Adverse childhood experiences among women prisoners: relationships to suicide attempts and drug abuse.

BACKGROUND: Women prisoners are known to suffer from an accumulation of factors known to increase the risk for several major health problems. This study examines the prevalence of adverse childhood experiences (ACE) and the relationship between such experiences and suicide attempts and drug use among incarcerated women in Norway. METHODS: A total of 141 women inmates (75% of all eligible) were interviewed using a structured interview guide covering information on demographics and a range of ACE related to abuse and neglect, and household dysfunction. The main outcome variables were attempted suicide and adult drug abuse. RESULTS: Emotional, physical and sexual abuse during childhood was experienced by 39%, 36% and 19%, respectively, and emotional and physical neglect by 31% and 33%, respectively. Looking at the full range of ACE, 17% reported having experienced none, while 34% reported having experienced more than five ACEs. After controlling for age, immigrant background and marital status, the number of ACEs significantly increased the risk of attempted suicide and current drug abuse. CONCLUSION: The associations observed between early life trauma and later health risk behaviour indicate the need for early prevention. The findings also emphasize the important role of prison health services in secondary prevention among women inmates.

Suicide or accident? A psychological autopsy study of suicide in youths under the age of 16 compared to deaths labeled as accidents.

OBJECTIVE: In the present paper, we describe suicide in youths under 16 years of age and compare their risk factors for suicide to those of older adolescents as described in the literature. Furthermore, we evaluate the possible mislabeling of suicides as accidents, and vice versa. METHOD: We used the data from a nationwide psychological autopsy of youths 15 years and younger who had committed suicide or died in accidents in Norway from 1993 to 2004 (n = 84). We additionally constructed a suicide index to distinguish between the two causes of death. RESULTS: The young suicide victims presented, with little gender difference, fewer obvious risk factors and less suicide intent than commonly described for older adolescents. The suicide index distinguished quite well between suicides and accidents, with few cases indicating a possible mislabeling, although some suicide cases could have been labeled as uncertain. CONCLUSION: In line with previous research, suicides in 11-15-year-olds have many similarities to suicides in older adolescents in terms of external circumstances, but they present less apparent warning signs. In our total sample of 84 deaths, there were few indications of incorrect labeling.

Differences between children and adolescents who commit suicide and their peers: A psychological autopsy of suicide victims compared to accident victims and a community sample.

BACKGROUND: The purpose of this study was to gain knowledge about the circumstances related to suicide among children and adolescents 15 years and younger. METHODS: We conducted a psychological autopsy, collecting information from parents, hospital records and police reports on persons below the age of 16 who had committed suicide in Norway during a 12-year period (1993-2004) (n = 41). Those who committed suicide were compared with children and adolescents who were killed in accidents during the same time period (n = 43) and with a community sample. RESULTS: Among the suicides 25% met the criteria for a psychiatric diagnosis and 30% had depressive symptoms at the time of death. Furthermore, 60% of the parents of the suicide victims reported the child experienced some kind of stressful conflict prior to death, whereas only 12% of the parents of the accident victims reported such conflicts. CONCLUSION: One in four suicide victims fulfilled the criteria for a psychiatric diagnosis. The level of sub-threshold depression and of stressful conflict experienced by youths who committed suicide did not appear to differ substantially from that of their peers, and therefore did not raise sufficient concern for referral to professional help.

Health care help seeking behaviour among prisoners in Norway.

BACKGROUND: Prisoners are associated with high health care needs compared with the general population. This study aims to investigate prisoners' use of health service. METHODS: A cross-sectional study of 29 prisons in central and southern parts of Norway. A questionnaire was distributed to 1, 454 prisoners (90% response rate). Multilevel analyses were employed to analyse help seeking behaviour among the prisoners. RESULTS: Help seeking was substantially associated with sleep problems and drug problems. There was also a tendency for closed prisons as well as high staffing levels of healthcare professionals to be associated with elevated health care use. CONCLUSIONS: This study suggests that sleep problems and drug use are most frequently associated with health service use. The differences in health care use between prisons suggest that the implementation of prison health care standards should be addressed.

The impact of ADHD and conduct disorder in childhood on adult delinquency: a 30 years follow-up study using official crime records.

