Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custody
Abstract Background The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm...
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BMC
2025-08-01
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| Series: | Population Health Metrics |
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| Online Access: | https://doi.org/10.1186/s12963-025-00408-7 |
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| author | Darcy J. Coulter Lindsay A. Pearce Matthew Legge Jesse T. Young David B. Preen Ed Heffernan Jocelyn Jones Stuart A. Kinner |
| author_facet | Darcy J. Coulter Lindsay A. Pearce Matthew Legge Jesse T. Young David B. Preen Ed Heffernan Jocelyn Jones Stuart A. Kinner |
| author_sort | Darcy J. Coulter |
| collection | DOAJ |
| description | Abstract Background The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source. Method We used three data sources – self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement. Results The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0–24.5), 14.8% (95%CI 9.6–18.1), and 44.2% (95%CI 33.2–54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3–11.5), 26.8% (95%CI 18.9–33.5), and 40.9% (95%CI 30.1–48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources’ agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses. Conclusions Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced. |
| format | Article |
| id | doaj-art-bee04915ff414d408bb2af9990eb6d6d |
| institution | Kabale University |
| issn | 1478-7954 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Population Health Metrics |
| spelling | doaj-art-bee04915ff414d408bb2af9990eb6d6d2025-08-20T03:43:25ZengBMCPopulation Health Metrics1478-79542025-08-0123111310.1186/s12963-025-00408-7Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custodyDarcy J. Coulter0Lindsay A. Pearce1Matthew Legge2Jesse T. Young3David B. Preen4Ed Heffernan5Jocelyn Jones6Stuart A. Kinner7Justice Health Group, enAble Institute, Curtin UniversityJustice Health Group, enAble Institute, Curtin UniversityJustice Health Group, enAble Institute, Curtin UniversitySchool of Population Health, Curtin UniversitySchool of Population and Global Health, The University of Western AustraliaForensic Mental Health Group, Queensland Centre for Mental Health ResearchMaladjiny Research Centre, Kurongkurl Katitjin, Edith Cowan UniversityJustice Health Group, enAble Institute, Curtin UniversityAbstract Background The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source. Method We used three data sources – self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement. Results The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0–24.5), 14.8% (95%CI 9.6–18.1), and 44.2% (95%CI 33.2–54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3–11.5), 26.8% (95%CI 18.9–33.5), and 40.9% (95%CI 30.1–48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources’ agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses. Conclusions Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced.https://doi.org/10.1186/s12963-025-00408-7Dual diagnosisMental illnessSubstance usePrisonPrevalenceIndigenous |
| spellingShingle | Darcy J. Coulter Lindsay A. Pearce Matthew Legge Jesse T. Young David B. Preen Ed Heffernan Jocelyn Jones Stuart A. Kinner Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custody Population Health Metrics Dual diagnosis Mental illness Substance use Prison Prevalence Indigenous |
| title | Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custody |
| title_full | Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custody |
| title_fullStr | Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custody |
| title_full_unstemmed | Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custody |
| title_short | Prevalence of mental illness, substance use disorder, and dual diagnosis among adults in custody |
| title_sort | prevalence of mental illness substance use disorder and dual diagnosis among adults in custody |
| topic | Dual diagnosis Mental illness Substance use Prison Prevalence Indigenous |
| url | https://doi.org/10.1186/s12963-025-00408-7 |
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