Global Estimates of the Prevalence of Depression among Prisoners: A Systematic Review and Meta-analysis

Abstract

Background. Prison populations tend to be marginalized and disadvantaged of the rights and freedoms that other people in the community benefit from. Their separation from families, a narrow room and lack of privacy in the prison, violence between prisoners, and the uncertainty about the future result in psychological distress, for example, depression. The review has synthesized previous studies conducted on the topic and summarized to formulate recommendations for future prison health care services. Methods. We systematically searched the databases: PubMed, Psych Info, and SCOPUS, as well as manual Google Scholar searches, were conducted to retrieve published literature globally. We have included observational studies, written in English language. Estimates were pooled using a random-effects model. The study protocol was registered in PROSPERO with protocol number CRD42020156108. Subgroup and sensitivity analysis was conducted, and heterogeneity across the studies was evaluated using Q and the I 2 -test. Publication bias was assessed by inspection of the funnel plot and Egger’s regression test. Result. A total of 1313 studies were initially identified through the electronic database; among these, a total of 73 full-text articles were retrieved for further appraisal. Further, 32 full-text articles were included in the final systematic review and meta-analysis. In this meta-analysis, the pooled prevalence of depression among prisoners was 36.9% (95% CI; 27.3-47.6). The pooled prevalence of depression among prisoners in the developing and developed countries was 39.2% and 33.1%, respectively. Moreover, the prevalence of depression was 19.1% and 54% for the studies that used diagnostic and screen tools to diagnose or screen depression, respectively. A leave-one-out analysis revealed that the pooled prevalence of depression among prisoners was not dependent on a single study removal or addition. Thus, the pooled prevalence of depression ranges between 35.3 and 38.0%. Conclusion. The prevalence of depression among prisoners was high. Therefore, regular and continuous screening of depressive symptoms for prisoners along with its appropriate management is highly recommended.

Animal Crossing and COVID-19: A Qualitative Study Examining How Video Games Satisfy Basic Psychological Needs During the Pandemic

“…Beyond the pandemic, situations and contexts which thwart such basic needs can result in psychological distress, and this includes patients having to undergo long-term bedrest, grieving individuals, people with mobility issues, or even incarcerated prisoners, among others ( Maloni et al, 2002 ; Bedaso et al, 2020 ). Video games may provide psychological relief for individuals going through difficult emotional experiences in life.…”

Screening male prisoners for depression and anxiety with the PHQ-9 and GAD-7 at NHS Healthcheck: patterns of symptoms and caseness threshold

“…Given the possibility of under-reporting as well as over reporting of some symptoms such as suicidality, a caseness threshold of 10 or more may be satisfactory for the GAD-7 but not for the PHQ-9. The diagnostic algorithm suggested that only 17.9% prisoners had a depressive episode which is in the expected range for caseness for a depressive episode (15.0-23.9%) when standardised psychiatric interviews were used in previous studies [14]. However, the diagnostic algorithm method tends to have low sensitivity [28] for depressive episodes so it may miss some cases, including some who may be at risk of suicide and selfharm.…”

“…Given previous concerns about false positives when screening prisoners for mental health problems with community derived thresholds [14][15][16], we conducted a dendrogram of scores of 3 or more on the core items of the PHQ-9 and GAD-7 in all those who scored > 10 on the PHQ-9. We found five clusters, the largest of which (cluster 3) had daily core symptoms of depression with suicide ideation, poor concentration, feeling slowed down or restless, irritability or fear of something bad happening.…”

“…In England prisoners could be screened for depression and anxiety disorders alongside screening for risk of cardiovascular disease through NHS Healthchecks [11] to improve both mental and physical health together. However, selfrated screening instruments that are commonly used for the most prevalent mental disorders in prisoners and the community, namely depression and anxiety disorders, such as the Patient Health Questionnaire (PHQ-9) [12] for depression and the Generalised Anxiety Disorder Assessment (GAD-7) [13] might be susceptible to false positive results [14][15][16]. A metaanalysis of depression screening studies in prisoners estimated the prevalence of depressive episodes to be 19.1% (95% CI 15.0-23.9) but screening by self-rated measures of depression estimated depression to be present in 54.0% (95% CI 43.8-63.9%) [14].…”

“…However, selfrated screening instruments that are commonly used for the most prevalent mental disorders in prisoners and the community, namely depression and anxiety disorders, such as the Patient Health Questionnaire (PHQ-9) [12] for depression and the Generalised Anxiety Disorder Assessment (GAD-7) [13] might be susceptible to false positive results [14][15][16]. A metaanalysis of depression screening studies in prisoners estimated the prevalence of depressive episodes to be 19.1% (95% CI 15.0-23.9) but screening by self-rated measures of depression estimated depression to be present in 54.0% (95% CI 43.8-63.9%) [14]. There was considerable variation in the methods used to estimate depression by interview or self-rated measure, and the population varied by country, nature of prison, sentence or remand status, and selection by clinical or demographic factors.…”