Health and wellbeing of offenders on probation in England: an exploratory study

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• 作者：Dr Anees Ahmed Abdul Pari ; MPH^a ; ^c ; ^{anees.pari@dph.ox.ac.uk} ; Emma Plugge ; DPhil^a ; Sarah Holland ; BSc^b ; Janet Maxwell ; MFPH^c ; Premila Webster ; FFPH^a
• 刊名：The Lancet
• 出版年：2012
• 出版时间：23 November, 2012
• 年：2012
• 卷：380
• 期：supp_S3
• 页码：S21
• 全文大小：1K

文摘

Background

A growing amount of published work indicates that offenders in incarcerated settings have much poorer mental and physical health than does the general population. However, little is known about the health status of offenders, especially those on probation. Identification of these issues and engagement with health services is essential. The aim of this study was to assess self-reported health status, quality of life, and access to health services in a sample of probationers in England to inform policy makers of future service requirements.

Methods

This cross-sectional study was undertaken between May, and July, 2011, in Reading and Newbury, UK. Self-administered questionnaires including the SF-36 health survey (version 2), alcohol use disorder identification test (AUDIT), drug abuse screening test, and questions about access to health services and lifestyle indicators were administered to a pragmatic sample of 132 offenders older than 18 years who presented at probation offices. All statutory cases were eligible when they attended probation offices on a predetermined study day, except when the offender was assessed as presenting a high risk of harm to staff. Data were anonymised and completed questionnaires were analysed with descriptive statisitcs, t tests for independent sample means, and Z tests for the difference between two independent proportions. Additionally, we used multiple stepwise logistic regression with backward stepwise elimination to identify factors associated with poor mental health.

Findings

Most participants were men (n=109 [83 % ]), which is similar to the national probation caseload (Z test, p=0¡¤59). Mean age of participants was 34¡¤9 years (SD 12¡¤8), and their age distribution was similar to the national probation caseload, except that more participants were older than 50 years (19¡¤7 % vs 5¡¤7 % ; Z=6¡¤58; p<0¡¤0001). Further, study participants were of similar ethnic composition to the national probation data, with most white British. The probationers had significantly lower SF-36 scores on all eight subscales than the general UK population. The mental component summary (MCS) score was significantly lower than in the general population (40¡¤9 vs 50¡¤0, 95 % CI for difference ?10¡¤8 to ?7¡¤4; p<0¡¤0001), even in individuals from socioeconomic class V (40¡¤9 vs 49¡¤9, ?10¡¤9 to ?7¡¤2, p<0¡¤0001). 65 % (95 % CI 45¡¤1-85¡¤3) of female and 43 % (33¡¤7-52¡¤5) of male probationers screened positive for depression (as identified by a cutoff of <42 of the Mental Component summary score of SF-36 V2 scale). After accounting for confounding factors, poor mental health was significantly associated with history of self-harm (odds ratio [OR] 3¡¤33, 95 % CI 1¡¤1-7¡¤2; p=0¡¤011), drug misuse (1¡¤23, 1¡¤1-1¡¤4; p=0¡¤003), and visit to a general practitioner in the past 12 months (4¡¤05, 1¡¤4-8¡¤5; p=0¡¤002). About 44 % of female and 43 % of male probationers were deemed to be hazardous drinkers (AUDIT >8). Prevalence of hazardous drinking in female probationers was significantly higher than women in the general population (44 % vs 15 % , 95 % CI for difference ?0¡¤49 to ?0¡¤08; p<0¡¤0001) and was similar to that for female prisoners (Z test, p=0¡¤665). 46 % of male and 30 % of female probationers reported a significantly larger use of illegal drugs in the previous year by contrast with 13 % of men, and 8 % of women in the general population (for men, Z=-9¡¤57, p<0¡¤0001; for women, Z=3¡¤93, p<0¡¤0001). Of 57 probationers who were identified as hazardous drinkers, only 13 (23 % ) had accessed drug and alcohol services in the previous year. Similarly, 62 probationers were screened positive for depression in our group, of whom only 16 (26 % ) managed to get access to a mental health service in the previous year.

Interpretation

The results of this study confirm that probationers have poorer health¡ªespecially mental health¡ªthan the general population and are less likely to access health-care services. There are some limitations in interpretation of the results. Ours was a small pragmatic sample so is subject to large sampling error, which makes extrapolation of results to the entire UK probation population difficult. Nevertheless, these results are important for a hard-to-reach population, and especially if they are replicated in similar settings with time. Commissioners should be aware of the needs of this group.

Funding

NHS Berkshire West, Reading and Thames Valley Probation Agency.