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Profiling Mentally Ill Offenders in Hong Kong: a 5-year Retrospective Review Study.

Introduction

Prevalence of mental illness in incarcerated population

Forensic psychiatry involves assessment and treatment of people with mental disorders who come into the legal system. (1-3) In the incarcerated population, psychiatric morbidity has been reported to be high in both remanded (63% of males and 76% of females) and sentenced (37% of males and 57% of females) prisoners. (4-7) The estimated prevalence of severe mental illness in the incarcerated population has been reported to be 9% to 20%, compared with 6% in the general population. (8-11) The increased prevalence is likely to be related to deinstitutionalisation, limited community resources, prominent court decisions and legislative rulings, and the 'revolving door' phenomenon. (12,13) In a systematic review of 62 studies that included 23,000 prisoners from 12 countries, the prevalence of psychosis, major depression, and antisocial personality disorder was found to be several times higher in prisoners than in the general population. (14)

Relationship between crime and mental illness

The high prevalence of mental illness in remanded and sentenced populations could reflect the association between crime and mental illness (schizophrenia, personality disorder, depression, substance misuse, intellectual disability, and dementia). Patients with schizophrenia have been reported to be more likely to commit violent offences, although evidence on the association between schizophrenia and crime is conflicting. (15) In a study in Sweden, the rate of violent offences was four times higher in schizophrenia patients, although the overall crime rate of male schizophrenia patients was similar to that of the general population. (16) There is a strong association between acute psychotic symptoms and violence, and psychotic symptoms account for most of the very violent behaviour. (17,18) In the Dunedin birth cohort, the violence rate among those with schizophrenia-spectrum disorders increases five-fold (in those with criminal convictions) to seven-fold (self-reported). (19)

In the United Kingdom, up to 78% of prisoners have a personality disorder, with antisocial personality disorder being the most common, followed by paranoid (in men) and borderline personality disorders (in women). (20) In a systematic review of 62 studies about mental disorder in prisons, 65% of male prisoners had a personality disorder and 47% had a dissocial personality disorder. (14)

The typology of depressed shoplifters includes isolated young adults under stress and older people with chronic depression, depression associated with acute loss, and personality disorder with an aggressive swing. (21,22) Similarly, shoplifting in middle-aged women is associated with depression and anxiety symptoms, particularly if shoplifting is the sole conviction. (22)

Substance misuse, combined with mental illness or personality disorder, is common among forensic psychiatric patients. (20) Alcohol and drugs may be associated with criminal behaviour because intoxication can impair judgement and reduce inhibition. In withdrawal states, agitation and psychotic symptoms, such as paranoia, can predispose one to violent behaviour. Additionally, various forms of theft are committed to purchase illicit substances. Substance misuse is more prevalent in individuals with personality disorder, and alcohol misuse is associated with increased violence in people with antisocial personality disorder. (23)

A meta-analysis of sex offenders reported strong association between low intelligence and paedophilic sex offences, but not for other types of sex offences. (24) A case series reported that 11% of those charged with arson had learning disability. (25) In a retrospective review of 2397 patients in memory and ageing centre, the common manifestations of criminal behaviour in patients with frontotemporal dementia were theft, traffic violations, sexual advances, trespassing, and public urination, whereas patients with Alzheimer dementia commonly committed traffic violations. (26)

Forensic psychiatric services

Prisons are left to deal with inmates whose behaviour does not reach admission criteria to psychiatric services despite 'being marked enough to interfere with discipline and communication'. (27,28) The provision of forensic psychiatric services varies considerably among countries and is governed by different mental health laws. (1,29-31) In United Kingdom, forensic psychiatric services are delivered through high-security psychiatric hospitals, medium-security psychiatric units, low-security psychiatric units, community forensic mental health teams, and independent private secure psychiatric facilities, whereas admission and transfer are governed by the Mental Health Act. (32)

In Hong Kong, admission and transfer to psychiatric units are governed by the Mental Health Ordinance. (33) Hong Kong has no high-security psychiatric hospital. Psychiatric criminals are taken to the Siu Lam Psychiatric Centre (SLPC) of the Correctional Services Department and cared for by outreach services provided by the Forensic Psychiatric Department of Castle Peak Hospital. The SLPC is the only facility of its kind in Hong Kong. It receives mentally ill offenders sentenced by the courts for compulsory psychiatric inpatient treatment, as well as remanded and sentenced individuals who require psychiatric assessment and treatment referred by courts and correctional institutions. In recent years, the number of new cases seen at the SLPC by visiting psychiatrists has been approximately 1100 to 1300 per year.

