title: Psychiatric diagnosis and differential risks of offending following discharge.
abstract: Psychiatric diagnosis is not considered a risk factor for offending following discharge. However, treatment interventions and aftercare are strongly influenced by clinical primary diagnosis. We compared differential risks of reoffending of patients falling into six primary diagnostic categories following discharge from Medium Secure Units in the UK: schizophrenia/schizoaffective disorder; delusional disorder; mania/hypomania; depressive disorder; organic brain syndrome; personality disorder. We followed up 1344 patients, on average 6.2 years (SD=2.1) at risk, discharged from 7 of 14 Regional Medium Secure services in England and Wales. Outcomes were period prevalence, incidence, and cumulative probability of criminal conviction. Established demographic and criminal history predictors of reoffending were observed across different diagnostic categories. Risks of all offending were increased for personality disorder, violence/acquisitive offending for delusional disorder, sexual offending for mania/hypomania and violence/acquisitive offending for organic brain syndrome. Patterns of risk over time differed markedly between categories of mental disorder. Most patients with personality disorder who offended violently did so within 4 years of discharge. A subgroup with delusional disorder demonstrated increased risk of violent offending 5 years after discharge. Differential risks of reoffending are observed between different diagnostic groups. Clinical diagnosis should be included together with established risk measures in risk management following discharge. Close supervision of patients with personality disorder should begin immediately after discharge when risks of reoffending are greatest. For delusional disorder further investigation is needed into the marked increase in risk of violence after 5 years.
authors: Violence Prevention Research Unit, Queen Mary University of London, Garrod Building, Turner Street, London E1 2AD, England, UK.
authors: Jeremy W
authors: JW
authors: Coid
authors: West China School of Public Health, Sichuan University, 29 Wangjiang Rd, Wuhou, Chengdu, Sichuan, China.
authors: Min
authors: M
authors: Yang
authors: Violence Prevention Research Unit, Queen Mary University of London, Garrod Building, Turner Street, London E1 2AD, England, UK. Electronic address: s.ullrich@qmul.ac.uk.
authors: Simone
authors: S
authors: Ullrich
authors: Department of Medicine, Imperial College London, London SW7 2AZ, UK.
authors: Nicole
authors: N
authors: Hickey
authors: Three Bridges Unit, Ealing Hospital, Uxbridge Road, Southall UB1 3HW, UK.
authors: Nadji
authors: N
authors: Kahtan
authors: Violence Prevention Research Unit, Queen Mary University of London, Garrod Building, Turner Street, London E1 2AD, England, UK.
authors: Mark
authors: M
authors: Freestone
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis; D003415:Crime / Q000331:legislation & jurisprudence / Q000523:psychology* / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D010351:Patient Discharge / Q000331:legislation & jurisprudence*; D010554:Personality Disorders / Q000175:diagnosis; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis; D012563:Schizophrenia, Paranoid / Q000175:diagnosis; D012742:Sex Offenses / Q000331:legislation & jurisprudence / Q000523:psychology / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D014754:Violence / Q000331:legislation & jurisprudence / Q000523:psychology / Q000706:statistics & numerical data
keywords: Differential risk of psychiatric diagnoses; Medium security; Risk of violent and other offending following discharge