BACKGROUND: Few longitudinal studies have explored lifetime criminality in adults with a childhood history of severe mental disorders. In the present study, we wanted to explore the association between adult delinquency and several different childhood diagnoses in an in-patient population. Of special interest was the impact of disturbance of activity and attention (ADHD) and mixed disorder of conduct and emotions on later delinquency, as these disorders have been variously associated with delinquent development. METHODS: Former Norwegian child psychiatric in-patients (n = 541) were followed up 19-41 years after hospitalization by record linkage to the National Register of Criminality. On the basis of the hospital records, the patients were re-diagnosed according to ICD-10. The association between diagnoses and other baseline factors and later delinquency were investigated using univariate and multivariate Cox regression analyses. RESULTS: At follow-up, 24% of the participants had been convicted of criminal activity. In the multivariate Cox regression analysis, conduct disorder (RR = 2.0, 95%CI = 1.2-3.4) and hyperkinetic conduct disorder (RR = 2.7, 95% CI = 1.6-4.4) significantly increased the risk of future criminal behaviour. Pervasive developmental disorder (RR = 0.4, 95%CI = 0.2-0.9) and mental retardation (RR = 0.4, 95%CI = 0.3-0.8) reduced the risk for a criminal act. Male gender (RR = 3.6, 95%CI = 2.1-6.1) and chronic family difficulties (RR = 1.3, 95% CI = 1.1-1.5) both predicted future criminality. CONCLUSIONS: Conduct disorder in childhood was highly associated with later delinquency both alone or in combination with hyperactivity, but less associated when combined with an emotional disorder. ADHD in childhood was no more associated with later delinquency than the rest of the disorders in the study population. Our finding strengthens the assumption that there is no direct association between ADHD and criminality.

Is the high mortality risk in sentenced offenders independent of previous imprisonment?

The mortality in prisoners is high. However, our knowledge about the mortality in convicted offenders, irrespective of incarceration history, is limited. Our aim was to investigate possible predictors for over-all and cause specific mortality in a nation-wide study of convicted offenders with and without previous imprisonment. This case-control study drew random samples of deceased and living offenders (N = 1,112) from four complete cohorts of convicted offenders, two male (born 1967 and 1977, respectively), and two female (born 1967-70 and 1977-80, respectively). All criminal records were systematized and information about date and cause of death was collected on those deceased. Multivariable analyses demonstrated that age at first court conviction (OR = 0.88, 95% CI = 0.84-0.93), drug related crimes (OR = 1.99, 95% CI = 1.23-3.22), and crime diversity (1.51, 95% CI = 1.07-2.13) were significant predictors of premature death in males. In females, age at first court conviction (OR = 0.92, 95% CI = 0.88-0.97), drug related crimes (OR = 2.24, 95% CI = 1.37-3.69) and belonging to the oldest cohort (OR = 2.10, 95% CI = 1.35-3.26) were significant predictors of premature death. Age at first court conviction remained a significant predictor for death in all cause specific multivariable mortality analyses. In addition, having committed drug related crimes and high crime diversity were strong predictors for substance related deaths. Males did more often die in accidents or commit suicide. Somatic deaths were most often encountered in the oldest cohort. Incarceration did not remain a significant predictor for premature death in any of the multivariable analyses. Measures intended to prevent premature death in convicted offenders should target wider populations than hitherto acknowledged.

[Mental health among teenage boys remanded to prisoner]. / Mental helse hos varetektsfengslede tenåringsgutter.

BACKGROUND: Incarceration of young people should be avoided according to Norwegian policy. Even so, young people reside in our prisons at all times. Our aim was to investigate their mental health. MATERIAL AND METHODS: Among 42 teenage boys (below 20 years of age) remanded to prison, 40 consented to participate in the study. Socio-demographic data were collected and a structured diagnostic instrument (K-SADS) was used to assess their mental health. RESULTS: Only four participants had no mental disorder. The 36 who had mental disorders had a mean of 2.5 diagnoses. The most common diagnosis was substance abuse/dependence (n = 31). 30 of the adolescents had serious conduct disorders and nine of them fulfilled the ICD-10 criteria for a dissocial personality disorder. Anxiety and/or depressive disorders (n = 14) and hyperkinetic disorders (n = 12) were also frequent. Many of the adolescents had unmet treatment needs in addition to large social problems, such as disrupted education and unemployment. Three of four adolescents had an immigrant background. INTERPRETATION: Teenage boys remanded to prison have a variety of complex problems. They have an extensive need for psychiatric treatment, drug treatment, education and employment. This calls for multidisciplinary coordinated interventions to avoid further negative development of chronic maladjustment with substance abuse, mental problems and crime.

