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Severe mental illness in 33 588 prisoners worldwide: systematic review and meta-regression analysis
- Authors:
- FAZEL Seena, SEEWALD Katherine
- Journal article citation:
- British Journal of Psychiatry, 200(5), May 2012, pp.364-373.
- Publisher:
- Cambridge University Press
High levels of psychiatric morbidity in prisoners are well documented but it is not known whether these are increasing or whether prevalence differs between low, middle, and high income countries. This systematic review evaluated prevalence studies for psychotic illness and major depression in prisoners. Inclusion criteria were, publication 1966- 2012, unselected prison samples and use of clinical examination or semi-structured instruments to make DSM or ICD diagnoses. A total of 109 samples were identified, including 33 588 prisoners in 24 countries. Data were meta-analysed using random-effects models. The pooled prevalence of psychosis was 3.6% in male prisoners and 3.9% in females. 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%). The pooled prevalence of major depression was 10.2% in male prisoners and 14.1% in females. Apart from depression in the USA, the prevalence of these disorders did not appear to be increasing over time. High levels of psychiatric morbidity have been consistently reported in prisoners from many countries over the four decades. However, further research is needed to confirm whether higher rates of mental illness are found in low- and middle-income nations, and to examine trends over time within nations with large prison populations.