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Dual Diagnosis: Prevalence, Risk Factors, and Relationship With Suicide Risk in a Nationwide Sample of French Prisoners
Author(s) -
Lukasiewicz Michael,
Blecha Lisa,
Falissard Bruno,
Neveu Xavier,
Benyamina Amine,
Reynaud Michel,
Gasquet Isabelle
Publication year - 2009
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/j.1530-0277.2008.00819.x
Subject(s) - prison , psychiatry , medicine , dual diagnosis , substance abuse , psychology , clinical psychology , criminology
Background: Axis I psychiatric disorders (PD) and substance use disorders (SUD) are common in prison, but only few studies have focused on their association in this setting. Dual diagnosis (DD) (the co‐occurrence of a SUD and any axis I disorder) is known to have a poorer prognosis and to require more intense supportive care. Objectives: The objectives of this study were (1) to describe prisoners with DD (prevalence and characteristics); (2) to compare DD prisoners with 3 other groups of prisoners: no diagnosis (ND), SUD alone, or other isolated PD; and (3) to evaluate the impact of DD on suicide risk in prison. Method: A random stratified strategy was used to select 23 various types of prisons and 998 prisoners. Diagnoses were assessed using a unique procedure, each prisoner being evaluated by 2 psychiatrists, 1 junior, using a structured interview (MINI 5 plus), and 1 senior, using an open clinical interview. Following interviews, clinicians met to establish a list of diagnoses. Cloninger’s temperament and character inventory was also used. Results: Of the prisoners, 26.3% had a DD. DD prevalence was almost 80% in prisoners with SUD, while only one‐third of the prisoners with an axis I PD had co‐morbid SUD. No significant differences were observed in drug use patterns between DD and SUD without co‐morbid PDs. DD showed the strongest association with suicide risk [OR = 5.7 (1.7–4.6)]. Conclusion: DD is very frequent in prison and is a major risk factor for suicide. Systematic psychiatric/SUD screening of prisoners with either a SUD or an axis I PD should be encouraged.