Abstract
Released prisoners diagnosed with psychotic disorders have elevated rates of violent reoffending risk and their exposure to adverse neighborhood environments may contribute to this risk. We identified all released sentenced prisoners in Sweden between 2003 and 2013 (n = 47226) and followed them up for a median period of 4.4 years. We identified prisoners who had ever been diagnosed with a psychotic disorder (n = 3782) or prescribed antipsychotics (n = 7366). We examined 3 neighborhood characteristics: income, proportion of welfare recipients, and crime rate. By fitting generalized mixed-effects and negative binomial regression models and adopting within-individual designs that controlled for all time-invariant unmeasured confounders within each individual, we estimated neighborhood intraclass correlations (ICCs) and associations between specific neighborhood characteristics and violent reoffending. Neighborhood factors explained 13.5% (95% CI: 10.9%; 16.6%) of the violent reoffending risk among released prisoners diagnosed with psychotic disorders. This contrasted with 4.3% (95% CI: 3.7%; 4.9%) in all released prisoners. However, after controlling for unmeasured confounding, these estimates were not statistically significant (ICCpsychotic disorders = 0.9%; 95% CI: −0.8%; 2.3%; ICCall prisoners = 0.3%; 95% CI: −0.02%; 0.6%). Similarly, none of the within-individual correlations between the specific neighborhood factors and violent reoffending were significantly different from zero. We found consistent results when we investigated prisoners with other psychiatric and substance use disorders. These findings suggest that placing released prisoners with psychotic disorders in less deprived neighborhoods might not reduce their violent reoffending risk, which may also apply to other psychiatric disorders. The assessment, treatment, and community linkage of high-risk prisoners as a strategy to reduce reoffending needs further research.
Highlights
The global prison population reached an estimated 10.4 million individuals in 2015, which represents a 20% increase since 2000.1 Nearly 30 million individuals enter and leave prisons each year across the world.[2]
Some evidence suggests that neighborhood factors predict reoffending,[7,8,9] it is uncertain whether neighborhood influences affect former prisoners with psychotic disorders who reoffend at higher rates than other prisoners.[10,11]
The absolute rates of violent reoffending were elevated in psychiatric disorders, in those diagnosed with psychotic and personality disorders, as well as in certain sociodemographic categories, including males, younger age groups, and during periods of disadvantage across all of the examined exposure variables
Summary
The global prison population reached an estimated 10.4 million individuals in 2015, which represents a 20% increase since 2000.1 Nearly 30 million individuals enter and leave prisons each year across the world.[2].
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