Abstract
BackgroundAttention-deficit hyperactivity disorder (ADHD) is highly prevalent amongst prison inmates and the criminal justice system (CJS) likely bears considerable costs for offenders with ADHD. We aimed to examine the relationship between ADHD and health-related quality of life (HRQoL) and quality-adjusted life years (QALY) amongst imprisoned adults; and to estimate the annual expenditure associated with ADHD status in prison.MethodsAn observational study was performed in 2011–2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 (HUI3) was used to measure health status, and to calculate attribute specific HRQoL scores and QALY. Health service utilisation was obtained through inspection of medical prison records. Inmates with ADHD were compared with inmates without ADHD.ResultsInmates with ADHD had significantly lower QALYs, with a clinically significant adjusted difference of 0.13. Psychiatric co-morbidity accounted for the variation of ADHD on the HUI3 emotion domain only. Medical costs for inmates with ADHD were significantly higher; and behaviour-related prison costs were similar to prisoners without ADHD, reflecting a low frequency of recorded critical incidents.ConclusionsADHD may directly contribute to adverse health and quality of life through cognitive and executive function deficits, and co-morbid disorders. The extrapolation of conservative cost estimates suggests that the financial burden of medical and behavior-related prison care for inmates with ADHD in the UK is approximately £11.7 million annually. The reported cost estimates are conservative as there is great variability in recorded critical incidents in prisons. In turn, for some prison establishments the prison care costs associated with prisoners with ADHD may be considerably greater.
Highlights
Attention-deficit hyperactivity disorder (ADHD) is highly prevalent amongst prison inmates and the criminal justice system (CJS) likely bears considerable costs for offenders with ADHD
Research on health-related quality of life (HRQoL) and costs related to adult ADHD is limited in the general population and is virtually non-existent in the prison population
We addressed this paucity of data on HRQoL, quality-adjusted life years (QALY), service utilization, and costs attributable to ADHD based on 1 year in prison
Summary
Attention-deficit hyperactivity disorder (ADHD) is highly prevalent amongst prison inmates and the criminal justice system (CJS) likely bears considerable costs for offenders with ADHD. Among the general population attention-deficit hyperactivity disorder (ADHD) confers significant financial burden [1, 2] and given the disproportionate prevalence in the prison population, the criminal justice system (CJS) likely bears considerable economic consequences for offenders with ADHD. ADHD is a childhood onset neurodevelopmental disorder [3] often persisting into adulthood It is one of the most common mental health disorders in children with recent prevalence estimates ranging between 5.9 and 7.1% [4, 5]. ADHD confers significant impairment [15], and reduced quality of life [16] to those afflicted by it It is highly prevalent amongst prison inmates, with a meta-analytical prevalence estimate of 25.5% [17]. Prison inmates with ADHD are reported to be at significant risk for having increased psychiatric co-morbidity and poorer psychosocial adjustment to the prison environment [18,19,20,21]
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