Integrated approach needed for reducing crime in bipolar disorder patients
medwireNews: Criminal justice problems are relatively common among patients with bipolar disorder, but researchers have identified an array of risk factors that they believe will provide guidance when evaluating patients and identifying preventive strategies.
A range of historical, clinical, and contextual factors were found to increase the risk for criminal involvement, but two multivariate analyses indicated the risk was particularly high for patients who were unemployed (odds ratio [OR]=3.89-4.27), of non-White race (OR=3.68-3.93), who had previously been detained as juveniles (OR=4.25-5.17), had a prior arrest while manic or using drugs (OR=3.28-3.62), used illicit drugs in the past year (OR=3.31-3.98), or showed both social and occupational impairment (OR=4.75-4.80).
Patrick McCabe (University of Massachusetts Medical School, USA) and team note that a lot of these factors also increase the risk for criminal involvement in the general population.
As a result, "approaches to reduce [criminal] involvement will require that these issues be dealt with in the broader context of mental health and other services, including access to appropriate healthcare."
They add: "To be most effective, such care needs to be integrated and coordinated between criminal justice and community-based providers and initiated when the earliest evidence for criminal involvement emerge."
The factors were identified based on 34,508 wave 2 respondents of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) with valid responses to the mania section. At least one manic episode in the past 3 years was reported for 623 of the respondents, of these 62 (10.8%) had involvement with the criminal justice system during their self-identified most severe episode.
The researchers comment in the Journal of Affective Disorders on the heightened risk associated with past juvenile detention, saying that to mitigate a "chronic pattern of criminal activity," it will be important to intervene with "evidence-based diversion programs rather than traditional criminal or juvenile justice processing."
They say the "most successful efforts are likely to be those in which a close coordination between the juvenile justice and community-based mental health systems exists and where the juvenile justice system plays a more distinct role in treatment delivery."
Poor access to appropriate mental healthcare and lower rates of use is also an important consideration, and may account for some of the increased risk among ethnic minority groups, say McCabe and team. They also found that the risk for arrest among patients with both social and occupational impairment was concentrated in those without health insurance.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Lucy Piper, Senior medwireNews Reporter