Women prisoners are known to suffer from an accumulation of factors known to increase the risk for several major health problems. This study examines the prevalence of adverse childhood experiences (ACE) and the relationship between such experiences and suicide attempts and drug use among incarcerated women in Norway.
A total of 141 women inmates (75% of all eligible) were interviewed using a structured interview guide covering information on demographics and a range of ACE related to abuse and neglect, and household dysfunction. The main outcome variables were attempted suicide and adult drug abuse.
Emotional, physical and sexual abuse during childhood was experienced by 39%, 36% and 19%, respectively, and emotional and physical neglect by 31% and 33%, respectively. Looking at the full range of ACE, 17% reported having experienced none, while 34% reported having experienced more than five ACEs. After controlling for age, immigrant background and marital status, the number of ACEs significantly increased the risk of attempted suicide and current drug abuse.
The associations observed between early life trauma and later health risk behaviour indicate the need for early prevention. The findings also emphasize the important role of prison health services in secondary prevention among women inmates.
Secular trends in the criminal activity of conduct disordered adolescents admitted as psychiatric in-patients in Norway were examined. A nationwide sample of 650 adolescents hospitalised with DSM-IV Conduct Disorder during the years 1963-1990 was followed up 12-33 years after index hospitalisation by register linkage to the National Crime Register. In all, 469 patients, 82% of the males and 57% of the females, had a criminal record at follow-up. The study population was divided into four consecutive cohorts and gender-specific cohort differences in registered criminality were investigated, using survival analysis. There was a marked increase and subsequent levelling off in overall registered criminality from the first to the most recent cohort of conduct disordered females, in contrast to unchanged crime rates in conduct disordered males. Monitoring specific types of crime, males' violent crime rates initially increased but levelled off in more recent cohorts, whereas female violent crime rates increased steadily, with the highest level seen in the most recent cohort. A marked increase in drug offences was observed in both genders. Cox regression demonstrated numerous strong cohort effects, even when controlling for other important factors, including substance use comorbidity. Research into causal mechanisms is warranted.
Filicide is the tragic crime of murdering one's own child. Previous research has found that the offending parents are commonly depressed and that suicide is often associated as an actual act or an intention. Yet, filicide is an underreported crime and previous studies have been strained with methodological problems. No comprehensive international studies on filicide have been presented in the literature until now.
This was a descriptive, comprehensive, register-based study of all filicides in Austria and Finland during 1995-2005. Filicide-suicide cases were also included.
Most of the perpetrators were the biological mothers; in Austria 72%, in Finland 52%. Suicide followed filicide either as an attempt or a fulfilled act in 32% and 54% of the cases in Austria and Finland, respectively. Psychotic mood disorders were diagnosed for 10% of the living perpetrators in Austria, and 12% in Finland. Non-psychotic depression was diagnosed in 9% of surviving perpetrators in Austria, 35% in Finland.
The data from the two countries demonstrated that filicide is such a multifaceted and rare phenomenon that national data from individual countries seldom offer sufficient scope for its thorough study. Further analyses are needed to produce a complete picture of filicide.
Prisoners are associated with high health care needs compared with the general population. This study aims to investigate prisoners' use of health service.
A cross-sectional study of 29 prisons in central and southern parts of Norway. A questionnaire was distributed to 1, 454 prisoners (90% response rate). Multilevel analyses were employed to analyse help seeking behaviour among the prisoners.
Help seeking was substantially associated with sleep problems and drug problems. There was also a tendency for closed prisons as well as high staffing levels of healthcare professionals to be associated with elevated health care use.
This study suggests that sleep problems and drug use are most frequently associated with health service use. The differences in health care use between prisons suggest that the implementation of prison health care standards should be addressed.
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Few longitudinal studies have explored lifetime criminality in adults with a childhood history of severe mental disorders. In the present study, we wanted to explore the association between adult delinquency and several different childhood diagnoses in an in-patient population. Of special interest was the impact of disturbance of activity and attention (ADHD) and mixed disorder of conduct and emotions on later delinquency, as these disorders have been variously associated with delinquent development.
Former Norwegian child psychiatric in-patients (n = 541) were followed up 19-41 years after hospitalization by record linkage to the National Register of Criminality. On the basis of the hospital records, the patients were re-diagnosed according to ICD-10. The association between diagnoses and other baseline factors and later delinquency were investigated using univariate and multivariate Cox regression analyses.
At follow-up, 24% of the participants had been convicted of criminal activity. In the multivariate Cox regression analysis, conduct disorder (RR = 2.0, 95%CI = 1.2-3.4) and hyperkinetic conduct disorder (RR = 2.7, 95% CI = 1.6-4.4) significantly increased the risk of future criminal behaviour. Pervasive developmental disorder (RR = 0.4, 95%CI = 0.2-0.9) and mental retardation (RR = 0.4, 95%CI = 0.3-0.8) reduced the risk for a criminal act. Male gender (RR = 3.6, 95%CI = 2.1-6.1) and chronic family difficulties (RR = 1.3, 95% CI = 1.1-1.5) both predicted future criminality.
Conduct disorder in childhood was highly associated with later delinquency both alone or in combination with hyperactivity, but less associated when combined with an emotional disorder. ADHD in childhood was no more associated with later delinquency than the rest of the disorders in the study population. Our finding strengthens the assumption that there is no direct association between ADHD and criminality.