Objectives

This study aimed to determine the prevalence of mental illness in offenders referred to psychiatrists at the SLPC from January 2011 to March 2016 and any associations between crime and mental illness in these offenders.

Methods

This retrospective review study was approved by the Research and Ethics Committee of the New Territories West Cluster of the Hospital Authority and the Research and Ethics Committee of the Correctional Services Department.

Case notes at the SLPC from 1 January 2011 to 31 March 2016 were reviewed. Data on sex, age on admission, educational level, principal psychiatric diagnosis, index offence, source and reason of referral, and outcome were collected. For offenders with multiple admissions, only data from the latest admission were used. Psychiatric diagnosis was made within 2 weeks. Each case was discussed in the weekly clinical case round chaired by senior psychiatrists and a consensus was reached on the principal diagnosis (if any) based on the 10th revision of the International Classification of Diseases. (34) The index offences were classified into 16 categories using the Australian and New Zealand Standard Offence Classification. (35)

Two-sample t test was used to compare the age between sex groups. Pearson's Chi square test was used to determine any difference in the distribution of principal diagnosis, index offence, and reason for referral between sex groups. Cramer's V was computed to assess the strength of association. If the distribution of a variable differed significantly between sex groups, the same test was repeated for sub-items. Statistical analysis was conducted using the SPSS (version 12.0; IBM Corp, Armonk [NY], US). An alpha value of <0.01 was considered statistically significant.

Results

Case notes of 4492 offenders (75% males) aged 14 to 93 (mean, 40.6; standard deviation, 13.2) years were reviewed. Male offenders were younger than female offenders (40.0 [+ or -] 13.3 years vs 42.2 [+ or -] 12.8 years, p = 0.001, Table 1). Among males, the proportion of the age group of 18 to 39 years was larger than that of the age group of 40 to 64 years (50% vs 42%), but the distribution was reversed among females (43% vs 51%). Most (54%) offenders had secondary-level education.

The distribution of principal diagnosis differed significantly between sexes (p < 0.001, Table 2), with a moderate association between principal diagnosis and sex (r = 0.210). Of all cases, 73% had a diagnosable mental disorder (70% in males and 79% in females). The most common diagnosis was 'schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders' (25%), followed by 'mental and behavioural disorders due to psychoactive substance use' (22% in males vs 16% in females, p < 0.001), especially for alcohol-related disorders (4% vs <0.5%, p < 0.001). Heroin was the most commonly used substance. 'Mood (affective) disorder' was more prevalent in females than males (19% vs 7%, p < 0.001), as was 'anxiety, dissociative, stress-related, somatoform and other non-psychotic mental disorders' (9% vs 5%, p < 0.001). Dissocial personality disorder and paraphilic disorders, such as exhibitionistic disorder and fetishism, were more prevalent in males, whereas borderline personality disorder was more prevalent in females. The prevalence of 'intellectual disabilities', 'pervasive and specific developmental disorders', 'behavioural and emotional disorders with onset usually occurring in childhood and adolescence', and 'behavioural syndromes associated with physiological disturbances and physical factors' was higher in males than in females (p < 0.05). 'Behavioural syndromes associated with physiological disturbances and physical factors' was the least prevalent diagnosis, which was more common in females than in males (p < 0.05).

The distribution of the index offence differed significantly between sexes (p < 0.001, Table 3), with a strong association between index offence and sex (r = 0.342). 'Theft and related offences' was the most prevalent (39% in females vs 16% in males, p < 0.001), followed by 'acts intended to cause injury' (16% vs 22%, p < 0.001) and 'illicit drug offences' (15% vs 10%, p < 0.001). Offences involving violence, such as 'sexual assault and related offences', 'property damage and environmental pollution', and 'public order offences', were more prevalent in males than females (p < 0.001).

