title: Patterns of justice involvement among adults with schizophrenia and bipolar disorder: key risk factors.
abstract: OBJECTIVE
  Adults with serious mental illness have a relatively high risk of criminal justice involvement. Some risk factors for justice involvement are known, but the specific interaction of these risk factors has not been examined. This study explored the interaction of gender, substance use disorder, and psychiatric diagnosis among patients with schizophrenia or bipolar disorder to identify subgroups at higher risk of justice involvement.
  
  
  METHODS
  Administrative service records of 25,133 adults with schizophrenia or bipolar disorder who were clients of Connecticut's public behavioral health system during 2005-2007 were merged with state records of criminal convictions, incarceration, and other measures of justice involvement. The main effects and the effects of interactions of gender, substance use disorder, and psychiatric diagnosis on risk of justice involvement ("offending") were estimated by using multivariable logistic regression.
  
  
  RESULTS
  Men with bipolar disorder and co-occurring substance use disorder had the highest absolute risk of offending in every category of justice involvement. For both men and women, bipolar disorder was associated with an increased risk of offending versus schizophrenia, but the increase was significantly greater for women. Substance use disorder also increased risk of offending more among women than men, especially among those with schizophrenia.
  
  
  CONCLUSIONS
  Men and women with bipolar disorder and substance use disorders have much higher risk of justice involvement than those with schizophrenia, especially those without a substance use disorder. Research is needed to validate these effects in other populations and specify risk factors for justice involvement among adults with mental illness.
authors.affiliation: Dr. Robertson, Dr. Swanson, and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail: allison.gilbert@duke.edu). Dr. Frisman and Dr. Lin are with the School of Social Work, University of Connecticut, West Hartford.
authors.forename: Allison G
authors.initials: AG
authors.lastname: Robertson
authors.affiliation: Dr. Robertson, Dr. Swanson, and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail: allison.gilbert@duke.edu). Dr. Frisman and Dr. Lin are with the School of Social Work, University of Connecticut, West Hartford.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Swanson
authors.affiliation: Dr. Robertson, Dr. Swanson, and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail: allison.gilbert@duke.edu). Dr. Frisman and Dr. Lin are with the School of Social Work, University of Connecticut, West Hartford.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Frisman
authors.affiliation: Dr. Robertson, Dr. Swanson, and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail: allison.gilbert@duke.edu). Dr. Frisman and Dr. Lin are with the School of Social Work, University of Connecticut, West Hartford.
authors.forename: Hsiuju
authors.initials: H
authors.lastname: Lin
authors.affiliation: Dr. Robertson, Dr. Swanson, and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail: allison.gilbert@duke.edu). Dr. Frisman and Dr. Lin are with the School of Social Work, University of Connecticut, West Hartford.
authors.forename: Marvin S
authors.initials: MS
authors.lastname: Swartz
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D003416:Criminal Law / Q000706:statistics & numerical data; D057237:Criminals / Q000706:statistics & numerical data*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology*; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology