title: Mental disorder, imprisonment and reduced life expectancy--A nationwide psychiatric inpatient cohort study.
abstract: BACKGROUND
  There is a strong correlation between severe mental illness and criminality, but little is known about how these two problem areas together may affect health outcomes.
  
  
  OBJECTIVE
  The objective of this paper is to compare survival rates of male psychiatric inpatients over a 25-year period who have and have not been subject to imprisonment, allowing for nature of psychiatric morbidity.
  
  
  METHODS
  A nationwide cohort of men who had ever been psychiatric inpatients was identified from Icelandic data-registers, and their diagnoses after first discharge, cumulative incidence of imprisonment, and mortality established from records. Using a nested case-control design, survival differences were determined between those ever imprisoned and those never imprisoned.
  
  
  RESULTS
  Between January 1983 and March 2008, 7665 men were admitted to psychiatric wards in Iceland, of whom 812 (10.6%) had served a prison sentence during that time. Cumulative incidence of imprisonment was highest in the youngest age group (21%). Substance use and personality disorders were more common amongst those imprisoned. All-cause mortality, adjusted for diagnosis, age, and year of admission, was twice as high amongst those imprisoned as those not imprisoned (Hazard ratio = 2.0, 95% CI 1.5-2.6, p < 0.001).
  
  
  CONCLUSIONS
  Our findings indicate that psychiatric inpatients with criminal records should receive special attention with respect to all aspects of their health, not only within psychiatric services but also through more collaboration between the healthcare and judicial systems.
authors.affiliation: Mental Health Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.|Faculty of Medicine, University of Iceland, Reykjavik, Iceland.|Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, The University of Gothenburg, Gothenburg, Sweden.
authors.forename: Steinn
authors.identifier: http://orcid.org/0000-0001-8320-5607
authors.initials: S
authors.lastname: Steingrimsson
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Martin I
authors.initials: MI
authors.lastname: Sigurdsson
authors.affiliation: Prison and Probation Administration of Iceland, Reykjavik, Iceland.
authors.forename: Hafdis
authors.initials: H
authors.lastname: Gudmundsdottir
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Thor
authors.initials: T
authors.lastname: Aspelund
authors.affiliation: Mental Health Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
authors.forename: Andres
authors.initials: A
authors.lastname: Magnusson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D003415:Crime; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D007297:Inpatients / Q000523:psychology* / Q000706:statistics & numerical data; D008017:Life Expectancy; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010554:Personality Disorders / Q000453:epidemiology / Q000523:psychology; D011330:Prisons / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D015996:Survival Rate; D014937:Work