Predictors of Psychiatric Hospitalization in Ex-Prisoners With Substance Use Problems

• Author: Agneta Öjehagen,Martin O. Olsson,Louise Brådvik,Anders Håkansson
• Date: 01 April 2015
• Published date: 01 April 2015
• DOI: 10.1177/0022042615575374
• Subject Matter: Articles

Journal of Drug Issues

2015, Vol. 45(2) 202 –213

© The Author(s) 2015

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DOI: 10.1177/0022042615575374

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Article

Predictors of Psychiatric

Hospitalization in Ex-Prisoners

With Substance Use Problems:

A Data-Linkage Study

Martin O. Olsson1, Agneta Öjehagen1, Louise Brådvik1,

and Anders Håkansson1

Abstract

This study analyzed predictors of psychiatric hospitalization in ex-prisoners with substance

use problems (N = 4,081) assessed with the Addiction Severity Index and followed post-

release for hospitalizations with psychiatric diagnoses (including suicide attempts). Thirty-four

percent were hospitalized, and in Cox regression, several substance-related variables predicted

hospitalization, including use of heroin, sedatives, and polysubstance. A secondary analysis, with

a psychiatric non-substance focus, excluded hospitalizations involving only substance-related

disorders or only a personality disorder in addition to a substance-related disorder. With this

definition, 10% were hospitalized, and significant baseline predictors were previous psychiatric

hospitalization (hazard ratio [HR] = 1.83), previous suicide attempt (HR = 1.91), depression

(HR = 1.33), anxiety (HR = 1.37), sedative use (HR = 1.46), and, negatively, amphetamine use

(HR = 0.71). Substance-related variables may predict all-cause psychiatric hospitalizations

in prisoners with substance use problems, whereas non-substance-related psychiatric

hospitalization may be predicted by baseline psychiatric problems, which calls for attention to

psychiatric problems in this setting.

Keywords

prison, substance use disorders, co-morbidity, criminal justice

Introduction

Psychiatric disorders and substance use disorders (SUDs) are common among clients in the crim-

inal justice system. In a review of 62 surveys, Fazel and Danesh (2002) concluded that prison

inmates were several times more likely than the general population to have a psychosis or major

depression, and 10 times more likely to have a personality disorder. Also, in another international

systematic review from prison populations, alcohol abuse and dependence were reported in 18%

to 30% of males and 10% to 24% of females, and drug abuse and dependence were reported in

10% to 48% of males and 30% to 60% of female clients, respectively (Fazel, Bains, & Doll,

1Department of Clinical Sciences Lund, Division of Psychiatry, Lund University, Sweden

Corresponding Author:

Anders Håkansson, Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Malmö Addiction

Center, SUS Malmö, Jan Waldenströms gata 77, S-205 02 Malmö, Sweden.

Email: anders_c.hakansson@med.lu.se

575374JODXXX10.1177/0022042615575374Journal of Drug IssuesOlsson et al.

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