PriSUD-Nordic-Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study.

BACKGROUND: A large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research. OBJECTIVE: The overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison. METHODS: PriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release. RESULTS: PriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages. CONCLUSIONS: PriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35182.

Drug use and re-imprisonment: A prospective study of the Norwegian Offender Mental Health and Addiction (NorMA) cohort.

Background: Re-imprisonments are common among people in prison who use drugs. This study aims to describe sociodemographic factors, mental health and level of pre-prison substance use in a cohort of people in prison, and to investigate re-imprisonment during follow-up according to their level of pre-prison drug use. Methods: This was a prospective study using baseline data from the Norwegian Offender Mental Health and Addiction (NorMA) cohort (n = 733) recruited in 2013-2014 linked to data from the Norwegian Prison Registry and the Norwegian Cause of Death Registry. Self-reported drug use before imprisonment was measured at baseline using the Drug Use Disorder Identification Test (DUDIT). The outcome of interest was re-imprisonment examined using Cox regression. We excluded 32 persons because they were not released before the study ended. The study sample included 701 persons, with a total time-at-risk of 2479 person-years. Results: Almost half of the study sample reported high-risk drug use before imprisonment (DUDIT score >24). During the study period, 43% (n = 267) were re-imprisoned. People with high-risk use had a hazard ratio (HR) of 4.20 (95% CI: 2.95-5.97) of re-imprisonment compared with people with low-risk use (DUDIT score <6). Older age and more education than primary school were associated with a reduced risk of re-imprisonment. Conclusion: Compared with low-risk use, high-risk drug use is highly prevalent among people in prison and is associated with higher rates of re-imprisonment. This highlights the need for screening and treatment of drug use disorders among people in prisons.

Quality of prison life, violence and mental health in Dubrava prison.

PURPOSE: The purpose of this paper is to explore the association between the quality of prison life and mental health among prisoners and the occurrence of violence. DESIGN/METHODOLOGY/APPROACH: In total, 203 prisoners from Dubrava Correctional Center in Kosovo participated. Data on background characteristics of the prisoners, quality of prison life, mental health symptoms and exposure to physical, psychological and sexual violence were collected through interviewer-administered questionnaires. Data were analyzed using general linear models (GLM) and manual backwards model search with step-wise exclusion. FINDINGS: The GLM analysis showed a significant negative association between anxiety symptom load (-1.4), physical violence (-1.5) and psychological violence (-1.9), and quality of prison life. Furthermore, it appeared that prisoners rating of quality of life (QoL) increased with time among prisoners not exposed to violence, while this was not seen among prisoners exposed to violence. Finally, there was an inverse association between the dimensions of respect, fairness, humanity and good staff/prisoner relations, and the proportion of prisoners exposed to violence. ORIGINALITY/VALUE: An environment with higher levels of respect, fairness, humanity and good relations between staff and prisoners was associated with lower levels of violence. Hence, a prison that focuses on promoting QoL and good mental health among prisoners will show lower levels of violence, thereby making the prison a more tolerable place for the prisoners and a better working environment for prison staff.

Use of healthcare services in the region of origin among patients with an immigrant background in Denmark: a qualitative study of the motives.

BACKGROUND: In Denmark, immigrants have been found to have a higher use of healthcare services abroad. Since this use may have an impact on both the individual patient and the healthcare system in the country of residence, research into underlying reasons is of increasing relevance. This study therefore investigates what motives patients with an immigrant background have for seeking healthcare services in their region of origin. METHODS: The study was based on 10 semi-structured interviews with 10 patients who had an immigrant background, primarily originating from Turkey and the Middle East, recruited at a clinic of immigrant medicine in Denmark. The interviews were analysed thematically to elucidate motives for seeking healthcare services abroad, with focus on identifying push and pull factors. RESULTS: Four motives for seeking healthcare in the region of origin were salient in the material: the perception of availability, in terms of quantity and access; familiarity, conceptualised as feeling comfortable within the healthcare system; perception of quality of services; and finally, the perceived need for a second opinion. All motives emerged simultaneously as push factors, motivating immigrants to explore healthcare services abroad, and pull factors, attracting them to their country of origin. Affordability did not emerge as an independent motive but influenced the other factors. CONCLUSION: The use of healthcare services abroad by patients with an immigrant background constitutes active health-seeking behaviours shaped by a range of factors perceived to be limiting access to high-quality services in Denmark. Further research, including quantitative studies, should be initiated to investigate the importance of these motives among larger, more diverse immigrant groups, consequences for treatment regimes, and the healthcare professionals' perspective on the use of healthcare in the region of origin among immigrant patients.