Abstract
BackgroundNumerous poor health outcomes have been documented in the world’s large and growing population of prisoners and ex-prisoners. Repeat justice involvement and incarceration is normative for ex-prisoners in most countries. This study aimed to identify important health-related predictors of re-incarceration and to quantify their contribution to predicting re-incarceration.MethodsParticipants were 1 325 adult ex-prisoners in Queensland, Australia. We developed a multivariate Cox proportional hazards model for re-incarceration including health-related covariates from a pre-release survey.ResultsIn addition to well-established risk factors (criminal history, drug-related sentence, younger age, male gender and Indigenous ethnicity), several health-related variables were important risk factors for re-incarceration in multivariate analyses, including risky use of cannabis (hazard ratio 1.27; 95% confidence interval 1.06, 1.51), amphetamines (HR 1.20; 95%CI 0.99, 1.46) or opioids (HR 1.33; 95%CI 1.08, 1.63) prior to incarceration, central nervous system medication prescription (HR 1.28; 95%CI 1.06, 1.54), reporting that maintaining physical health post-release was not important (HR 1.52; 95%CI 0.98, 2.36) and poverty prior to incarceration (HR 1.24; 95%CI 1.02, 1.52). Sedentary behaviour (HR 0.82; 95%CI 0.68, 1.00), obesity (HR 0.81; 95%CI 0.64, 1.02), multiple lifetime chronic illnesses (HR 0.85; 95%CI 0.71, 1.01) and a history of self-harm (HR 0.72; 95%CI 0.59, 0.88) were associated with a reduced risk of re-incarceration. Inclusion of health-related variables in the model improved prediction of re-incarceration compared to a model with only demographic and criminal justice predictors, leading to an increase in adjusted proportion of explained variation of 0.051 (95%CI 0.031, 0.107).ConclusionsHealth-related factors predict re-incarceration after adjustment for demographic and criminal justice factors. Further research is required to establish the reproducibility of our findings and understand the causal pathways linking health at release from prison to re-incarceration.Electronic supplementary materialThe online version of this article (doi:10.1186/s40352-015-0022-6) contains supplementary material, which is available to authorized users.
Highlights
Numerous poor health outcomes have been documented in the world’s large and growing population of prisoners and ex-prisoners
Records for 1322 participants were successfully linked to Queensland Corrective Services (QCS) reincarceration data, three of these participants were not released from prison within the study period and were subsequently excluded
Of the remaining participants (N = 1319), 721 (55%) were re-incarcerated during the study period and 598 (45%) were censored, either because of death (n = 25) or because they had not returned to prison by the study end date (n = 573)
Summary
Numerous poor health outcomes have been documented in the world’s large and growing population of prisoners and ex-prisoners. Incarceration is associated with deteriorating health (Massoglia 2008a, 2008b; Brinkley-Rubinstein 2013), increased risk of future offending (Durose et al 2014) and worsening socioeconomic outcomes for offenders and their families, including homelessness (Dyb 2009) and reduced income (Western et al 2001). Very high rates of substance dependence (Fazel et al 2006) and mental illness (Fazel and Danesh 2002) have been observed among prisoners and ex-prisoners Both groups are at greatly increased risk of communicable disease, including sexually transmitted infections (STIs), hepatitis B and C, and human immunodeficiency virus (HIV) (Fazel and Baillargeon 2011; Butler et al 2013). In most countries the health needs of prisoners receive relatively little policy attention (Lines 2006) and remarkably little is known about broader health outcomes after release from prison, or how these may shape future offending trajectories
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