Filicide in Austria and Finland--a register-based study on all filicide cases in Austria and Finland 1995-2005.

BACKGROUND: Filicide is the tragic crime of murdering one's own child. Previous research has found that the offending parents are commonly depressed and that suicide is often associated as an actual act or an intention. Yet, filicide is an underreported crime and previous studies have been strained with methodological problems. No comprehensive international studies on filicide have been presented in the literature until now. METHODS: This was a descriptive, comprehensive, register-based study of all filicides in Austria and Finland during 1995-2005. Filicide-suicide cases were also included. RESULTS: Most of the perpetrators were the biological mothers; in Austria 72%, in Finland 52%. Suicide followed filicide either as an attempt or a fulfilled act in 32% and 54% of the cases in Austria and Finland, respectively. Psychotic mood disorders were diagnosed for 10% of the living perpetrators in Austria, and 12% in Finland. Non-psychotic depression was diagnosed in 9% of surviving perpetrators in Austria, 35% in Finland. CONCLUSION: The data from the two countries demonstrated that filicide is such a multifaceted and rare phenomenon that national data from individual countries seldom offer sufficient scope for its thorough study. Further analyses are needed to produce a complete picture of filicide.

Low internalised restraint predicts criminal recidivism in young female prisoners.

BACKGROUND: The Weinberger Adjustment Inventory (WAI) measures social-emotional adjustment along two dimensions: distress and restraint. Four types of adjustment according to this measure have been shown to correlate with criminal recidivism among young male prisoners: reactive (high distress, low restraint), suppressor (high distress, high restraint), non-reactive (low distress, low restraint) and repressor (low distress, high restraint). AIM: To evaluate the predictive potential of the WAI among young female prisoners. METHODS: Women under 30 years old, consecutively admitted to one of three Norwegian prisons, were asked to complete the WAI. Most of those eligible (102, 94%) did so. Re-conviction data were collected from the National Crime Register 38 months (SD = 9.0) after release. RESULTS: The overall re-conviction rate was 38%. Rates differed according to the four WAI types: 53% in the non-reactive, 50% in the reactive, 22% in the suppressor and 11% in the repressor group (p = 0.006). Kaplan-Meier analyses showed that group differences were explained by the WAI restraint dimension (p = 0.008). Differences on the distress dimension did not influence re-conviction. Cox regression analysis (adjusting for age at first court conviction and prior offences) found that women with low restraint scores were almost three times as likely to re-offend as women with high restraint scores. CONCLUSION: The WAI appears to be an effective tool for identifying women who are particularly vulnerable to re-offending. Evidence of high capacity for restraint is protective, regardless of distress levels and even after adjusting for the effect of other criminologically important factors. The findings are suggestive that there may be value in individualising 'treatment' or rehabilitation programmes for prisoners.

The prisoner as patient - a health services satisfaction survey.

BACKGROUND: There is evidence for higher morbidity among prison inmates than in the general population. Despite this, patient satisfaction with the prison health services is scarcely investigated. The aim of the present study was to investigate patient satisfaction with prison health services in Norway and to analyze possible patient and service effects. METHODS: The survey took part in 29 prisons in the southern and central part of Norway, representing 62% of the total prison capacity in Norway. A total of 1,150 prison inmates with prison health services experiences completed a satisfaction questionnaire (90% response rate). The patients' satisfaction was measured on a 12-item index. Multilevel analyses were used to analyze both patient and service characteristics as predictors of satisfaction. RESULTS: The study revealed high levels of dissatisfaction with prison health services. There were substantial differences between services, with between-service-variance accounting for 9% of the total variance. Satisfaction was significantly associated with a senior staff member's evaluation of the health services possessing adequate resources and the quality of drug abuse treatment. At the patient level, satisfaction was significantly associated with older age, frequent consultations and better self-perceived health. CONCLUSION: Prison inmates' satisfaction with the health services provided are low compared with patient satisfaction measured in other health areas. The substantial differences observed between services - even when adjusting for several known factors associated with patient satisfaction - indicate a potential for quality improvement.

Penrose's law revisited: the relationship between mental institution beds, prison population and crime rate.

