PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours

Abstract

Prevalence rates of PTSD are higher in the prison population than in the community. We sought to systematically review the extent to which this disorder is associated with other mental health disorders and problematic suicidal or aggressive behaviours in the prison population. Methods Studies reporting a relationship between PTSD and comorbid mental disorders and/or problematic behaviours in imprisoned adolescent and adult populations were identified from four bibliographic indexes. Primary studies involving clinical interviews, validated instruments leading to DSM or ICD diagnoses, or validated self-report questionnaires such as the PTSD checklist were included. Random-effects meta-analysis was conducted where possible. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results This review identified 36 studies, with a combined sample of 9594 participants, (6478 male and 2847 female prisoners) from 11 countries. Thirty-four of the identified studies employed a cross-sectional design. We identified significant associations between PTSD and comorbid mental disorders including depression (OR = 3.4, 95% confidence interval (CI): 2.3-4.9), anxiety (OR = 2.9, 95% confidence interval (CI): 1.8-4.7) and substance use (OR = 1.9, 95% confidence interval (CI): 1.5-2.4). We also identified significant associations between PTSD and suicidality (OR = 3, 95% confidence interval (CI): 2.4-3.8) and aggressive behaviours (this latter finding was not subject to meta-analysis). Significant methodological heterogeneity was identified between studies.

Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal

“…High rates of lifetime depression (45%) and current depression (33%) were seen in this special population, similar to previous studies in Nepal and in other countries [48,50]. Though these scores are higher than those found by the WHO after a humanitarian crisis/ trauma exposure, they are similar to findings from a recent meta-analysis [26,52].…”

“…There has been a preconception among many mental health professionals that PTSD does not exist in Nepal [29]. Since PTSD is highly comorbid with other common illnesses such as depression and GAD [48][49][50], it might be missed during evaluation. Patients not acknowledging the impact of trauma may also lead to underreporting of the trauma related illness [40].…”

A double-edged sword: Children’s experiences of visiting a parent in prison in Scotland

“…Allely (2015) has noted that for those with sensory sensitivities, the prison environment can be particularly challenging. The prevalence of sensory sensitivities, such as autism and PTSD, within the prison population is unknown; however, research indicates that figures are higher than the general population (Facer-Irwin et al, 2019; Fazio et al, 2012; King and Murphy, 2014). Such prisoners are more likely to have unique and complex needs (Allely, 2015).…”

Post traumatic stress disorder in incarcerated populations: current clinical considerations and recommendations

“…Moore et al (2013) have argued that improving screening approaches will “ensure trauma experiences are carefully reviewed and appropriate measures are put in place to support young people at each stage of their incarceration, not only at the point of admission, which is often the main focus given the risks associated with first-time incarceration” (Moore et al , 2013, p. 868). Facer-Irwin et al (2019) have recently emphasised that there is currently no routine screening for PTSD in clinical services, and PTSD is also typically undiagnosed and untreated within prison settings (Fazel et al , 2016; Jakobowitz et al , 2017; Tyler et al , 2019 – see Facer-Irwin et al , 2019).…”