Severe mental illness in 33 588 prisoners worldwide: systematic review and meta-regression analysis

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>High levels of psychiatric morbidity in prisoners have been documented in many countries, but it is not known whether rates of mental illness have been increasing over time or whether the prevalence differs between low–middle-income countries compared with high-income ones.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To systematically review prevalence studies for psychotic illness and major depression in prisoners, provide summary estimates and investigate sources of heterogeneity between studies using meta-regression.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Studies from 1966 to 2010 were identified using ten bibliographic indexes and reference lists. Inclusion criteria were unselected prison samples and that clinical examination or semi-structured instruments were used to make DSM or ICD diagnoses of the relevant disorders.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We identified 109 samples including 33 588 prisoners in 24 countries. Data were meta-analysed using random-effects models, and we found a pooled prevalence of psychosis of 3.6% (95% CI 3.1–4.2) in male prisoners and 3.9% (95% CI 2.7–5.0) in female prisoners. There were high levels of heterogeneity, some of which was explained by studies in low–middle-income countries reporting higher prevalences of psychosis (5.5%, 95% CI 4.2–6.8;<jats:italic>P</jats:italic>=0.035 on meta-regression). The pooled prevalence of major depression was 10.2% (95% CI 8.8–11.7) in male prisoners and 14.1% (95% CI 10.2–18.1) in female prisoners. The prevalence of these disorders did not appear to be increasing over time, apart from depression in the USA (<jats:italic>P</jats:italic>=0.008).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>High levels of psychiatric morbidity are consistently reported in prisoners from many countries over four decades. Further research is needed to confirm whether higher rates of mental illness are found in low- and middle-income nations, and examine trends over time within nations with large prison populations.</jats:p></jats:sec>

Non-pharmacological interventions for reducing aggression and violence in serious mental illness: A systematic review and narrative synthesis

“…Patients with serious mental illness (SMI) are at higher risk of committing acts of violence than the general population [1,2,3] and are over-represented in the criminal justice setting [4,5,6,7] yet the majority of the violence literature pertains to an offending population without mental disorder. People with personality disorder (PD) have similarly increased violence rates and this increases further if the diagnosis is antisocial PD (ASPD) [8].…”

Preventing crime in cooperation with the mental health care profession

“…According to a systematic review of surveys on psychiatric disorders in general prison populations, about one in seven prisoners in western countries is diagnosed with psychotic illnesses or major depression [12]. According to Torrey et al [37] at least 16 % of inmates in jails and prisons in the USA have a serious mental illness; they state that there are three times more seriously mentally ill persons in jails and prisons than in hospitals.…”

Introduction

“…Lorsqu'on met en tension les différents segments du système de justice pénale avec la notion de santé mentale, la prison s'impose évi-demment comme un lieu qui cristallise l'attention. Ainsi, la prévalence élevée d'individus en milieu carcéral souffrant de problèmes de santé mentale est maintenant bien établie (Fazel et Seewald, 2012). Les données d'enquêtes à grande échelle en Europe, en Amérique du Nord et du Sud, en Asie et au Moyen-Orient soulignent la grande vulnéra-bilité d'une population éprouvant des diffi cultés multiples, allant bien au-delà de la psychopathologie.…”