In 1939, Lionel Penrose published a cross-sectional study from 18 European countries, including the Nordic, in which he demonstrated an inverse relationship between the number of mental hospital beds and the number of prisoners. He also found strong negative correlations between the number of mental hospital beds and the number of deaths attributed to murder. He argued that by increasing the number of mental institution beds, a society could reduce serious crimes and imprisonment rates. The aim of the study was to test Penrose's theories longitudinally by monitoring the capacity of all psychiatric institutions and prisons in a society over time. From official statistics, we collected and systematized all relevant information regarding the number of mental institution beds and prisoners in Norway during the years 1930-2004, along with major crime statistics for the same period. During the years 1930-59, there was a 2% population-adjusted increase in mental institution beds and a 30% decrease in the prison population. During 1960-2004, there was a 74% population-adjusted decrease in mental institution beds and a 52% increase in the prison population. The same period saw a 500% increase in overall crime and a 900% increase in violent crimes, with a concurrent 94% increase in the size of the country's police force. Penrose's law proved remarkably robust in the longitudinal perspective. As opposed to Penrose, however, we argue that the rise in crime rates only to a very limited extent can be attributed to mental health de-institutionalization.

Drug use and mental health problems among prison inmates--results from a nation-wide prison population study.

Prisons all over the western world are known to be inhabited by a biased sample of the population. More information is needed on how problems in diverse areas interact. The present study investigated how general welfare deficiencies, drug use and mental health problems were related in a representative prison population. Data stem from a level-of-living survey among a nationwide representative sample of Norwegian prison inmates. The sample was drawn randomly from the official register of prison inmates. Data were collected through structured personal interviews (computer assisted). Analyses presented in this paper are based on the male part of the sample (n=225). Only 24% of male prisoners were affected by neither drug use problems nor mental health problems. Investigating the relationship between variables indicated an increasing accumulation of childhood stressors and general welfare deficiencies with increasing drug use and mental health problems. As health problems are intertwined with more general social problems, health promotion among prison inmates is clearly a multidisciplinary task, requiring close collaboration between different service providers and systems of care.

Exploring gender issues in the development from conduct disorder in adolescence to criminal behaviour in adulthood.

Using results from a large Norwegian follow-up study of former adolescent psychiatric in-patients we have traced the progression from mental disorders requiring hospitalisation in adolescence to registered criminal behaviour in adulthood, particularly highlighting gender differences. A nationwide representative sample of 1095 adolescent psychiatric inpatients (46% females) was followed up 15-33 years after admission to the National Centre for Child and Adolescent Psychiatry in Oslo, Norway. In adolescence 45% fulfilled the DSM-IV criteria for a disruptive behaviour disorder. At follow-up, 63% of the males and 39% of the females had a criminal record. Among females, psychoactive substance use disorder in adolescence seemed to be a sine qua non for later registered criminality, with intravenous drug use a potent risk factor for life-course-persistent criminality. The same strong association between drug use and criminality was not found in males. Factor analysis demonstrated that while the DSM-IV Conduct Disorder criteria structure was similar across genders, the prevalence of the various forms of expression was different in males and females. The differences between individuals with violent and non-violent crimes were more substantial in males than in females. There were marked gender differences in the criminal profiles observed, with the females' criminal career developing in a less serious manner than in males: females had later criminal debut, a lower number of acts on record, less diverse criminal behaviour, and an escalation in the severity of offences over time was less frequently encountered. However, secular trend analyses indicated that gender differences had diminished over the last several decades, with females "catching up" with their male counterparts. Overall, the results demonstrated important qualitative and quantitative gender differences in the criminal behaviour of former adolescent psychiatric in-patients. The results may be of use in prevention.

Social adversities in first-time and repeat prisoners.

