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Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population

Preliminary evidence suggests that adherence to antipsychotic medication reduces criminal recidivism among patients diagnosed with schizophrenia. However, existing studies operationalize antipsychotic adherence as a binary variable (usually using a threshold of ≥80%), which does not reflect the prev...

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Autores principales: Rezansoff, Stefanie N, Moniruzzaman, Akm, Fazel, Seena, McCandless, Lawrence, Somers, Julian M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581906/
https://www.ncbi.nlm.nih.gov/pubmed/28637202
http://dx.doi.org/10.1093/schbul/sbx084
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author Rezansoff, Stefanie N
Moniruzzaman, Akm
Fazel, Seena
McCandless, Lawrence
Somers, Julian M
author_facet Rezansoff, Stefanie N
Moniruzzaman, Akm
Fazel, Seena
McCandless, Lawrence
Somers, Julian M
author_sort Rezansoff, Stefanie N
collection PubMed
description Preliminary evidence suggests that adherence to antipsychotic medication reduces criminal recidivism among patients diagnosed with schizophrenia. However, existing studies operationalize antipsychotic adherence as a binary variable (usually using a threshold of ≥80%), which does not reflect the prevalence of suboptimal adherence in real-world settings. The purpose of the current analysis was to investigate the association between successive ordinal levels of antipsychotic adherence and criminal recidivism in a well-defined sample of offenders diagnosed with schizophrenia (n = 11462). Adherence was measured using the medication possession ratio (MPR) and analyzed as a time-dependent covariate in multivariable regression models. Data were drawn from linked, comprehensive diagnostic, pharmacy and justice system records, and individuals were followed for an average of 10 years. Adjusted rate ratios (ARR) and confidence intervals (CI) are reported. Overall mean MPR was 0.41. Increasing levels of antipsychotic adherence were not associated with progressively lower rates of offending. However, when compared to the reference group (MPR ≥ 80%) all lower adherence levels were significantly associated (P < .001) with increased risk of violent (ARR = 1.58; 95% CI = 1.46–1.71) and nonviolent (ARR = 1.41; 95% CI = 1.33–1.50) offenses. Significance was replicated in separate sensitivity analyses. Previously published studies reporting reductions in crime may have been influenced by antipsychotic adherence ≥80%. Binary operationalization of adherence is an inaccurate predictor of recidivism. Future research addressing functional outcomes of antipsychotic adherence should conceptualize adherence as an incremental independent variable.
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spelling pubmed-55819062017-09-06 Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population Rezansoff, Stefanie N Moniruzzaman, Akm Fazel, Seena McCandless, Lawrence Somers, Julian M Schizophr Bull Regular Articles Preliminary evidence suggests that adherence to antipsychotic medication reduces criminal recidivism among patients diagnosed with schizophrenia. However, existing studies operationalize antipsychotic adherence as a binary variable (usually using a threshold of ≥80%), which does not reflect the prevalence of suboptimal adherence in real-world settings. The purpose of the current analysis was to investigate the association between successive ordinal levels of antipsychotic adherence and criminal recidivism in a well-defined sample of offenders diagnosed with schizophrenia (n = 11462). Adherence was measured using the medication possession ratio (MPR) and analyzed as a time-dependent covariate in multivariable regression models. Data were drawn from linked, comprehensive diagnostic, pharmacy and justice system records, and individuals were followed for an average of 10 years. Adjusted rate ratios (ARR) and confidence intervals (CI) are reported. Overall mean MPR was 0.41. Increasing levels of antipsychotic adherence were not associated with progressively lower rates of offending. However, when compared to the reference group (MPR ≥ 80%) all lower adherence levels were significantly associated (P < .001) with increased risk of violent (ARR = 1.58; 95% CI = 1.46–1.71) and nonviolent (ARR = 1.41; 95% CI = 1.33–1.50) offenses. Significance was replicated in separate sensitivity analyses. Previously published studies reporting reductions in crime may have been influenced by antipsychotic adherence ≥80%. Binary operationalization of adherence is an inaccurate predictor of recidivism. Future research addressing functional outcomes of antipsychotic adherence should conceptualize adherence as an incremental independent variable. Oxford University Press 2017-09 2017-06-20 /pmc/articles/PMC5581906/ /pubmed/28637202 http://dx.doi.org/10.1093/schbul/sbx084 Text en © The Author 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Regular Articles
Rezansoff, Stefanie N
Moniruzzaman, Akm
Fazel, Seena
McCandless, Lawrence
Somers, Julian M
Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population
title Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population
title_full Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population
title_fullStr Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population
title_full_unstemmed Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population
title_short Adherence to Antipsychotic Medication and Criminal Recidivism in a Canadian Provincial Offender Population
title_sort adherence to antipsychotic medication and criminal recidivism in a canadian provincial offender population
topic Regular Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581906/
https://www.ncbi.nlm.nih.gov/pubmed/28637202
http://dx.doi.org/10.1093/schbul/sbx084
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