Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-26T16:47:15.566Z Has data issue: false hasContentIssue false
  • English
  • Français

The prevalence and geographic distribution of complex co-occurring disorders: a population study

Published online by Cambridge University Press:  20 May 2015

J. M. Somers ,
A. Moniruzzaman ,
S. N. Rezansoff ,
J. Brink  and
A. Russolillo
J. M. Somers*
Affiliation:
Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
A. Moniruzzaman
Affiliation:
Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
S. N. Rezansoff
Affiliation:
Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
J. Brink
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
A. Russolillo
Affiliation:
Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
*
*Address for correspondence: Dr J. M. Somers, Faculty of Health Sciences, Simon Fraser University, 3635 Hillcrest Avenue, North Vancouver, BC V7R 4B7, Canada. (Email: jsomers@sfu.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

A subset of people with co-occurring substance use and mental disorders require coordinated support from health, social welfare and justice agencies to achieve diversion from homelessness, criminal recidivism and further health and social harms. Integrated models of care are typically concentrated in large urban centres. The present study aimed to empirically measure the prevalence and distribution of complex co-occurring disorders (CCD) in a large geographic region that includes urban as well as rural and remote settings.

Methods.

Linked data were examined in a population of roughly 3.7 million adults. Inclusion criteria for the CCD subpopulation were: physician diagnosed substance use and mental disorders; psychiatric hospitalisation; shelter assistance; and criminal convictions. Prevalence per 100 000 was calculated in 91 small areas representing urban, rural and remote settings.

Results.

2202 individuals met our inclusion criteria for CCD. Participants had high rates of hospitalisation (8.2 admissions), criminal convictions (8.6 sentences) and social assistance payments (over $36 000 CDN) in the past 5 years. There was wide variability in the geographic distribution of people with CCD, with high prevalence rates in rural and remote settings.

Conclusions.

People with CCD are not restricted to areas with large populations or to urban settings. The highest per capita rates of CCD were observed in relatively remote locations, where mental health and substance use services are typically in limited supply. Empirically supported interventions must be adapted to meet the needs of people living outside of urban settings with high rates of CCD.

