Femårsuppföljning för tvångsvårdade kvinnor. Inverkan av psykiska problem på utfallet

Sammanfattning: Aim: The study focus is a sample of women with drug dependence admitted to compulsory treatment according to the Swedish act of care for drug abusers (LVM, 1988:870) and according to the act of care for young persons (LVU, 1990:52). From a cohort consecutively admitted to residential treatment at Lunden between 1997 and 2000, a sample of 132 women was selected for a five year follow-up. They were evaluated at base-line using a structured assessment procedure including, psychiatric diagnoses (ICD-10; DSM-IV), personality disorders (DSM-IV) and tests of symptoms, personality patterns and neuropsychological problems. All participants provided written consent. The study was approved by the Ethical Committee of Lund University (LU 88-02; Dnr. 586/2005). Method: 109 of 124 clients (88%), still alive, were interviewed face-to-face five years after the index admission. A triangulation approach was used with cross-section data like DOK, the tests used at base-line and process data like the Timeline-Follow-Back interview. Register data from causes of death and hospital admission registers from the EPC at the Swedish National Department of Health, and data on criminal sentences from the Council of Crime Prevention (BRÅ) were added, covering data for the entire cohort (n=230) from 11 years prior base-line admittance to 2006. Results: Study I demonstrated that hospital admission and criminal patterns peaked around the time of the admission but decreased over time. The psychological and physical health of the sample, the social status of the women five years after discharge was improved in the group with a prolonged abstinence as well as for those having one year or more of abstinence. The levels of abstinence at follow-up were 42-48% for one year, 30-36% for two continuous years and 17% continously abstinent from discharge up to five years. Psychological improvement was found for all patients with longer periods of abstinence, as was a decrease of criminal sentences and hospital admissions. Conduct disorders and antisocial personality disorder were negative predictors. Borderline personality disorder was not. Study II analyzed the validity of self-reported criminal behavior with databases of criminal offences and judical sanctions. Theft, drug offences and violence- and prison sentences were investigated for 106 women. The results imply that self-reported data of criminal behavior are comparable, though the validity of self-report may vary between types of criminal offences involvement. Data on theft and drug offence were slightly over reported while violence sentences were slightly under reported. Study III showed that clients with more personality disorder features remained more symptomatic than those with fewer personality disorder features. Client with Borderline personality disorder features were more symptomatic independently of abstinence or not. Study IV evaluated the influence of personality disorder features on social functioning like employment, arrest and hospitalization at follow-up. 106 were evaluated with SCID II, the SCL-90, (GSI) and the TLFB. At follow-up, older women were less likely to work. Obsessive-compulsive and dependent personality disorders were associated with increased chances of employment whereas conduct disorder features and avoidant personality disorder features were not. Conduct disorder features only were associated with unemployment and criminal justice record.