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The economic consequences of attention-deficit hyperactivity disorder in the Scottish prison system

The economic consequences of attention-deficit hyperactivity disorder in the Scottish prison system


Title: The economic consequences of attention-deficit hyperactivity disorder in the Scottish prison system
Author: Young, Susan   orcid.org/0000-0002-8494-6949
González, Rafael A.
Fridman, Moshe
Hodgkins, Paul
Kim, Keira
Gudjonsson, Gisli H.
Date: 2018-06-25
Language: English
Scope: 210
University/Institute: Reykjavík University (RU)
Háskólinn í Reykjavík (HR)
School: Viðskiptadeild (HR)
School of Business (RU)
Department: Sálfræði (HR)
Psychology (RU)
Series: BMC Psychiatry;18(1)
ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-018-1792-x
Subject: Psychiatry and Mental health; ADHD; Health-related quality of life; Economic evaluation; Quality-adjusted life years; Prison; Costs; Fangelsisvist; Fangelsi; Lífsgæði
URI: https://hdl.handle.net/20.500.11815/1353

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Citation:

Young, S., González, R. A., Fridman, M., Hodgkins, P., Kim, K. og Gudjonsson, G. H. (2018). The economic consequences of attention-deficit hyperactivity disorder in the Scottish prison system. BMC Psychiatry, 18(1), 210. doi:10.1186/s12888-018-1792-x

Abstract:

Background: Attention-deficit hyperactivity disorder (ADHD) is highly prevalent amongst prison inmates and the criminal justice system (CJS) likely bears considerable costs for offenders with ADHD. We aimed to examine the relationship between ADHD and health-related quality of life (HRQoL) and quality-adjusted life years (QALY) amongst imprisoned adults; and to estimate the annual expenditure associated with ADHD status in prison. Methods: An observational study was performed in 2011–2013, at Porterfield Prison, Inverness, United Kingdom (UK). The all male sample included 390 adult prison inmates with capacity to consent and no history of moderate or severe intellectual disability. Participants were interviewed using the Diagnostic Interview for ADHD in Adults 2.0. The Health Utilities Index Mark 3 (HUI3) was used to measure health status, and to calculate attribute specific HRQoL scores and QALY. Health service utilisation was obtained through inspection of medical prison records. Inmates with ADHD were compared with inmates without ADHD. Results: Inmates with ADHD had significantly lower QALYs, with a clinically significant adjusted difference of 0.13. Psychiatric co-morbidity accounted for the variation of ADHD on the HUI3 emotion domain only. Medical costs for inmates with ADHD were significantly higher; and behaviour-related prison costs were similar to prisoners without ADHD, reflecting a low frequency of recorded critical incidents. Conclusions: ADHD may directly contribute to adverse health and quality of life through cognitive and executive function deficits, and co-morbid disorders. The extrapolation of conservative cost estimates suggests that the financial burden of medical and behavior-related prison care for inmates with ADHD in the UK is approximately £11.7 million annually. The reported cost estimates are conservative as there is great variability in recorded critical incidents in prisons. In turn, for some prison establishments the prison care costs associated with prisoners with ADHD may be considerably greater.

Rights:

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/).

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