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Risk of Homelessness after Prison Release and Recidivism: A Danish Nationwide, Register-Based, Cohort Study
36 Pages Posted: 28 Apr 2023
More...Abstract
Background: Transitional periods between and across services have been linked to homelessness. We studied the risk of homelessness after prison release and re-offending.
Methods: We did a register-based nationwide cohort study of 37,382 people aged at least 15 years released from prison in Denmark from January 1, 2001, until December 31, 2021, born 1980-2007. Information on release date, homeless shelter contact, psychiatric disorders, and recidivism were obtained from the linked population-based registers. We estimated incidence rate (IR) and incidence rate ratio (IRR) using Poisson regression analysis adjusting for potential confounders. We furthermore calculated cumulative incidences.
Findings: The study cohort included 37,382 individuals (34,792 males (93∙1%) and 2590 females (6∙9%)) aged 15-41 years of age who were released from prison during 2001-2021, accounting for 202,197 person-years (mean follow-up: 5∙4 person-years) at risk. Overall, 1843 (4∙9%) individuals became homeless during follow-up. One year after release from prison, 2∙1% had at least one homeless shelter contact, and it was 20∙7% in those with a history of homelessness. The IR of first homeless shelter contact after release was 102∙5 per 1000 person-years for individuals with prior homelessness and 6∙7/1000 person-years in individuals without (IRR 16∙4, 95% CI 14∙8-18∙2 adjusted for sex, age, and calendar year). Individuals who additionally had a mental illness had a higher IRR (22∙6, 95% CI 19∙7-25∙9) compared with those without either and substantially higher for those with prior homelessness and co-occurring drug use disorder (IRR 25∙0, 21∙6-28∙9). Within two years after release, the cumulative probability of recidivism was 74∙7% (95% CI 74∙3-75∙2). In people who were homeless after prison release, the IRR for recidivism was 1∙5 (95% CI 1∙3-1∙7) compared with no homelessness.
Interpretation: Reducing risks of becoming homeless after prison release, especially in individuals with psychiatric disorders, and in women, could lead to reductions in repeat offending.
Funding: This study was funded by a grant from the Lundbeckfonden (grant number: F-61171-23-50). SF is funded by the Wellcome Trust (#202836/Z/16/Z) and Oxford Health NIHR Biomedical Research Centre.
Declaration of Interest: We declare no competing interests.
Ethical Approval: Legal permission was obtained from the Danish Data Protection Agency (P-2020-504), Statistics Denmark, and the Danish Health Data Authority. Ethical permission is not required for register- based studies according to Danish regulations.
Keywords: Prisons, Recidivism, Crime, Ill-housed Persons, Homeless Youth, Public Health, Health Policy, Minority Groups, Psychiatry, Substance-related Disorders, Health Inequities, Social Support
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