Prevalence and Predictors of Reincarceration after Correctional Center Release: A Population-based Comparison of Individuals with and without Schizophrenia in Ontario, Canada [2020]

Objectives:
Individuals with schizophrenia are overrepresented in correctional facilities relative to their population-based prevalence. The purpose of this study was to determine the rate and predictors of reincarceration of individuals with schizophrenia after release from correctional facilities.

Methods:
This was a retrospective cohort study that included all people released from Ontario’s provincial correctional facilities from January 1 to December 31, 2010. Individuals with schizophrenia were identified using a population-based algorithm. The primary outcome was time to reincarceration. Covariates included sociodemographic characteristics (age, sex, neighborhood income quintile, urban/rural residence), health service utilization (primary care physician visits, psychiatrist visits, psychiatric and nonpsychiatric hospitalizations, emergency department visits), and other clinical comorbidity. Survival analysis was used to examine the association between schizophrenia and reincarceration.

Results:
Among 46,928 individuals, N = 3,237 (7%) had a diagnosis of schizophrenia. Approximately 67.5% of these individuals were reincarcerated within 5 years following their first release in 2010, compared to 58.8% of individuals without schizophrenia. Individuals with schizophrenia were 40% (HR = 1.39, 95% CI, 1.33 to 1.45) more likely to be reincarcerated following release than the control group after adjusting for demographic characteristics. This association reduced to 8% (HR = 1.08, 95% CI,1.03 to 1.14) after adjusting for prior health service utilization, prior correctional involvement, and comorbidities.

Conclusion:
Individuals with schizophrenia were more likely to experience reincarceration after release from correctional facilities. This risk is partly explained by prior correctional involvement, health service utilization, and comorbidities. Future research should focus on risk factors predicting the higher reincarceration rate and interventions to reduce correctional involvement.

Mayuri Mahentharan, MSc, Fiona G. Kouyoumdjian, MD, MPH, PhD, Claire de Oliveira, PhD, Tomisin Iwajomo, MPH, Alexander I. F. Simpson, MBChB, BMedSci, Roland Jones, MD, PhD, Paul Kurdyak, MD, PhD
The Canadian Journal of Psychiatry, August 28, 2020
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