Understanding the Similarities and Differences between Fetal Alcohol Spectrum Disorder and Mental Health Disorders
3. Prevalence of Mental Health Disorders
There appears to be a high prevalence of people in the CJS who have been diagnosed with mental health disorders (Canadian Institute for Health Information 2008), but these studies do not discuss whether those with mental health disorders in the CJS have also been evaluated for or diagnosed with FASD. Therefore, it is not known to what extent the inflated rates of mental health disturbances in the CJS are also associated with individuals having an FASD. Mental health issues are now recognized as a major co-occurring factor in people with FASD, resulting in considerable disability (O’Connor and Paley 2009).
Estimates of rates of mental health disorders can vary greatly, depending on the population studied (e.g., among those in the general population, those in the CJS, or those with FASD) and the methodology used. Numerous studies have shown associations between people having mental health disorders and those having FASD, as well as links between individuals with mental health disorders and those in the CJS. This prevents a simple comparison between those with FASD and those with mental health disorders.
In the study by Streissguth et al. (1996), it was found that up to 90% of people with FASD had been treated for a mental disorder. In a sub-group of 25 adult men and women from that study (Famy et al. 1998), using structured clinical interviews, 15 met criteria for current or past alcohol or drug dependence, 11 had experienced a major depressive episode, 10 reported psychotic symptoms, 5 were diagnosed with bipolar disorder, 5 received a diagnosis of anxiety disorder, and 10 were diagnosed with personality disorders. Of the 25, 18 had received some form of psychiatric treatment.
Table 1 shows the lifetime prevalence rates in Canada for the general population, for the general male federal incarcerated population, and for non-incarcerated adult males and females with FASD.
|Disorder||General adult population||Incarcerated adult malesTable note 3||Adult males with FASDTable note 4||Adult females with FASDTable note 4|
|Depression||8%Table note 1||29.8%||40%||50%|
|Psychosis||1%Table note 1||10.4%||47%||30%|
|Anxiety||12%Table note 1||55.6%||0||50%|
|Antisocial personality disorder||6-9%Table note 1||74.9%||21%||14%|
|Substance abuse||15.9%Table note 2||52.9%||60%Table note *||60%Table note *|
|Alcohol abuse||46.6%Table note 2||69.8%||60%Table note *||60%Table note *|
- Table note 1
Public Health Agency of Canada 2002.
- Table note 2
Canadian Community Health Survey: Mental Health and Well-being 2002 in Tjepkema 2004.
- Table note 3
Motiuk and Porporino 1992
- Table note 4
Famy et al. 1998
- Table note *
Combined substance and alcohol abuse
In its most recent data, the CSC reports that 13% of male offenders and 29% of female offenders in federal custody were identified as showing mental health problems upon admission (Correctional Service of Canada 2009), although these data do not directly translate to the specific diagnoses of mental health disorders shown above. These numbers are lower than the diagnoses made in incarcerated adults in the previous study. When compared to the general population, adult incarcerated males and adults with FASD have significantly higher rates of mental health disorders. The FASD rates of specific disorders are based on small sample sizes.
Other studies have confirmed significant life-long challenges for people with FASD and mental health concerns. Children with prenatal alcohol exposure appear to show significantly more psychopathology, including symptoms of anxiety, disruptive behaviours, and mood disorders when compared to those without prenatal alcohol exposure (Walthall et al. 2008). People with FASD have significantly higher rates of oppositional defiant disorder, conduct disorder, and ADHD than the general population (Burd et al. 2003; Mattson et al. 2011).
In their study of youth in the CJS who had been referred to a forensic psychiatric facility for a psychiatric/psychological assessment, Conry et al. (1997) found that the most common psychiatric diagnoses, for both youth with FASD and controls (youth in the CJS also referred for a psychiatric/psychological assessment and not diagnosed with FASD), were conduct disorder, ADHD, and substance use disorder. All youth with FASD had at least one psychiatric diagnosis, and many had multiple diagnoses. There were no significant differences in the rates of mental health disorders between youth with FASD and controls. A confirmed history of prenatal alcohol exposure was not obtained for the control group, and some may have had prenatal alcohol exposure.
A summary report on mental disorder, substance use, and criminal justice contact prepared for the British Columbia Ministry of Health Services (2005) indicated that
“the forms of mental illness most prevalent among youth in the general population (e.g., “hyperkinetic syndrome”) were 4-5 times more prevalent among youth in the corrections system. Youth in corrections were significantly more likely to have been diagnosed with a substance use disorder in the past year (2.9-4.8 times [more prevalent]). Adults in the corrections system were more likely (1.2-1.9 times [more prevalent]) to have been diagnosed in the previous year with a mental illness than the general population. Rates of substance use were 11-13 times greater than the general population rates” (p. 15).
Concurrent use of alcohol and drugs has been found to be associated with a significant number of crimes. Brochu et al. (2001) indicate that approximately 40% of crimes are associated with the use of and addiction to alcohol, illicit drugs, or both; half of jail inmates had consumed alcohol and/or drugs on the day of the offence. Reports have suggested that, when people with FASD are committing offences, they are likely to be influenced by others, and having a substance use disorder further compromises their judgment.
Fazel and Danesh (2002) did a systematic review of psychiatric assessments in general adult prison populations in western countries and found that prisoners were several times more likely to have psychosis and major depression, and about 10 times more likely to have antisocial personality disorder, than the general population. Fazel et al. (2008) later analyzed 25 surveys of mental health disorders among adolescents in juvenile detention and correctional facilities, and found that they were about 10 times more likely to suffer from psychosis than the general adolescent population. Girls were more often diagnosed with major depression than boys. The authors indicate that deliberate self-harm and repeat offending are common, and that some disorders such as substance misuse and conduct disorder could be risk factors for recidivism. The authors do not comment whether many of these individuals had diagnosed or undiagnosed FASD.
People with FASD frequently have multiple mental health issues, including ADHD, mood disorders (such as depression and bipolar disorder), anxiety disorders, and substance abuse, which could increase the risk for suicidal behaviour (Mattson et al. 2011). Streissguth et al. (1996) found that for adults with FASD, 43% reported suicide threats and 23% reported a history of suicide attempts, suggesting that individuals with FASD have an increase in lifetime suicide attempts relative to the general population.
Compared to the general population, there is a higher rate of mental health disorders among people in the CJS. For individuals in the CJS who also have FASD, this rate appears disproportionately higher.
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