated schizophrenia Am J Psychiatry 2014 171 3 332 339 24220644
- [29]Chang Z Lichtenstein P Asherson PJ Larsson H Developmental twin study of attention problems: high heritabilities throughout development JAMA Psychiatry 2013 70 3 311 318 23303526
- [30]Polanczyk G Rohde LA Epidemiology of attention-deficit/hyperactivity disorder across the lifespan Curr Opin Psychiatry 2007 20 4 386 392 17551354
- [32]Pearson FS Lipton DS A meta-analytic review of the effectiveness of corrections-based treatments for drug abuse Prison J 1999 79 4 384 410 10.1177/0032885599079004003 · DOI
- [33]Mitchell O Wilson DB MacKenzie DL Does incarceration-based drug treatment reduce recidivism? a meta-analytic synthesis of the research J Exp Criminol 2007 3 4 353 375 10.1007/s11292-007-9040-2 · DOI
- [34]Rich JD McKenzie M Larney S Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial Lancet 2015 386 9991 350 359 26028120 PMC4522212
- [36]Binswanger IA Stern MF Deyo RA Release from prison—a high risk of death for former inmates N Engl J Med 2007 356 2 157 165 17215533 PMC2836121
Cited by
Sorted by citations
Subcommittee on Attention-Deficit/Hyperactivity Disorder, S. C. O. Q. I. A. M. (2011) · Pediatrics · doi:10.1542/peds.2011-2654 · Cited by 2,185 · see citing works
Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., et al. (2019) · Pediatrics · doi:10.1542/peds.2019-2528 · Cited by 1,410 · see citing works
“70 It is indicated in prospective studies that patients with ADHD, whether treated or not, are at increased risk for early death, suicide, and increased psychiatric The KASs are presented, followed by information on medication, psychosocial treatments, and special circumstances.”
Tiihonen, J., Mittendorfer-Rutz, E., Majak, M., Mehtälä, J., Hoti, F., Jedenius, E., Enkusson, D., Leval, A., Sermon, J., Tanskanen, A., et al. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.1322 · Cited by 670 · see citing works
Risk factors for interpersonal violence: an umbrella review of meta-analyses
Fazel, S., Smith, E. N., Chang, Z., & Geddes, J. R. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2018.145 · Cited by 185 · see citing works
Self-citationCoghill, D., Banaschewski, T., Cortese, S., Asherson, P., Brandeis, D., Buitelaar, J., Daley, D., Danckaerts, M., Dittmann, R. W., Doepfner, M., et al. (2023) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-021-01871-x · Cited by 180 · see citing works
Yoon, I. A., Slade, K., & Fazel, S. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000214 · Cited by 167 · see citing works
Self-citationMolero, Y., Zetterqvist, J., Binswanger, I. A., Hellner, C., Larsson, H., & Fazel, S. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.17101112 · Cited by 60 · see citing works
Self-citation
- Authors
- Chang, Z., Lichtenstein, P., Långström, N., Larsson, H., & Fazel, S.
- Affiliations
- Warneford Hospital (GB)
- Karolinska Institutet (SE)
- Uppsala University (SE)
- Örebro University (SE)
- Corresponding author
- Fazel, Seena
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2016-11-01
- Volume
- 316
- Issue
- 17
- Pages
- 1798
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC5100822
- OpenAlex
- W2548550313
- Cited by
- 130
- References
- 7
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 21 · 2023: 13 · 2022: 15 · 2021: 12 · 2020: 7 · 2019: 10 · 2018: 24 · 2017: 10 · 2016: 1
- FWCI
- 42.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Wellcome Trust (095806)
- National Institute of Mental Health (R01MH102221)
- Topics
- Social Sciences › Sociology and Political Science › Criminal Justice and Corrections Analysis
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- violent reoffending, prisoner release, psychotropic drugs, antipsychotic drugs, psychostimulants, antidepressants, antiepileptic drugs, recidivism, medication dispensing, prison overcrowding
- MeSH terms
- Adolescent, Adult, Aftercare, Crime, Female, Humans, Male, Middle Aged, Drug Prescriptions, Prisoners, Psychotherapy, Psychotropic Drugs, Sweden, Violence, Cohort Studies, Substance-Related Disorders
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