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Health, social and criminal justice factors associated with dual diagnosis among incarcerated adults in Brazil and Australia: a cross-national comparison

Abstract

Purpose

To estimate the prevalence of dual diagnosis and identify health, social and criminal justice factors associated with dual diagnosis among incarcerated adults in Australia and Brazil.

Methods

We compared data from cross-sectional surveys of incarcerated adults (aged ≥ 18 years) in Australia and Brazil. Using data from linked emergency department, hospital, and in-prison medical records in the Australian sample, and from the Composite International Diagnostic Interview (CIDI) in the Brazilian sample, participants were categorised as having: (1) no mental disorder; (2) substance use disorder only; (3) mental illness only; or (4) dual diagnosis. A multivariate multinomial logistic regression model was fitted to identify factors associated with dual diagnosis in each country.

Results

Approximately one quarter of participants in both Australia (22%) and Brazil (25%) met the diagnostic criteria for dual diagnosis. In both countries, dual diagnosis was associated with being female [relative risk (RR) = 2.25 (95% CI 1.47–3.43) Australia; RR = 2.59 (95% CI 1.79–3.74) Brazil], having a history of prior incarceration [RR = 2.99 (95% CI 1.99–4.48) Australia; RR = 2.27 (95% CI 1.57–3.29) Brazil], and having comorbid physical health problems [RR = 1.54 (95% CI 1.08–2.19) Australia; RR = 2.53 (95% CI 1.75–3.65) Brazil].

Conclusions

Despite differences in health, social, and criminal justice systems between Australia and Brazil, the prevalence of and factors associated with dual diagnosis in incarcerated adults appear to be similar in the two countries. A number of generalisable principles can be inferred and should be considered in health and criminal justice policy making.

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Funding

The Brazilian study was funded by Brazil's Ministry of Health and Ministry of Science and Technology, via grant no. 554553/2005 (AI type) under the CNPq 07/2005 funding cycle, and by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—CAPES, whose grant no. 88881.131763/2016-01 provided a PhD scholarship for Maira Mendes. The Australian study was funded by National Health and Medical Research Council (NHMRC) Strategic Award APP409966 and Project Grant APP1002463. Rohan Borschmann is supported by NHMRC Early Career Fellowship APP1104644. Stuart Kinner is supported by NHMRC Senior Research Fellowship APP1078168.

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Correspondence to Rohan Borschmann.

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The authors declare they have no conflicts of interest.

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Borschmann, R., dos Santos, M.M., Young, J.T. et al. Health, social and criminal justice factors associated with dual diagnosis among incarcerated adults in Brazil and Australia: a cross-national comparison. Soc Psychiatry Psychiatr Epidemiol (2020). https://doi.org/10.1007/s00127-020-01832-w

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Keywords

  • Mental disorder
  • Dual diagnosis
  • Substance use
  • Prison
  • Incarceration