The three most common principal psychiatric diagnoses were moderately associated with 'acts intended to cause injury', 'theft and related offences', 'illicit drug offences', 'property damage and environmental pollution', 'fraud, deception, and related offences', and 'sexual assault and related offences' (r = 0.257, p < 0.001, Table 4). 'Acts intended to cause injury' was most prevalent in those with 'schizophrenia and other related disorders' than in those with other two diagnoses (31% vs 19% vs 17%, p < 0.001). 'Theft and related offences' was most prevalent in those with mood disorders than in those with other two diagnoses (38% vs 20% vs 18%, p < 0.001). 'Illicit drug offences' was most prevalent in those with 'mental and behavioural disorders due to psychoactive substance' than those with other two diagnoses (22% vs 8% vs 6%, p < 0.001).

Of the 4492 offenders, 1446 (32%) were referred by correctional institutions for psychiatric assessment and treatment, most commonly for 'depressed mood' (15%) and 'psychotic symptoms' (16%), whereas 3046 (68%) were referred by the courts for psychiatric report: 2763 (91%) by the Magistrates' Courts, 214 (7%) by the District Court, and 67 (2%) by the High Court. The distribution of principal diagnosis differed significantly between the two types of referral (p < 0.001), with a strong association between principal diagnosis and type of referral (r < 0.332). Those referred by correctional institutions had a higher proportion of 'disorders related to substance abuse and dependence'. 'Self-harm' and 'suicidal tendency' were more common in males (27%), younger age groups (25%), and illicit drug offenders (30%), whereas 'unstable emotion', 'aggressive behaviour', and 'bizarre behaviour' were more common in females (p < 0.02). About 48% of the offenders required no psychiatric follow-up, whereas 38% required psychiatric follow-up. Those referred by courts had a higher proportion of 'schizophrenia and related disorders'. The most common outcome of psychiatric report was 'ordinary sentence with psychiatric follow-up' (46%), followed by 'hospital order (compulsory psychiatric inpatient treatment)' (25%) and 'ordinary sentence without psychiatric follow-up' (25%).

Discussion

Offender characteristics

Of all people arrested in Hong Kong during 2011 to 2015, 72% of males and 28% of females were arrested for indictable offences, with a male-to-female ratio of 2.54 to 1. (36) For people aged <40 years, the percentage was 59% in males and 48% in females. In the United Kingdom in 2009, <20% of arrests were for females, (37) whereas in the United States in 2010, approximately 25% of arrests were for females. (38)

In Hong Kong during 2011 to 2016, the most common offences for which males were arrested were 'burglary and theft' (29%), 'violent and sexual offences' (28%), and 'serious drug offences' (8%). (39) For females, the most common offences were 'burglary and theft' (54%), 'violent and sexual offences' (14%), 'fraud and forgery' (9%), and 'serious drug offences' (6%).

The sex ratio for those at the SLPC was 2.91 to 1, which was higher than that in the arrested population. In females, the proportion of the age-group 40 to 64 years was higher than the younger age groups. This could be explained by the nature of SLPC, as only offenders with suspected mental health problems were referred to SLPC. The distribution of crimes by sex and age groups was confounded by the prevalence of mental illnesses in different sex and age groups, in different crimes, and in custodial populations, as well as differences in classification of offences.

Mental disorders among offenders

In the present study, 73% of offenders at SLPC (79% in males and 70% in females) had a diagnosable mental disorder, comparable to other studies. (4,6,7) Remanded prisoners have a higher risk of mental disorder because of multiple factors, such as adjustment issues in relation to incarceration and prison environment, stresses from ongoing court proceedings and uncertainties about the offence and potential sentence and consequences, withdrawal from drugs and alcohol, dependence, and drug-induced psychosis.

Schizophrenia and related psychotic disorders

'Acts intended to cause injury' was associated with schizophrenia and related psychotic disorders, although 'theft and related offences' was also prevalent in schizophrenia, consistent with other studies. (15-19) The proportion of homicides committed by people with psychosis is consistent across countries. Nevertheless, in our study, 12 (15%) of 80 of the 'homicide and related offences' were perpetrated by people with a schizophrenia-spectrum disorder, compared with 5% to 8% in Caucasian populations. (40) This could be explained by the low homicide rate in Hong Kong. In addition, not all people charged with homicide were psychiatrically assessed at SLPC.

