Substance misuse and violent crime: Swedish population study
http://www.100md.com
《英国医生杂志》
1 Centre for Violence Prevention, Karolinska Institute, PO Box 23000, SE-104 35 Stockholm, Sweden, 2 Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
Correspondence to: M Grann martin.grann@cvp.se
Introduction
Swedish citizens have a unique identification number that can be used to link data across health and crime registers. The hospital discharge register contains diagnoses of all individuals who are admitted to any general, psychiatric, or secure hospital for assessment or treatment. All patients are given a clinical diagnosis on discharge according to ICD-9 (until 1996) and ICD-10 (from 1997) (international classification of diseases, 9th and 10th revisions). This register is valid and reliable for psychiatric diagnoses.2
The national crime register includes conviction data for people aged 15 (the age of criminal responsibility) and older. We extracted information on all individuals who had committed violent crimes—homicide, aggravated assault, common assault, robbery, threatening behaviour and harassment, arson, and any sexual offence. We included every violent crime committed by each convicted individual. Conviction data included those whose court ruling involved a mental health disposal; a non-custodial sentence, caution, or fine; a finding of legal insanity.
We identified individuals from the hospital discharge register with any principal or secondary diagnosis of alcohol misuse and alcohol induced psychoses (codes 291, 303, and F10), drug misuse and drug induced psychoses (292, 304, and F11-19) from 1 January 1988 to 31 December 2000 and linked them to the crime register. We calculated the population attributable risk (PAR; the absolute difference in the rate of violent crimes per 1000 inhabitants in the whole population and the rate in individuals that had not been patients with substance misuse), and the population attributable risk fraction (PAF; the proportion of violent crimes in the whole population that may be attributed to patients with substance misuse) with standard methods assuming Sweden's average population over age 15 during 1988-2000 was 6 724 503.3
During 1988-2000, 127 789 individuals (1.9% of the population) were discharged from hospital with diagnoses of substance misuse (mean age at first admission 49.1 (standard deviation 16.4) years; 28.4% female) and committed 80 215 violent crimes. The individual population attributable risk fractions for alcohol and substance misuse were 16.1% and 11.6% (table). The overall population attributable risk fraction for substance misuse was not calculated by adding these individuals' population attributable risk fractions, as some were admitted on repeated occasions, and a particular individual may have been diagnosed with alcohol or drug misuse on separate hospitalisations. The overall population attributable risk fraction for patients discharged with a principal diagnosis of substance misuse was 23.3%. We redid the analyses including secondary diagnoses of alcohol and drug misuse, which increased the population attributable risk fraction slightly to 24.7% (data not shown).
Population attributable risk (PAR) and population attributable risk fraction (PAF) of patients with substance misuse to violent crime in Sweden 1988-2000
Comment
Steadman H, Mulvey E, Monahan J, Robbins P, Applebaum P, Grisso T, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998;55: 393-401.
Grann M, Haggard U, Tengstrom A, Woodhouse A, Langstroem N, Holmberg G, et al. Some experiences from registers of interest to forensic research in Sweden. Swed J Forensic Sci 1998;3: 78-80.
Rothman KJ, Greenland S. Modern epidemiology. 2nd ed. Philadelphia: Lippincott-Raven, 1998.
Gossop M, Marsden J, Stewart D, Kidd T. The national treatment outcome research study (NTORS): 4-5 year follow-up results. Addiction 2003;98: 291-303.
Farrell M, Strang J. Britain's new strategy for tackling drugs misuse. BMJ 1998;316: 1399-1400.(Martin Grann, associate p)
Correspondence to: M Grann martin.grann@cvp.se
Introduction
Swedish citizens have a unique identification number that can be used to link data across health and crime registers. The hospital discharge register contains diagnoses of all individuals who are admitted to any general, psychiatric, or secure hospital for assessment or treatment. All patients are given a clinical diagnosis on discharge according to ICD-9 (until 1996) and ICD-10 (from 1997) (international classification of diseases, 9th and 10th revisions). This register is valid and reliable for psychiatric diagnoses.2
The national crime register includes conviction data for people aged 15 (the age of criminal responsibility) and older. We extracted information on all individuals who had committed violent crimes—homicide, aggravated assault, common assault, robbery, threatening behaviour and harassment, arson, and any sexual offence. We included every violent crime committed by each convicted individual. Conviction data included those whose court ruling involved a mental health disposal; a non-custodial sentence, caution, or fine; a finding of legal insanity.
We identified individuals from the hospital discharge register with any principal or secondary diagnosis of alcohol misuse and alcohol induced psychoses (codes 291, 303, and F10), drug misuse and drug induced psychoses (292, 304, and F11-19) from 1 January 1988 to 31 December 2000 and linked them to the crime register. We calculated the population attributable risk (PAR; the absolute difference in the rate of violent crimes per 1000 inhabitants in the whole population and the rate in individuals that had not been patients with substance misuse), and the population attributable risk fraction (PAF; the proportion of violent crimes in the whole population that may be attributed to patients with substance misuse) with standard methods assuming Sweden's average population over age 15 during 1988-2000 was 6 724 503.3
During 1988-2000, 127 789 individuals (1.9% of the population) were discharged from hospital with diagnoses of substance misuse (mean age at first admission 49.1 (standard deviation 16.4) years; 28.4% female) and committed 80 215 violent crimes. The individual population attributable risk fractions for alcohol and substance misuse were 16.1% and 11.6% (table). The overall population attributable risk fraction for substance misuse was not calculated by adding these individuals' population attributable risk fractions, as some were admitted on repeated occasions, and a particular individual may have been diagnosed with alcohol or drug misuse on separate hospitalisations. The overall population attributable risk fraction for patients discharged with a principal diagnosis of substance misuse was 23.3%. We redid the analyses including secondary diagnoses of alcohol and drug misuse, which increased the population attributable risk fraction slightly to 24.7% (data not shown).
Population attributable risk (PAR) and population attributable risk fraction (PAF) of patients with substance misuse to violent crime in Sweden 1988-2000
Comment
Steadman H, Mulvey E, Monahan J, Robbins P, Applebaum P, Grisso T, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998;55: 393-401.
Grann M, Haggard U, Tengstrom A, Woodhouse A, Langstroem N, Holmberg G, et al. Some experiences from registers of interest to forensic research in Sweden. Swed J Forensic Sci 1998;3: 78-80.
Rothman KJ, Greenland S. Modern epidemiology. 2nd ed. Philadelphia: Lippincott-Raven, 1998.
Gossop M, Marsden J, Stewart D, Kidd T. The national treatment outcome research study (NTORS): 4-5 year follow-up results. Addiction 2003;98: 291-303.
Farrell M, Strang J. Britain's new strategy for tackling drugs misuse. BMJ 1998;316: 1399-1400.(Martin Grann, associate p)