Seena Fazel Profile picture
May 19, 2022 8 tweets 3 min read Read on X
What effects do prisons have on repeat offending? Our new paper examines this across 44 Swedish prisons. V brief thread. Paper #OA: journals.plos.org/plosone/articl… 1/ Image
We compared reoffending rates in people who were in different prisons at the same security level (between-individual), adjusting for measured confounds, and also examined repeat offending in the same person released from different prisons (within-individual). Two approaches. 2/ Image
To do this, we selected a reference prison with the lowest reoffending risk within each of the 3 security levels. Then we followed up released prisoners for reoffending using national crime register for an average of 8 yrs. 3/
Findings were consistent across the 3 security levels. Found no differences in reoffending risks when conducting within-individual analyses. Eg in high security, hazards ranged up to 1.6 between individuals but not when the same person was released from different prisons 4/ Image
So what does it mean? Previous work suggested that the prison environment, eg in its ‘climate’, contributes to reoffending. These findings do not support that. Individual-level risk factors are more relevant to reduce recidivism - supported by other evidence. 5/ Image
Finally, the study suggests that research designs in prison research need to more fully account for individual level factors when studying recidivism. In other studies, we used sibling controls to investigate risk factors: thelancet.com/journals/lanps… 6/ Image
And another study using within-individual approach to investigate the effects of medication on reoffending. Highlights potential role of treatment for psychiatric disorders and substance misuse: jamanetwork.com/journals/jama/… 7/
And this is a systematic review of recidivism rates around the world. Most countries report 2-yr reconviction rates of 30-60%. Rearrest and reimprisonment rates also high:
wellcomeopenresearch.org/articles/4-28/…

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More from @seenafazel

Sep 28, 2023
Focusing on one statistic, particularly PPV (positive predictive value=proportion classified as high risk at a cut off that have the outcome), should have no place in a reasoned/balanced discussion of suicide risk assessment. A range of performance measures is now standard. 🧵👇
In recommended PROBAST guidelines to assess bias risk, model calibration and discrimination ‘must’ be assessed. Cut-offs can follow - allow for testing of measures of classification, e.g. sensitivity, specificity, PPV and negative predictive value (NPV). pubmed.ncbi.nlm.nih.gov/30596875/
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If one focuses on PPV in a simplistic way, then can counter with the observation that 997/1000 predictions of low risk were 'accurate' (because NPV of OxSATS=99.7%). Underlines the point about using a range of measures – but prioritise discrimination and calibration.
Read 12 tweets
Sep 20, 2023
Our new paper!! Development and validation of a new prediction model for suicide risk in people who have self-harmed.
Very different to previous prediction tools - and directly addresses concerns by some experts and NICE.
#OA: 1/ mentalhealth.bmj.com/content/26/1/e…
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16M people self-harm/year - and suicide risk is 20x increased in the next yr (or 1 in 50-100 people). Current guidelines recommend intensive psychol treatments for all - not realistic for most health systems. Hence the need for possible risk stratification. See recent reviews👇.
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In particular, some have argued for screening *out* people at very low risk, so resources (incl. personalised assessment) can be targeted to those at elevated suicide risk. See (NPV=negative predictive value); our NEJM paper (). bmj.com/content/351/bm…
nejm.org/doi/10.1056/NE…

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Read 17 tweets
Jan 23, 2023
New paper!! Examines a neglected population in the area of health and justice - people given community snetneces. What is contribution of psychiatric disorders to any and violent reoffending? Large population study (n=82k), sibling controls. Short 🧵👇thelancet.com/journals/lanpu…
Despite community *sentences* being widely used, reoffending rates are not low. Recidivism rates in UK >25% over 1 yr. In many countries, >20% over 1-2 yrs. Figure 👇from 2019 review (and note higher rates in Norway than Ireland/Holland): journals.plos.org/plosone/articl… 2/
Little known about modifiable risk factors for reoffending, esp. psychiatric disorder and substance misuse. Previous work not used diagnostic categories or considered familial confounding. These disorders common in this population, who rarely seek help from community services. 3/
Read 16 tweets
Nov 2, 2022
New paper! Antipsychotics are widely prescribed in people with personality disorders. Using Danish population registers, we examined links between these medications and self-harm, suicide, and being charged with violent crimes? Short 🧵 @EBMentalHealth #OA Image
Primary analysis was to use a within-individual design to test associations between those dispensed antipsychotics and adverse outcomes. This design examines outcome rates when someone is dispensed (i.e. prescribed and collected) meds compared to when they are not dispensed meds
Included all diagnosed with personality disorders in mental health services during 2007-2016 (n=166k). Antipsychotics: ACT codes N05A (esp. quetiapine, olanzapine, risperidone). Outcomes: self-harm and suicide mortality, and suspicions for violent crimes (from national registers)
Read 14 tweets
Mar 11, 2021
Our new paper examines associations between specific antipsychotics and a wide range of crime outcomes, incl. arrests and convictions for violent and drug-related offences. Analyses data on all prescriptions 2006-13 in Sweden. Some novel findings. #OA: cambridge.org/core/journals/… 1/
First, the overall pattern emerges that antipsychotics are associated with clear reductions in all crime outcomes. Shown in between-individual models (crime rates in people dispensed meds vs those not dispensed meds) - among the persons who were prescribed antipsychotics 2/
Also found in within-individual models - where crime rates are compared within each individual (during periods on and off medication in the same person). Figure shows rate ratios adjusted for age and other meds (where less than 1 equates to risk reduction on antipsychotics) 3/
Read 8 tweets

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