Personality disorders

In our study, 3% of offenders had personality disorder; dissocial personality disorder was more prevalent in males, and borderline personality disorder was more prevalent in females, consistent with other studies. (14,20) The low prevalence of personality disorders may be due to the retrospective review nature without structured diagnostic interviews. Moreover, only the principal diagnosis was collected; personality disorder as a secondary diagnosis was not counted and thus underestimated. Whether people with different ethnicities would attract a diagnosis of personality disorder may be a potential source of bias, but no conclusion could be drawn owing to methodological variations. (41)

Substance use disorders

In our study, the prevalence of mental and behavioural disorders due to psychoactive substance use was higher in males than females (22% vs 16%), particularly for alcohol-related disorders. Heroin was the most prevalent substance. (42) There is an association between heroin use and criminal behaviour. (43,44) In a review of aggressive behaviour in heroin users, aggression was more closely associated with personality factors. (45) In United Kingdom, over a third of male prisoners have used cannabis, and cannabis dependence was associated with violence in the Dunedin birth cohort. (46) Among offenders in SLPC, cannabis was not commonly used. In contrast, the number of methamphetamine abusers increased by 7% during 2013 to 2015. Methamphetamine use has been reported to be associated with violent crimes, although the causal relationship has not been established. (47)

Mood disorders

Acquisitive offending is associated with both mood disorders and female sex, consistent with other studies. (21,22) Associations between schizophrenia, bipolar disorder and depression, and self-reported violence are equally strong. (48) Approximately 7% of perpetrators of homicide have a lifetime diagnosis of mood disorder. (40) Homicide-suicide and infanticide have been reported to associate with depression. (49) Among offenders in SLPC, 7.5% (6 out of 80) of those indicted for homicide or related offences were diagnosed with a mood disorder.

Other diagnosis

In our study, compared with those without intellectual disability, those with intellectual disability were associated with sexual offences (25% vs 8%, p < 0.01), but the number of sexual offenders with intellectual disability was too small for subgroup analysis. (24,25) Similarly, those with intellectual disability were associated with arson (6.5% vs 1.9%, p < 0.01). In addition, those with dementia were associated with theft and related offences (46% vs 21%, p < 0.01), consistent with other study. (26) Nonetheless, the number of dementia cases was too small for subgroup analysis.

Referrals for psychiatric assessment

Suicide and non-fatal self-harm in prisoners was 500% higher than in a matched population in England and Wales. (6) Among offenders in SLPC, 25% were referred because of suicidal tendency and self-harm, with the referral rate higher in males. Remanded prisoners, especially young offenders, and those with a history of illicit drug offences are at higher risk of suicide tendency and self-harm. In the prison population of England and Wales, the male-to-female ratio of prison suicides was nearly 10 to 1, and half had at least one psychiatric diagnosis. (6) Among offenders in SLPC, the male-to-female ratio was about 5 to 1. Nearly 75% referred by courts had a psychiatric diagnosis, and 25% of them required compulsory inpatient treatment (hospital order).

Clinical implications

The high prevalence of mental illness in the remanded and sentenced populations in Hong Kong highlights the importance of forensic psychiatric services for detection, assessment, treatment, and rehabilitation to improve clinical outcomes and prevent relapses. Introduction of high-security psychiatric hospitals as a long-term measure is suggested. Intermediate measures include implementation of interventional programmes in collaboration with the Correctional Services Department for those with high risk of re-offending. Strategies for prison suicide risk assessment and prevention especially for young male illicit drug offences should be implemented, as should interventional programmes for prisoners with substance misuse (such as motivational interviewing programmes) and violence risk assessment and management. In addition, both physical health and social problems affect mentally ill offenders' ability to cope with life in prison, pre- and post-release.

Limitations

One limitation of our study is that only the principal psychiatric diagnosis was collected. Multiple diagnoses were common, especially in the remanded populations. Approximately 25% of males and 33% of females on remand had two or more psychiatric diagnoses. (50) The number of offenders with psychiatric diagnosis might be underestimated, such as those with substance abuse dependence and personality disorder. Of the 4492 offenders in SLPC, 10% of data were missing and may have affected the real distribution of the variables. Longitudinal studies using structured clinical diagnostic interviews are warranted to further explore the association between mental illness and crime. Additional variables (eg, ethnicity and the number of previous offences) should have been collected to determine an association of cultural and behavioural factors with mental illness or crime.

