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Psychotropic medication may lower risk for violent reoffending

Rates of violent reoffending were lower among released prisoners in Sweden when they were dispensed antipsychotics, psychostimulants and medication for addictive disorders, according to recent findings.

“Most programs to reduce reoffending focus on psychosocial interventions, but their effect sizes are weak to moderate. As psychiatric and substance use disorders, which increase reoffending rates, are overrepresented among jail and prison populations, treatment with appropriate psychotropic medications offers an alternative strategy to reduce reoffending,” Zheng Chang, PhD, of Karolinska Institutet, Stockholm, and colleagues wrote. “In the general population, randomized clinical trials and observational studies have demonstrated associations between psychotropic medications and reductions in violence and crime. However, the evidence to modify reoffending risk is limited to a few small observational studies.”

To assess associations between psychotropic medications and violent reoffending, researchers analyzed data from population-based registers for 22,275 released prisoners in Sweden. Study participants had a mean age of 38 years. Median follow-up was 4.6 years.

During follow-up, there were 4,031 individuals with 5,653 violent reoffenses.

Dispensing antipsychotics was associated with a risk difference of 39.7 (95% CI, 11.3-57.7) fewer violent reoffenses per 1,000 person-years.

Dispensing psychostimulants was associated with a risk difference of 42.8 (95% CI, 2.2-67.6) fewer violent reoffenses per 1,000 person-years.

Dispensing medications for addictive disorders was associated with a risk different of 36.4 (95% CI, 2.1-54) fewer violent reoffenses per 1,000 person-years.

Conversely, antidepressants (HR = 1.09; 95% CI, 0.83-1.43) and antiepileptics (HR = 1.14; 95% CI, 0.79-1.65) were not significantly associated with violent reoffending rates.

Psychological treatments for substance abuse were the most common prison-based program, associated with a risk difference of 23.2 (95% CI, 10.3-34.1) fewer violent reoffenses per 1,000 person-years.

“There are a few effective reentry programs in the United States that incorporate social context. In Sweden, the social context of successful rehabilitation for ex-prisoners is already inherent in society, and when people with mental illnesses commit violent crimes, perhaps the underlying cause is more often primarily related to brain disorders — treatable with medication — rather than social-environmental factors,” Jeffrey Swanson, PhD, of Duke University School of Medicine, Durham, North Carolina, wrote in an accompanying editorial. “Chang and colleagues conclude, ‘Evidence-based provision of psychotropic medications to released prisoners may have the potential to make substantial improvements to public health and safety, particularly in countries that are undergoing decarceration.’ However, this may not be the only lesson to be gleaned from their findings. An equally or perhaps more profound lesson may be that other countries should try to be more like Sweden.” – by Amanda Oldt

Disclosure: Chang and Swanson report no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.