Physical multimorbidity, concurrent psychiatric morbidity, and emergency department presentation among adults released from prison: a prospective cohort study from Queensland, Australia.

backgroundPeople released from prison have elevated rates of physical and psychiatric morbidity, and emergency department (ED) presentation when compared with the general population. However, little is known about the specific health concerns that are associated with these high rates of ED presentation. The aims of this study were to (a) ascertain the prevalence of multimorbidity (physical multimorbidity and concurrent psychiatric morbidity) in a sample of adults prior to release from prison, and (b) examine the association between physical multimorbidity, psychiatric morbidity, and ED presentations in this sample following release from prison.

methodsWe prospectively linked pre-release survey data collected between 1 August 2008 and 31 July 2010 from a representative cohort of 1325 sentenced adults in Queensland, Australia, to person-level ED, correctional, and death records. We assessed the multimorbidity of participants using the Cumulative Illness Rating Scale. The association between multimorbidity and rate of ED presentations was assessed by fitting a multivariable Andersen-Gill model to identify sociodemographic and criminal justice covariates. A sensitivity analysis was also conducted in which psychiatric morbidity was disaggregated into a 4-level dual diagnosis variable (none, mental illness only, substance use disorder only, dual diagnosis) and was fit separately from the physical multimorbidity measure to ascertain the degree to which these factors predicted ED presentation rates.

results502 (48.0%) participants had multimorbidity, 265 (25.3%) had physical multimorbidity, and 608 (58.2%) had psychiatric morbidity. After adjustment for model covariates including dual diagnosis status, there was no statistically significant association between physical multimorbidity and ED presentation rate. However, after adjusting for model covariates including physical multimorbidity, participants with a diagnosis of either mental illness (aHR: 1.48; 95%CI: 1.08-2.03) or both mental illness and substance use disorder (aHR: 1.78; 95%CI: 1.33-2.37) had a higher rate of ED presentation than their counterparts without these diagnoses.

conclusionThe presence of psychiatric morbidity is associated with an increased rate of ED presentation. Targeted interventions for adults released from prison with psychiatric morbidity are urgently needed.