Conclusions

The prevalence of mental disorders among offenders referred to psychiatrists is high. The pattern of associations between crime and mental disorders in these offenders is comparable with that reported in overseas studies. As Siu Lam Psychiatric Centre is the only facility in Hong Kong for mentally ill offenders, our sample is representative, and our results provide cross-sectional pattern of forensic psychiatric service utilisation in Hong Kong.

Acknowledgements

The authors thank the SLPC staff who provided assistance.

Declaration

All authors have no conflicts of interest to disclose.

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Dr Bonnie WM Siu, MBChB, MRCPsych, FHKCPsych, FHKAM (Psychiatry), FRCPsych, Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.

Dr Oliver Chan, MBChB, MRCPsych, FHKCPsych, FHKAM (Psychiatry), Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.

Ms Cherie CY Au-Yeung, BSc, MStat, Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.

Dr Kavin KW Chow, MBChB, MRCPsych, FHKCPsych, FHKAM (Psychiatry), Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.

Dr Amy CY Liu, MBChB, MRC Psych, FHKCPsych, FHKAM (Psychiatry), Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.

Dr Dorothy YY Tang, MBBS, MRCPsych, FHKCPsych, FHKAM (Psychiatry), Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.

Dr SH Lui, MBBS, MRCPsych FHKCPsych, FHKAM (Psychiatry), Department of Forensic Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.

Dr Eric FC Cheung, MBBS, MRCPsych, FHKCPsych, FHKAM (Psychiatry), FRCPsych, Kwong Wah Hospital, Hong Kong SAR, China.

Dr M Lam, MBChB, MRCPsych, FHKCPsych, FHKAM (Psychiatry), Department of General Adult Psychiatry, Castle Peak Hospital, Hong Kong SAR, China.

Address for correspondence: Dr Bonnie WM Siu, Department of Forensic Psychiatry, Castle Peak Hospital, 15 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong.

Email: bonniew114m@yahoo.com

Submitted: 26 March 2018; Accepted: 9 July 2018

DOI: 10.12809/eaap1824
Table 1. Age and education level of offenders in Siu Lam Psychiatric
Centre.

Parameter                       Total (n = 4492) (*)  Males (n = 3346)
                                                            (*)

Age at admission, y               40.6 [+ or -] 13.2    40.0 [+ or -]
                                                        13.3
  <18                             78 (2)                66 (2)
  18-39                         2161 (48)             1671 (50)
  40-64                         1997 (44)             1417 (42)
  [greater than or equal to]65   195 (4)               146 (4)
  Unknown                         61 (1)                46 (1)
Education
  No formal education            101 (2)                66 (2)
  Primary                       1052 (23)              797 (24)
  Secondary                     2411 (54)             1790 (53)
  Tertiary                       423 (9)               306 (9)
  Unknown                        505 (11)              387 (12)

Parameter                       Females (n = 1146) (*)  p Value

Age at admission, y
                                 42.2 [+ or -] 12.8      0.001
  <18                            12 (1)
  18-39                         490 (43)
  40-64                         580 (51)
  [greater than or equal to]65   49 (4)
  Unknown                        15 (1)
Education                                                0.105
  No formal education            35 (3)
  Primary                       255 (22)
  Secondary                     621 (54)
  Tertiary                      117 (10)
  Unknown                       118 (10)

(*) Data are presented as No. (%) of offenders unless otherwise stated

Table 2. Distribution by principal psychiatric diagnosis.

Principal psychiatric diagnosis          No. (%) of offenders
                                      Total       Males      Females
                                    (n = 4492)  (n = 3346)  (n = 1146)

