Mental disorders in prison populations aged 15-21: national register study of two cohorts in FinlandBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38415.633762.F7 (Published 09 June 2005) Cite this as: BMJ 2005;330:1364
Full methodological details and extra references
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Permissions for this study were granted by the Criminal Sanctions Agency, the Ministry of Social Affairs and Health, and Helsinki University Central Hospital, Department of Psychiatry.
A unique personal identification number was assigned to all residents of Finland by the Finnish Population Register in 1971. Every resident is linked to the Finnish Health Care Register (HCR, founded in 1967) by this number.
The prison cohorts were retrieved from the nationwide Criminal Sanctions Agency register. This register includes all juvenile offenders who have committed their crimes aged 15 to 21 and have received unconditional prison sentences with the exception of young offenders with very short sentences (less than three months) or very long sentences (over four years). Thus, the register includes approximately 98% of all young offenders sentenced to prison. We compared the psychiatric inpatient treatments in two cohorts: the first consisted of all young offenders sentenced to a prison term in 1984–1985 and the second included all young offenders sentenced to a prison term in 1994–1995. Each young prisoner was entered into the cohort the year he was sentenced to prison for the last time as an adolescent prisoner, for which the age range in Finland is defined as between 15 and 21 years of age. For both cohorts psychiatric inpatient treatments and psychiatric inpatient diagnoses were counted before and after the conviction by using their unique personal identification numbers and linking them to the HCR. For the first cohort the observation period covered the years 1980–1989 and for the later cohort the observation period covered the years 1990–1999. The diagnoses had been entered in the HCR according to the ICD-8 until 1986, according to ICD-9 using the DSM-III-R criteria between 1987 and 1995, and according to ICD-10 criteria from 1996 onward. The HCR diagnoses studied were those of substance dependence, personality disorders, psychotic disorders and depression. Substance-induced psychotic disorders were not included in the psychotic disorders category.
After the exclusion of the prisoners with missing or incomplete personal identification numbers, the earlier cohort from the years 1984–1985 included 656 prisoners (original sample 719, with 63 (8.8%) missing IDs) and the later cohort 370 prisoners (original sample 377, with 7 (1.9%) missing IDs). This decrease over time in cohort size reflects the national policy and implemented changes to reduce the number of adolescent prisoners. The cohorts did not differ in terms of gender (Fisher’s exact test, P = 0.19); in the earlier cohort there were 18 (0.03%) girls, in the latter 5 (0.01%) girls. The median age when in prison for the first time was 19.7 years for the earlier cohort and for the later 20.1 years. This age difference of four months is of no practical importance though statistically significant (U = 109197, P = 0.008).
The diagnoses of young offenders were compared with those in the general population by a matched control sample from the nationwide Population Register. The controls were born on the same day, in the same municipality and were of the same gender as the law-offender and they had not been sentenced to prison whilst aged 15 to 21. For each study subject four control persons were assigned by random selection. If four controls were not found for a study person, that person was not assigned any control subjects. Thus, 3972 controls were used instead of the supposed 4108.
Discrete variables were analyzed with Fisher’s exact test when at least one of the variables was 5 or less. Means were compared with the Mann-Whitney test for not normally distributed data. Odds ratios (ORs) were calculated using binary logistic regression with categorical covariates
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