AIMS: To explore possible systematic differences between prison inmates serving their first sentence and inmates having experienced previous incarcerations. It is hoped that a better knowledge of these issues will make us better equipped to meet the rehabilitation needs of our prisoners and decrease their risk of reoffending and reincarceration. METHODS: In this cross-sectional study a randomly selected and nationally representative sample of 260 Norwegian prisoners, 100 serving their first sentence and 160 recidivists, was interviewed with special focus on childhood circumstances, education, work experience, and present social and economic situation. In addition their criminal records were collected from the National Crime Registry. RESULTS: In males multivariate analyses identified a number of variables independently and significantly associated with being a repeat offender. The odds for reincarceration increased significantly if the person fulfilled any one of the following criteria: having experienced the incarceration of a family member during childhood (OR = 3.6); having experienced childcare interventions during childhood (OR = 3.2); current drug abuse (OR = 2.6); current housing problems (OR = 2.3). In females only one strong correlation emerged: if the person had current drug problems the odds for being a recidivist increased substantially (OR = 10.9). CONCLUSIONS: While criminal reoffending and reincarceration seemed to be primarily associated with drug abuse in females, the childhood problems of male repeat offenders, compared with males serving their first sentence, indicate that these individuals' current multiple social and economic disadvantages were complex in origin and of long standing. Interventions aimed at preventing reoffending must take into account the gender differences demonstrated. AIM: ing at primary prevention, the negative effects associated with parental incarceration are crucial: how can one prevent the perpetuation of these problems from one generation to the next?

Attitudes towards prisoners, as reported by prison inmates, prison employees and college students.

BACKGROUND: Positive attitudes towards prisoners are important in securing the effectiveness of various correctional rehabilitation programs and the successful reintegration of prisoners after release. We wanted to investigate the attitudes towards prisoners among prison inmates, prison employees and college students. METHODS: The Attitudes Toward Prisoners scale was completed by 298 inmates in 4 Norwegian prisons, 387 employees working in the same prisons, and 183 college students. In addition, all respondents were asked a number of general questions about prisoners, crime and punishment. RESULTS: The study groups differed significantly in their attitudes towards prisoners, as measured by the Attitudes Toward Prisoners scale, with prison inmates holding the most positive attitudes. Prison officers held more negative attitudes than other prison employees. Prison employees working in female-only facilities held more positive attitudes than those working in male-only facilities. Students differed significantly in their attitudes, with those studying business economics holding more negative attitudes than those studying nursing. A number of strong correlations emerged between negative attitudes towards prisoners and more pessimistic and punitive answers on general questions about prisoners, crime and punishment. CONCLUSION: The attitudes towards prisoners differed markedly among the groups investigated. The findings could have important implications, particularly for the preventive work carried out in our prisons. Whether attitudes toward prisoners can be influenced by educational programs and the dispersion of factual information needs to be investigated.

Mental health consultations in a prison population: a descriptive study.

BACKGROUND: The psychiatric morbidity among prison inmates is substantially higher than in the general population. We do, however, have insufficient knowledge about the extent of psychiatric treatment provided in our prisons. The aim of the present study was to give a comprehensive description of all non-pharmacological interventions provided by the psychiatric health services to a stratified sample of prison inmates. METHODS: Six medium/large prisons (n = 928) representing 1/3 of the Norwegian prison population and with female and preventive detention inmates over-sampled, were investigated cross-sectionally. All non-pharmacological psychiatric interventions, excluding pure correctional programs, were recorded. Those receiving interventions were investigated further and compared to the remaining prison population. RESULTS: A total of 230 of the 928 inmates (25 %) had some form of psychiatric intervention: 184 (20 %) were in individual psychotherapy, in addition 40 (4 %) received ad hoc interventions during the registration week. Group therapy was infrequent (1 %). The psychotherapies were most often of a supportive (62 %) or behavioural-cognitive (26 %) nature. Dynamic, insight-oriented psychotherapies were infrequent (8 %). Concurrent psychopharmacological treatment was prevalent (52 %). Gender and age did not correlate with psychiatric interventions, whereas prisoner category (remanded, sentenced, or preventive detention) did (p < 0.001). Most inmates had a number of defined problem areas, with substance use, depression, anxiety, and personality disorders most prevalent. Three percent of all inmates were treated for a psychotic disorder. Remand prisoners averaged 14 sessions per week per 100 inmates, while sentenced inmates and those on preventive detention averaged 22 and 25 sessions per week per 100 inmates, respectively. Five out of six psychiatric health services estimated the inmates' psychiatric therapy needs as adequately met, both overall and in the majority of individual cases. CONCLUSION: Our results pertain only to prisons with adequate primary and mental health services and effective diversion from prison of individuals with serious mental disorders. Given these important limitations, we do propose that the service estimates found may serve as a rough guideline to the minimum number of sessions a prison's psychiatric health services should be able to fulfil in order to serve the inmates psychiatric needs. The results rely on the specialist services' own estimates only. Future studies should take other important informants, including the inmates themselves, into consideration.

Factor structure and individual patterns of DSM-IV conduct disorder criteria in adolescent psychiatric inpatients.