Mental disorders due to known
physiological conditions             113 (3)      84 (3)      29 (3)
Mental and behavioural disorders
due to psychoactive substance use
Alcohol-related disorders            154 (3)     149 (4)       5 (<0.5)
Opioid-related disorders              69 (2)      54 (2)      15 (1)
Multiple drug use and use of other
psychoactive substance-related       543 (12)    417 (12)    126 (11)
disorders
Others                               151 (3)     113 (3)      38 (3)
Schizophrenia, schizotypal,
delusional, and other non-mood
psychotic disorders
Paranoid schizophrenia               216 (5)     166 (5)      50 (4)
Schizophrenia, unspecified           594 (13)    464 (14)    130 (12)
Delusional disorder                   76 (2)      44 (1)      32 (3)
Unspecified nonorganic psychosis     145 (3)     100 (3)      45 (4)
Others                               103 (2)      80 (2)      23 (2)
Mood (affective disorders)
Bipolar affective disorder,
unspecified                           94 (2)      67 (2)      27 (2)
Depressive episode, unspecified      157 (3)      81 (2)      76 (7)
Dysthymia                             53 (1)      17 (1)      36 (3)
Others                               149 (3)      75 (2)      74 (6)
Anxiety, dissociative,
stress-related, somatoform and
other non-psychotic mental
disorders
Adjustment disorders                 162 (4)      92 (3)      70 (6)
Others                                96 (2)      64 (2)      32 (3)
Behavioural syndromes associated
with physiological disturbances
and physical factors                  15 (<0.5)    6 (<0.5)    9 (1)
Disorders of adult personality
and behaviour
Dissocial personality disorder        60 (1)      56 (2)       4 (<0.5)
Others                               118 (3)      69 (2)      49 (4)
Intellectual disabilities            124 (3)     103 (3)      21 (2)
Pervasive and specific
developmental disorders               23 (1)      23 (1)       0 (0)
Behavioural and emotional
disorders with onset usually
occurring in childhood and
adolescence                           42 (1)      37 (1)       5 (<0.5)
Not mentally ill                    1037 (23)    826 (25)    211 (18)
Pending diagnosis / unspecified
/ unknown                            198 (4)     159 (5)      39 (3)

Principal psychiatric diagnosis     p Value

Mental disorders due to known
physiological conditions             0.969
Mental and behavioural disorders
due to psychoactive substance use   <0.001
Alcohol-related disorders
Opioid-related disorders
Multiple drug use and use of other
psychoactive substance-related
disorders
Others
Schizophrenia, schizotypal,
delusional, and other non-mood
psychotic disorders                  0.464
Paranoid schizophrenia
Schizophrenia, unspecified
Delusional disorder
Unspecified nonorganic psychosis
Others
Mood (affective disorders)          <0.001
Bipolar affective disorder,
unspecified
Depressive episode, unspecified
Dysthymia
Others
Anxiety, dissociative,
stress-related, somatoform and
other non-psychotic mental
disorders                           <0.001
Adjustment disorders
Others
Behavioural syndromes associated
with physiological disturbances
and physical factors                 0.002
Disorders of adult personality
and behaviour                        0.183
Dissocial personality disorder
Others
Intellectual disabilities           <0.05
Pervasive and specific
developmental disorders             <0.01
Behavioural and emotional
disorders with onset usually
occurring in childhood and
adolescence                         <0.05
Not mentally ill                    <0.001
Pending diagnosis /unspecified
/ unknown                            0.055

Table 3. Distribution by index offence.

Index offence                              No. (%) of offenders
                                      Total (n = 4492)  Males (n = 3346)

Theft and related offences                969 (22)          525 (16)
Acts intended to cause injury             919 (20)          736 (22)
Illicit drug offences                     508 (11)          335 (10)
Sexual assault and related
offences                                  377 (8)           371 (11)
Property damage and
environmental pollution                   297 (7)           251 (8)
Fraud, deception, and
related offences                          255 (6)           185 (6)
Public order offences                     238 (5)           223 (7)
Abduction, harassment, and other
offences against a person                 185 (4)           148 (4)
Prohibited and regulated weapons,
and explosives offences                   181 (4)           149 (4)
Offences against justice
procedures, government security,
and government operations                 149 (3)           104 (3)
Robbery, extortion, and related
offences                                   88 (2)            81 (2)
Unlawful entry with intent/burglary,
breaking and entering                      88 (2)            79 (2)
Homicide and related offences              80 (2)            67 (2)
Dangerous or negligent acts
endangering people                         59 (1)            38 (1)
Miscellaneous offences                     39 (1)            30 (1)
Traffic and vehicle regulatory
offences                                   18 (<0.5)         15 (<0.5)
Unknown                                    42 (1)             9 (<0.5)

