Dual diagnosis: prevalence, risk factors, and relationship with suicide risk in a nationwide sample of French prisoners.
BACKGROUND
Axis I psychiatric disorders (PD) and substance use disorders (SUD) are common in prison, but only few studies have focused on their association in this setting. Dual diagnosis (DD) (the co-occurrence of a SUD and any axis I disorder) is known to have a poorer prognosis and to require more intense supportive care.


OBJECTIVE
The objectives of this study were (1) to describe prisoners with DD (prevalence and characteristics); (2) to compare DD prisoners with 3 other groups of prisoners: no diagnosis (ND), SUD alone, or other isolated PD; and (3) to evaluate the impact of DD on suicide risk in prison.


METHODS
A random stratified strategy was used to select 23 various types of prisons and 998 prisoners. Diagnoses were assessed using a unique procedure, each prisoner being evaluated by 2 psychiatrists, 1 junior, using a structured interview (MINI 5 plus), and 1 senior, using an open clinical interview. Following interviews, clinicians met to establish a list of diagnoses. Cloninger's temperament and character inventory was also used.


RESULTS
Of the prisoners, 26.3% had a DD. DD prevalence was almost 80% in prisoners with SUD, while only one-third of the prisoners with an axis I PD had co-morbid SUD. No significant differences were observed in drug use patterns between DD and SUD without co-morbid PDs. DD showed the strongest association with suicide risk [OR = 5.7 (1.7-4.6)].


CONCLUSIONS
DD is very frequent in prison and is a major risk factor for suicide. Systematic psychiatric/SUD screening of prisoners with either a SUD or an axis I PD should be encouraged.
Lukasiewicz
Michael
M
Université Paris-Sud, U669, and Université Paris-V, Paris, France. michael.lukasiewicz@gmail.com
Blecha
Lisa
L
Falissard
Bruno
B
Neveu
Xavier
X
Benyamina
Amine
A
Reynaud
Michel
M
Gasquet
Isabelle
I
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners / Q000523:psychology*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D013405:Suicide / Q000523:psychology; D055815:Young Adult; D000092864:Suicide Prevention