The prevalence and determinants of cardiometabolic disease among forensic patients in secure settings.

ac.person.orcid 0000-0003-1484-4469
ac.person.orcid 0000-0003-3510-5892
ac.person.position Staff
ac.person.position Staff
dc.contributor.advisor Dean, Kimberlie Ma, Trevor 2022-05-10T23:03:16Z 2022-05-10T23:03:16Z 2022
dc.description.abstract The aim of this study was to estimate the prevalence and identify potential determinants of cardiometabolic disease (CMD) in people with psychotic disorders in secure settings and compare these to people with psychotic disorders in the community. A systematic review of the literature was undertaken to determine existing rates of CMD indicators in people with psychotic disorders in secure settings. Data from a comprehensive health and wellbeing survey, the Forensic Mental Health Patient Survey (FMHPS), were obtained to determine the prevalence and determinants of CMD indicators in a sample of forensic patients. Findings were directly compared to a sample of people with psychotic disorders living in the community using data from the second Australian National Survey of High Impact Psychosis (SHIP). The weighted pooled prevalence rates from the reviewed studies were hypertension 25.0% (N=857, 95% CI 22.1-27.9), dyslipidaemia 29.2% (N=1,135, 95% CI 26.6-31.9), diabetes 11.2% (N=2,582, 95% CI 9.9-12.4), being overweight or obese 72.4% (N=840, 95% CI 69.4-75.5), cardiovascular disease 15.6% (N=1,047, 95% CI 13.4-17.8) and metabolic syndrome 23.5% (N=1,390, 95% CI 21.3-25.7). The prevalence of CMD indicators in the reviewed studies were predominantly higher compared to the general population. When directly compared, the forensic patient sample were older, more likely to be male, and more likely to be of Aboriginal and/or Torres Strait Islander background, than the community-based psychosis sample. The former also had higher rates of polypharmacy, clozapine prescribing, physical activity, and food consumption. However, on multivariate analysis, the forensic patients had a lower prevalence of hypertension (OR 0.36, 95% CI 0.23-0.57) and metabolic syndrome (OR 0.41, 95% CI 0.25-0.67) compared to the community-based psychosis sample. There are clearly important differences in the sociodemographic characteristics, treatment needs and lifestyle practices of forensic patients in secure settings and there may be aspects of secure care that actually reduce CMD risk, however the resultant impact on CMD prevalence is complex. Forensic patients in secure settings require early detection and assertive treatment of CMD indicators and further research to assess the feasibility and effectiveness of these interventions in secure settings is required.
dc.language English
dc.language.iso en
dc.publisher UNSW, Sydney
dc.rights CC BY 4.0
dc.subject.other forensic
dc.subject.other metabolic
dc.subject.other schizophrenia
dc.title The prevalence and determinants of cardiometabolic disease among forensic patients in secure settings.
dc.type Thesis
dcterms.accessRights open access
dcterms.rightsHolder Ma, Trevor
dspace.entity.type Publication
unsw.contributor.advisorExternal Mackinnon, Tobias; Justice Health and Forensic Mental Health Network 2022-05-10
unsw.relation.faculty Medicine & Health School of Psychiatry School of Psychiatry
unsw.subject.fieldofresearchcode 320221 Psychiatry (incl. psychotherapy)
unsw.thesis.degreetype Masters Thesis
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