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Offending prior to first psychiatric contact: a population-based register study

Published online by Cambridge University Press:  25 April 2012

H. Stevens ,
E. Agerbo ,
K. Dean ,
M. Nordentoft ,
P. R. Nielsen  and
P. B. Mortensen
H. Stevens*
Affiliation:
National Centre for Register-Based Research, Aarhus University, Denmark
E. Agerbo
Affiliation:
National Centre for Register-Based Research, Aarhus University, Denmark
K. Dean
Affiliation:
Institute of Psychiatry, King's College London, UK
M. Nordentoft
Affiliation:
Department of Psychiatry, Bispebjerg Hospital, Copenhagen, Denmark
P. R. Nielsen
Affiliation:
National Centre for Register-Based Research, Aarhus University, Denmark
P. B. Mortensen
Affiliation:
National Centre for Register-Based Research, Aarhus University, Denmark
*
*Address for correspondence: H. Stevens, M.Sc., National Centre for Register-Based Research, Aarhus University, Taasingegade 1, 8000 Aarhus C, Denmark. (Email: hs@ncrr.dk)
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Abstract

Background

There is a well-established association between psychotic disorders and subsequent offending but the extent to which those who develop psychosis might have a prior history of offending is less clear. Little is known about whether the association between illness and offending exists in non-psychotic disorders. The aim of this study was to determine whether the association between mental disorder and offending is present prior to illness onset in psychotic and non-psychotic disorders.

Method

In a nested case-control study, cases (n=101 890) with a first psychiatric contact during the period 1995 to 2006 were identified and matched by age and gender to population-based controls (n=2 236 195). Exposure was defined as prior criminal and violent offending.

Results

Males with one offence had an incidence rate ratio (IRR) of 2.32 [95% confidence interval (CI) 2.26–2.40] for psychiatric admission whereas two or more convictions yielded an IRR of 4.97 (95% CI 4.83–5.11). For violent offending the associations were stronger and IRRs of 3.97 (95% CI 3.81–4.12) and 6.18 (95% CI 5.85–6.52) were found for one and several offences respectively. Estimates for females were of a similar magnitude. The pattern was consistent across most diagnostic subgroups, although some variability in effect sizes was seen, and persisted after adjustment for substance misuse and socio-economic status (SES).

Conclusions

A prior history of offending is present in almost one in five patients presenting to mental health services, which makes it an important issue for clinicians to consider when assessing current and future risks and vulnerabilities.

Keywords

Crimeepidemiologyforensic psychiatry
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 12 , December 2012 , pp. 2673 - 2684
Copyright
Copyright © Cambridge University Press 2012

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