High death rate from alcohol and drug misuse in former prisoners

Alcohol and drug misuse are responsible for around a third of all deaths in former male prisoners and half in female ex-prisoners, according to a new study of almost 48000 ex-prisoners from Karolinska Institutet and University of Oxford. The study, which is being published in the published The Lancet Psychiatry, also shows that a substantial proportion of these deaths are from preventable causes, such as accidents and suicide.

Several studies have reported high death rates after release from prison, but few have looked at potential risk factors for these high rates. In the current study, investigators examined deaths in all individuals released from prison in Sweden between 1th January 2000 and 31th December 2009, in total 47326 prisoners.

The causes of death were assessed and compared with imprisoned siblings without substance use disorder (alcohol and illicit drug use) and other psychiatric disorders, to isolate the impact of the illnesses from the prison setting. The researchers then estimated the proportion of deaths that could be attributed to alcohol and substance abuse and other psychiatric disorders (i.e. schizophrenia, ADHD, depression), by calculating the population attributable fractions (PAF) the proportion of deaths that can be attributed to each risk factor.

The results show that roughly 6% (2874) of prisoners died after release, during an average follow-up of 5 years. 1276 deaths (44%) were due to potentially preventable external causes, accounting for roughly 3% of all external cause mortality in Sweden between 2000 and 2009. The researchers found a particularly high risk of death for prisoners with a history of drug and alcohol misuse following release from prison that persisted for years afterwards rather than just weeks as previously thought.

Related to alcohol and substance use

Around a third (34%) of all deaths in men and half (50%) in women released from prison were related to alcohol and substance use, even after accounting for the influence of socio-demographic, criminological, and familial (genetic and environmental) factors. Alcohol and substance abuse accounted for 42% of deaths from external causes in male ex-prisoners and 70% in female ex-prisoners. In contrast to previous research, the investigators found no evidence that other psychiatric disorders increased the post-release death rate.

The authors point out that although Sweden has a relatively low incarceration rate, the prevalence of substance abuse and severe psychiatric disorders reported in this study are similar to the UK, USA, and other high-income countries.

Study leader was Seena Fazel, Professor of Forensic Psychiatry at the University of Oxford, and first-study author was Zheng Chang, a Postdoc at the Department of Department of Medical Epidemiology and Biostatistics at Karolinska Institutet. Funding bodies has been The Wellcome Trust, the Swedish Research Council, and the Swedish Research Council for Health, Working Life and Welfare. This news article is an abbreviation of a press release issued by the Lancet Psychiatry.

Publication

Substance use disorders, psychiatric disorders, and mortality after release from prison: a nationwide longitudinal cohort study
Zheng Chang, Paul Lichtenstein, Henrik Larsson, Seena Fazel
The Lancet Psychiatry, online 22 April 2015, doi: http://dx.doi.org/10.1016/S2215-0366(15)00088-7