I'm now on my psychiatry rotation, and it would be an understatement to say that it has been interesting. Washington University is a big believer in biological models of psychiatric diseases - which means I need to have a good command of neurobiology and pharmacology to really understand what is going on with the ward patients - and this sentiment has grown more generally in the last 20-25 years.
One of the things we are taught in terms of epidemiology is the link between psychiatric disease and crime. As such, from a health policy standpoint, if we are trying to understand the net social impact of pharmacotherapy for psychiatric disease, we need to understand the impacts this may have on crime in addition to disease burden. A new working paper by Dave Marcotte and Sara Markowitz attempts to look into this issue:
In this paper we consider possible links between the advent and diffusion of a number of new psychiatric pharmaceutical therapies and crime rates. We describe recent trends in crime and review the evidence showing mental illness as a clear risk factor both for criminal behavior and victimization. We then briefly summarize the development of a number of new pharmaceutical therapies for the treatment of mental illness which diffused during the “great American crime decline.” We examine limited international data, as well as more detailed American data to assess the relationship between crime rates and rates of prescriptions of the main categories of psychotropic drugs, while controlling for other factors which may explain trends in crime rates. We find that increases in prescriptions for psychiatric drugs in general are associated with decreases in violent crime, with the largest impacts associated with new generation antidepressants and stimulants used to treat ADHD. Our estimates imply that about 12 percent of the recent crime drop was due to expanded mental health treatment.
As you can imagine, the authors have to work pretty hard to deal with all the unobserved heterogeneity/confounding that might lead to the spurious estimates of the treatment-drug relationship. I think the authors do a decent job (though any analysis of this sort will have limitations) and the 12% number, while seemingly high, is still lower than postulated impacts of other sources of the crime decline (abortion, reductions in lead exposure), and enough so that it actually sounds plausible.
3 comments:
Atheen,
This is very interesting, as what we are generally taught during residency is that having a mental illness other than substance abuse does not increase the risk of violent crime. And I also wonder how much of any decrease in criminal activity may be due to side effects of medication (such as amotivation from antidepressants) rather than their purported actions on psychiatric conditions.
Dan,
I'm glad you commented on this, because I was curious as to what a psychiatrist thought of the paper. I think your point about side effects is interesting. Do you know of any work that links these side effects to certain behaviors?
I wonder if it might be possible to take advantage of changes in development or coverage of "activating" versus "inactivating" antidepressants to see if drugs with different side effect profiles have different effects...
"what we are generally taught during residency is that having a mental illness other than substance abuse does not increase the risk of violent crime"
is there any good evidence for this or is it a myth?
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