Keywords

Epidemiologyforensic psychiatryhealth service researchpsychoactive substance use disorder
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 25 , Issue 3 , June 2016 , pp. 267 - 277
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aagard, J, Müller-Nielsen, K (2011). Clinical outcome of assertive community treatment (ACT) in a rural area in Denmark: a case–control study with a 2-year follow-up. Nordic Journal of Psychiatry 65, 299–305. doi:10.3109/08039488.2010.544405.Google Scholar
Andrews, DA, Dowden, C (2007). The risk-need-responsivity model of assessment and human service in prevention and corrections: crime-prevention jurisprudence. Canadian Journal of Criminology and Criminal Justice 49, 439–464.Google Scholar
Baillargeon, J, Binswanger, IA, Penn, JV, Williams, BA, Murray, OJ (2009 a). Psychiatric disorders and repeat incarcerations: the revolving prison door. American Journal of Psychiatry 166, 103–9.Google Scholar
Baillargeon, J, Penn, JV, Thomas, CR, Temple, JR, Baillargeon, G, Murray, OJ (2009 b). Psychiatric disorders and suicide in the nation's largest state prison system. Journal of the American Academy of Psychiatry Law 37, 188–93.Google Scholar
BC Stats (2013). Retrieved 28 December 2014 from http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjections.aspx Google Scholar
Culhane, D, Avery, JM, Hadley, T (1996). The treated prevalence of mental health and substance use disorders among adults admitted to the Philadelphia shelter system: Results from the integration of longitudinal data on shelter and mental health services utilization. The Selected Works of Dennis P. Culhane. Retrieved 12 December 2014 from http://works.bepress.com/dennis_culhane/55 Google Scholar
Cusack, KJ, Morrisey, JP, Cuddeback, GS, Prins, A, Williams, DM (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: a randomized trial. Community Mental Health Journal 46, 356–363.Google Scholar
Fazel, S, Geddes, JR, Kushel, M (2014). The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical policy recommendations. The Lancet 384, 1529–1540.Google Scholar
Gilmer, TP, Stefancic, A, Ettner, SL, Manning, WG, Tsemberis, S (2010). Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Archives of General Psychiatry 67, 645–652.Google Scholar
Harrison, P, Allen, MJ, Beck, J (2005). Prison and Jail Inmates at Midyear 2004 (Bureau of Justice Statistics) . U.S. Department of Justice: Washington, DC.Google Scholar
Hiday, VA, Ray, B (2010). Arrests two years after a well-established mental health court. Psychiatric Services 61, 263–268.Google Scholar
James, DJ, Glaze, LE (2006). Mental health problems of prison and jail inmates Bureau of Justice Statistics Special Report, U.S. Department of Justice, Office of Justice Programs, NCJ 213600, September 2006 (revised 12/14/06), pp. 1–11. Retrieved 20 December 2012 from http://bjs.ojp.usdoj.gov/content/pub/pdf/mhppji.pdf Google Scholar
Kariminia, A, Law, MG, Butler, TG, Corben, SP, Levy, MH, Kaldor, JM, Grant, L. (2007). Factors associated with mortality in a cohort of Australian prisoners. European Journal of Epidemiology 22, 417–28.Google Scholar
Kong, R, Au Coin, K (2008). Female offenders in Canada. Juristat 28, 1–28.Google Scholar
Lamont, A, Ukoumunne, OC, Tyrer, P, Thornicroft, G, Patel, R, Slaughter, J (2000). The geographical mobility of severely mentally ill residents in London. Social Psychiatry and Psychiatric Epidemiology 35, 164–169.Google Scholar
Landry, L, Sinha, M (2008). Adult Correctional Services in Canada, 2005/2006 (Juristat Catalogue No. 85-002-XIE, Vol. 28, No. 6). Statistics Canada: Ottawa, ON.Google Scholar
Lix, LM, Hinds, A, DeVerteuil, G, Robinson, JR, Walker, J, Roos, LL (2006). Residential mobility and severe mental illness: a population-based analysis. Administration and Policy in Mental Health 33, 160–171.Google Scholar
Luciano, A, Belstock, J, Malmberg, P, McHugo, GJ, Drake, RE, Xie, H, Essock, SM, Covell, NH (2014). Predictors of incarceration among urban adults with co-occurring severe mental illness and a substance use disorder. Psychiatric Services 65, 1325–1331.CrossRefGoogle Scholar
McNiel, DE, Binder, RL (2007). Effectiveness of a mental health court in reducing criminal recidivism and violence. American Journal of Psychiatry 164, 395–1403. doi:10.1176/appi.ajp.2007.06101664.CrossRefGoogle ScholarPubMed
Nielsen, SF, Hjorthoj, CR, Erlangsen, A, Nordentoft, M (2011). Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study. The Lancet 337, 2205–2214.Google Scholar
Nusselder, WJ, Slockers, MT, Krol, L, Slockers, CT, Looman, CW, van Beeck, EF (2013). Mortality and life expectancy in homeless men and women in Rotterdam: 2001–2010. PLoS ONE 8, e73979.CrossRefGoogle ScholarPubMed
Patterson, M, Markey, M, Somers, JM (2012). Multiple paths to just ends: using narrative interviews and timelines to explore health equity and homelessness. International Journal of Qualitative Methods 11, 132–151.Google Scholar
Rezansoff, SN, Moniruzzaman, A, Gress, C, Somers, JM (2013). Psychiatric diagnoses and multiyear criminal recidivism in a Canadian provincial offender population. Psychology, Public Policy, and Law 19, 443–453.Google Scholar
Ruiz, MA, Douglas, KS, Edens, JF, Nikolova, NL, Lilienfeld, SO (2012). Co-occurring mental health and substance use problems in offenders: implications for risk assessment. Psychological Assessment 24, 77–87. doi: 10.1037/a0024623.Google Scholar
SAMHSA (2007). Results from the 2006 National Survey on Drug Use and Health: National Findings Office of Applied Studies, NSDUH Series H-32, DHHS Publication No. SMA 07-4293, Rockville, MD. Retrieved 20 December 2012 from http://www.oas.samhsa.gov/nsduh/2k6nsduh/2k6Results.pdf Google Scholar
Somers, JM, Currie, L, Moniruzzaman, A, Eiboff, F, Patterson, M (2012). Drug treatment court of Vancouver: An empirical evaluation of recidivism. International Journal of Drug Policy 23, 393–400.Google Scholar
Somers, JM, Patterson, ML, Moniruzzaman, A, Currie, L, Rezansoff, SN, Palepu, A, Fryer, K (2013 a). Vancouver at home: pragmatic randomized trials investigating housing first for homeless and mentally ill adults. Trials 14, 365–385.Google Scholar
Somers, JM, Rezansoff, SN, Moniruzzaman, A (2013 b). Comparative analysis of recidivism outcomes following drug treatment court in Vancouver, Canada. International Journal of Offender Therapy and Comparative Criminology doi:10.1177/0306624X13479770.Google Scholar
Steadman, HJ, Osher, FC, Robbins, PC, Case, B, Samuels, S (2009). Prevalence of serious mental illness among jail inmates. Psychiatric Services 60, 761–765.Google Scholar
Stefancic, A, Henwood, BF, Melton, H, Shin, SM, Lawrence-Gomez, R, Tsemberis, S (2013) Implementing housing first in rural areas: pathways Vermont. American Journal of Public Health 103(S2), S206–S209. doi:10.2105/AJPH.2013.301606.Google Scholar
Szkopek-Szkopowski, T, Palmer, A, LePard, D, Robinson, D, Pauw, R, Tran, H (2013). Vancouver's mental health crisis: an update report. Vancouver Police Department. Retrieved 12 December 2014 from http://vancouver.ca/police/assets/pdf/reports-policies/mental-health-crisis.pdf Google Scholar
Thompson, S (2010). Policing Vancouver's mentally ill: The disturbing truth. Vancouver Police Department. Retrieved 12 December 2014 from https://vancouver.ca/police/assets/pdf/reports-policies/vpd-lost-in-transition-part-2-draft.pdf Google Scholar
Tsemberis, S, Kent, D, Respress, C (2012). Housing stability and recovery among chronically homeless persons with co-occurring disorders in Washington, DC. American Journal of Public Health 102, 13–16. doi: 10.2105/AJPH.2011.300320.Google Scholar
Visher, CA, Winterfield, L, Coggeshall, MB (2005). Ex-offender employment programs and recidivism: a meta-analysis. Journal of Experimental Criminology 1, 295–316.Google Scholar