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The mortality in prisoners is high. However, our knowledge about the mortality in convicted offenders, irrespective of incarceration history, is limited. Our aim was to investigate possible predictors for over-all and cause specific mortality in a nation-wide study of convicted offenders with and without previous imprisonment. This case-control study drew random samples of deceased and living offenders (N = 1,112) from four complete cohorts of convicted offenders, two male (born 1967 and 1977, respectively), and two female (born 1967-70 and 1977-80, respectively). All criminal records were systematized and information about date and cause of death was collected on those deceased. Multivariable analyses demonstrated that age at first court conviction (OR = 0.88, 95% CI = 0.84-0.93), drug related crimes (OR = 1.99, 95% CI = 1.23-3.22), and crime diversity (1.51, 95% CI = 1.07-2.13) were significant predictors of premature death in males. In females, age at first court conviction (OR = 0.92, 95% CI = 0.88-0.97), drug related crimes (OR = 2.24, 95% CI = 1.37-3.69) and belonging to the oldest cohort (OR = 2.10, 95% CI = 1.35-3.26) were significant predictors of premature death. Age at first court conviction remained a significant predictor for death in all cause specific multivariable mortality analyses. In addition, having committed drug related crimes and high crime diversity were strong predictors for substance related deaths. Males did more often die in accidents or commit suicide. Somatic deaths were most often encountered in the oldest cohort. Incarceration did not remain a significant predictor for premature death in any of the multivariable analyses. Measures intended to prevent premature death in convicted offenders should target wider populations than hitherto acknowledged.
Incarceration of young people should be avoided according to Norwegian policy. Even so, young people reside in our prisons at all times. Our aim was to investigate their mental health.
Among 42 teenage boys (below 20 years of age) remanded to prison, 40 consented to participate in the study. Socio-demographic data were collected and a structured diagnostic instrument (K-SADS) was used to assess their mental health.
Only four participants had no mental disorder. The 36 who had mental disorders had a mean of 2.5 diagnoses. The most common diagnosis was substance abuse/dependence (n = 31). 30 of the adolescents had serious conduct disorders and nine of them fulfilled the ICD-10 criteria for a dissocial personality disorder. Anxiety and/or depressive disorders (n = 14) and hyperkinetic disorders (n = 12) were also frequent. Many of the adolescents had unmet treatment needs in addition to large social problems, such as disrupted education and unemployment. Three of four adolescents had an immigrant background.
Teenage boys remanded to prison have a variety of complex problems. They have an extensive need for psychiatric treatment, drug treatment, education and employment. This calls for multidisciplinary coordinated interventions to avoid further negative development of chronic maladjustment with substance abuse, mental problems and crime.
In a Norwegian follow-up study of former adolescent psychiatric in-patients 222 patients who had committed violent crimes were compared to 287 patients who had committed non-violent crimes only. There were numerous significant differences between the criminal careers of violent and non-violent criminals. Individuals with a history of violent criminality only were uncommon and uncharacteristic of violent criminals in general. Regression analyses identified several strong and independent correlates of violent criminality. The study supported a division of antisocial behavior into violent and non-violent sub-groups, thus paralleling a concept of overt and covert pathways to delinquent behavior. The overt pathway seemed to be imbedded in the covert pathway.
In 1939, Lionel Penrose published a cross-sectional study from 18 European countries, including the Nordic, in which he demonstrated an inverse relationship between the number of mental hospital beds and the number of prisoners. He also found strong negative correlations between the number of mental hospital beds and the number of deaths attributed to murder. He argued that by increasing the number of mental institution beds, a society could reduce serious crimes and imprisonment rates. The aim of the study was to test Penrose's theories longitudinally by monitoring the capacity of all psychiatric institutions and prisons in a society over time. From official statistics, we collected and systematized all relevant information regarding the number of mental institution beds and prisoners in Norway during the years 1930-2004, along with major crime statistics for the same period. During the years 1930-59, there was a 2% population-adjusted increase in mental institution beds and a 30% decrease in the prison population. During 1960-2004, there was a 74% population-adjusted decrease in mental institution beds and a 52% increase in the prison population. The same period saw a 500% increase in overall crime and a 900% increase in violent crimes, with a concurrent 94% increase in the size of the country's police force. Penrose's law proved remarkably robust in the longitudinal perspective. As opposed to Penrose, however, we argue that the rise in crime rates only to a very limited extent can be attributed to mental health de-institutionalization.
Comment In: Nord J Psychiatry. 2009;63(3):26719306155
The objective of the study was to investigate the gender-specific prevalence of emotional and behavioural problems in children and adolescents in out-of-home childcare, compared with patients in child and adolescent psychiatric institutions. The total population of clients in residential childcare institutions in Oslo, Norway, was investigated by the use of standardized questionnaires (Achenbach's Child Behavior Checklist and Youth Self Report) and compared to all same-aged patients residing in child and adolescent psychiatric institutions in the same area at the same time. Boys in residential childcare had emotional and behavioural problem levels comparable to boys in child and adolescent psychiatric institutions, as measured by the questionnaires. Girls in residential childcare did not reach problem levels as high as those found in girls in psychiatric institutions, but problem levels were still well above those found in the general population. It was concluded that institutionalized childcare clients had a high prevalence of behavioural and emotional problems, as measured by Achenbach's Child Behavior Checklist and Youth Self Report.