We investigated the factor structure of the DSM-IV conduct disorder (CD) diagnostic criteria and typical individual patterns of CD subscales in an adolescent inpatient population using detailed hospital records of a Norwegian nationwide sample of 1087 adolescent psychiatric inpatients scored for the 15 DSM-IV CD criteria. Varimax rotated principal components and full-information factor analyses of 12 CD criteria were carried out separately for boys and girls employing two methods. Standardized values on three subscales of CD criteria were subjected to Ward's method of hierarchical cluster analyses followed by k-means relocation employing a double cross-replication design. Similar factor structures emerged regardless of factoring method and gender. With the exception of Criteria 8 ("Fire setting") and 14 ("Run away from home") the factor loadings for both genders were in accordance with Loeber's tripartite model, with Aggression, Delinquency, and Rule Breaking factors largely corresponding to Loeber's overt, covert and authority conflict pathways. A five-cluster solution proved highly replicable and interpretable. One cluster gathered adolescents without CD, and the remaining four described groups with different conceptually meaningful constellations of CD criteria, which were not equally prevalent in each gender. Delinquency appeared in all symptomatic clusters. The cluster analytic results highlighted typical forms of expressions of conduct problems, and the fact that these forms may not be equally prevalent in girls and boys even while the underlying structure of conduct problems may be similar across genders. Future research should address the prediction of specific outcomes from CD criteria subscales or constellations.

Continuities between emotional and disruptive behavior disorders in adolescence and personality disorders in adulthood.

OBJECTIVE: The purpose of this study was to quasiprospectively investigate continuities between emotional and disruptive behavior disorders in adolescence and personality disorders in adulthood. METHOD: One hundred thirty subjects (age: mean=43.2 years) who had been diagnosed with emotional and disruptive behavior disorders during adolescence (age: mean=14.6 years) and rediagnosed based on hospital records, according to DSM-IV, were interviewed with the Structured Interview for DSM-IV Personality to establish whether they suffered from personality disorders at the 28-year follow-up. RESULTS: Adolescents with disruptive behavior disorders were not more likely to have personality disorders in adulthood than adolescents with emotional disorders. Adolescents with disruptive behavior disorders were significantly more likely to have cluster B personality disorders at follow-up than adolescents with emotional disorders. Logistic regression analyses revealed that disruptive behavior disorders in females were significantly more strongly associated with a high risk of cluster B diagnoses at follow-up than in males. Emotional disorders were significant and independent predictors of cluster C personality disorders in women but not in men. Disruptive behavior disorders were a significant and independent predictor of antisocial personality disorders in men. CONCLUSIONS: These results support the view that personality disorders can be traced back to adolescent emotional and disruptive behavior disorders. The moderating effect of gender in cluster B and cluster C personality disorders suggests that sociocultural and biological factors may contribute to different adult outcomes in men and women with similar adolescent psychiatric disorders.

Can morbidity be inferred from prescription drug use? Results from a nation-wide prison population study.

AIM: To estimate psychiatric and somatic morbidity in a nation-wide prison population, as inferred from detailed medication sheets. METHOD: Medication sheets from 37 prisons, covering 90% of the Norwegian prison population, were collected and examined by experienced clinicians. All inmates on medication were assigned best-estimate psychiatric and/or somatic diagnoses according to the International Classification of Primary Care diagnostic system. RESULTS: Among the 2617 inmates 919 (35%) had psychiatric disorders, as estimated by our methodology. Depressive disorders (11%) and sleep disorders (11%) were most prevalent. Twenty-six inmates (1%) were prescribed medication indicative of affective psychosis and an additional 77 (3%) received anti-psychotic drugs in doses indicating other psychotic disorders, bringing the sum total of psychosis up to 103 (4%). A total of 848 inmates (32%) were estimated to suffer from somatic disorders. Various pain conditions were prevalent (11%) in addition to obstructive airway diseases and asthma (4%). Both psychiatric and somatic disorders were more prevalent in female prisoners. CONCLUSION: This study has demonstrated high psychiatric and somatic morbidity in a nation-wide population of prison inmates receiving adequate health services. As the morbidity estimates are inferred from prescription drug use they must be interpreted with caution. However, we do believe that our study, utilizing this unconventional but readily available source of information, has yielded valuable knowledge regarding the physical and mental health of a nation-wide prison population.