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Original Investigation
November 1, 2016

Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release

Author Affiliations
  • 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  • 2Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, England
  • 3Department of Neuroscience, Uppsala University, Uppsala, Sweden
  • 4School of Medical Sciences, Örebro University, Örebro, Sweden
JAMA. 2016;316(17):1798-1807. doi:10.1001/jama.2016.15380
Key Points

Question  Is the use of psychotropic medications associated with a lower risk of reoffending for violent crime among released prisoners?

Findings  In this cohort study of 22 275 released prisoners, 3 classes of psychotropic medications (antipsychotics, psychostimulants, and medications used for addictive disorders) were associated with statistically significant hazard ratios (0.58, 0.62, and 0.48, respectively) of violent reoffending.

Meaning  Evidence-based provision of psychotropic medications to released prisoners was associated with lower risk of reoffending.

Abstract

Importance  Individuals released from prison have high rates of violent reoffending, and there is uncertainty about whether pharmacological treatments reduce reoffending risk.

Objective  To investigate the associations between major classes of psychotropic medications and violent reoffending.

Design, Setting, and Participants  This cohort study included all released prisoners in Sweden from July 1, 2005, to December 31, 2010, through linkage of population-based registers. Rates of violent reoffending during medicated periods were compared with rates during nonmedicated periods using within-individual analyses. Follow-up ended December 31, 2013.

Exposures  Periods with or without dispensed prescription of psychotropic medications (antipsychotics, antidepressants, psychostimulants, drugs used in addictive disorders, and antiepileptic drugs) after prison release. Prison-based psychological treatments were investigated as a secondary exposure.

Main Outcomes and Measures  Violent crime after release from prison.

Results  The cohort included 22 275 released prisoners (mean [SD] age, 38 [13] years; 91.9% male). During follow-up (median, 4.6 years; interquartile range, 3.0-6.4 years), 4031 individuals (18.1%) had 5653 violent reoffenses. The within-individual hazard ratio (HR) associated with dispensed antipsychotics was 0.58 (95% CI, 0.39-0.88), based on 100 events in 1596 person-years during medicated periods and 1044 events in 11 026 person-years during nonmedicated periods, equating to a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed psychostimulants was 0.62 (95% CI, 0.40-0.98), based on 94 events in 1648 person-years during medicated periods and 513 events in 4553 person-years during nonmedicated periods, equating to a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1000 person-years. The within-individual HR associated with dispensed drugs for addictive disorders was 0.48 (95% CI, 0.23-0.97), based on 46 events in 1168 person-years during medicated periods and 1103 events in 15 725 person-years during nonmedicated periods, equating to a risk difference of 36.4 (95% CI, 2.1-54.0) fewer violent reoffenses per 1000 person-years. In contrast, antidepressants and antiepileptics were not significantly associated with violent reoffending rates (HR = 1.09 [95% CI, 0.83-1.43] and 1.14 [95% CI, 0.79-1.65], respectively). The most common prison-based program was psychological treatments for substance abuse, associated with an HR of 0.75 (95% CI, 0.63-0.89), which equated to a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1000 person-years.

Conclusions and Relevance  Among released prisoners in Sweden, rates of violent reoffending were lower during periods when individiduals were dispensed antipsychotics, psychostimulants, and drugs for addictive disorders, compared with periods in which they were not dispensed these medications. Further research is needed to understand the causal nature of this association.

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