Index offence                         No. (%) of offenders  p Value
                                       Females (n = 1146)

Theft and related offences                  444 (39)        <0.001
Acts intended to cause injury               183 (16)        <0.001
Illicit drug offences                       173 (15)        <0.001
Sexual assault and related
offences                                      6 (1)         <0.001
Property damage and
environmental pollution                      46 (4)         <0.001
Fraud, deception, and
related offences                             70 (6)          0.465
Public order offences                        15 (1)         <0.001
Abduction, harassment, and other
offences against a person                    37 (3)          0.079
Prohibited and regulated weapons,
and explosives offences                      32 (3)          0.014
Offences against justice
procedures, government security,
and government operations                    45 (4)          0.182
Robbery, extortion, and related
offences                                      7 (1)         <0.001
Unlawful entry with intent/burglary,
breaking and entering                         9 (1)          0.001
Homicide and related offences                13 (1)          0.055
Dangerous or negligent acts
endangering people                           21 (2)          0.074
Miscellaneous offences                        9 (1)          0.726
Traffic and vehicle regulatory
offences                                      3 (<0.5)       0.388
Unknown                                      33 (3)         <0.001

Table 4. Distribution by three most common principal psychiatric
diagnostic groups.

Index offence                               No. (%) of offenders
                                        Mental and     Schizophrenia,
                                        behavioural     schizotypal,
                                       disorders due    delusional,
                                      to psychoactive    and other
                                       substance use      non-mood
                                         (n = 917)       psychotic
                                                         disorders
                                                         (n = 1134)

Acts intended to cause injury            175 (19)         346 (31)
Theft and related offences               185 (20)         209 (18)
Illicit drug offences                    205 (22)          71 (6)
Property damage and
environmental pollution                   84 (9)          102 (9)
Fraud, deception, and related
offences                                  21 (2)           65 (6)
Prohibited and regulated weapons,
and explosives offences                   55 (6)           48 (4)
Abduction, harassment, and other
offences against a person                 36 (4)           44 (4)
Public order offences                     40 (4)           52 (5)
Sexual assault and related offences       10 (1)           72 (6)
Offences against justice procedures,
government security, and government
operations                                20 (2)           48 (4)
Robbery, extortion, and related
offences                                  21 (2)           19 (2)
Unlawful entry with intent/burglary,
breaking and entering                     20 (2)           15 (1)
Dangerous or negligent acts
endangering people                        16 (2)           20 (2)
Homicide and related offences              7 (1)           12 (1)
Miscellaneous offences                     7 (1)            4 (<0.5)
Traffic and vehicle regulatory
offences                                   7 (1)            1 (<0.5)
Unknown                                    8 (1)            6 (1)

Index offence                         No. (%) of offenders  p Value
                                              Mood
                                           (affective
                                           disorders)
                                           [n = 453]

Acts intended to cause injury                75 (17)        <0.001
Theft and related offences                  170 (38)        <0.001
Illicit drug offences                        36 (8)         <0.001
Property damage and
environmental pollution                      14 (3)         <0.001
Fraud, deception, and related
offences                                     39 (9)         <0.001
Prohibited and regulated weapons,
and explosives offences                      15 (3)          0.051
Abduction, harassment, and other
offences against a person                    26 (6)          0.213
Public order offences                        10 (2)          0.082
Sexual assault and related offences          17 (4)         <0.001
Offences against justice procedures,
government security, and government
operations                                   11 (2)          0.019
Robbery, extortion, and related
offences                                     10 (2)          0.576
Unlawful entry with intent/burglary,
breaking and entering                        10 (2)          0.267
Dangerous or negligent acts
endangering people                            5 (1)          0.613
Homicide and related offences                 6 (1)          0.594
Miscellaneous offences                        6 (1)          0.096
Traffic and vehicle regulatory
offences                                      3 (1)          0.052
Unknown                                       0 (0)          0.123
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Title Annotation:Theme Paper
Author:Siu, Bonnie W.M.; Chan, Oliver; Au-Yeung, Cherie C.Y.; Chow, Kavin K.W.; Liu, Amy C.Y.; Tang, Doroth
Publication:East Asian Archives of Psychiatry
Article Type:Report
Date:Dec 1, 2018
Words:5829
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