Elsevier

The Lancet

Volume 359, Issue 9306, 16 February 2002, Pages 545-550
The Lancet

Articles
Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys

https://doi.org/10.1016/S0140-6736(02)07740-1Get rights and content

Summary

Background

About 9 million people are imprisoned worldwide, but the number with serious mental disorders (psychosis, major depression, and antisocial personality disorder) is unknown. We did a systematic review of surveys on such disorders in general prison populations in western countries.

Methods

We searched for psychiatric surveys that were based on interviews of unselected prison populations and included diagnoses of psychotic illnesses or major depression within the previous 6 months, or a history of any personality disorder. We did computer-assisted searches, scanned reference lists, searched journals, and corresponded with authors. We determined prevalence rates of serious mental disorders, sex, type of prisoner (detainee or sentenced inmate), and other characteristics.

Findings

62 surveys from 12 countries included 22 790 prisoners (mean age 29 years, 18 530 [81%] men, 2568 [26%] of 9776 were violent offenders). 3·7% of men (95% CI 3·3–4·1) had psychotic illnesses, 10% (9–11) major depression, and 65% (61–68) a personality disorder, including 47% (46–48) with antisocial personality disorder. 4·0% of women (3·2–5·1) had psychotic illnesses, 12% (11–14) major depression, and 42% (38–45) a personality disorder, including 21% (19–23) with antisocial personality disorder. Although there was substantial heterogeneity among studies (especially for antisocial personality disorder), only a small proportion was explained by differences in prevalence rates between detainees and sentenced inmates. Prisoners were several times more likely to have psychosis and major depression, and about ten times more likely to have antisocial personality disorder, than the general population.

Interpretation

Worldwide, several million prisoners probably have serious mental disorders, but how well prison services are addressing these problems is not known.

Introduction

About 9 million people are imprisoned worldwide, including 2 million in the USA and 70 000 in the UK.1 Many psychiatric surveys have been done in prisons, but they have generally been small, have often included selected populations (such as prisoners referred to psychiatric services), and have not been assessed systematically. Indeed, three reviews included a total of only ten studies in general prison populations.2, 3, 4 More reliable estimates of the prevalence rates of serious mental disorders in prisoners, such as psychotic illnesses, major depression, and antisocial personality disorder should help inform public policy and prison health services. We have done a systematic review of psychiatric surveys of people in general prison populations in western countries (with results subdivided by disorder, sex, and type of prisoner).

Section snippets

Methods

We searched for studies of the prevalence of psychotic illnesses, major depression, or any personality disorder in general prison populations of western countries published between January, 1966, and January, 2001. We did computer-based searches (EMBASE, PsycINFO, MEDLINE, US National Criminal Justice Reference System Abstract Database), scanned relevant reference lists, searched forensic psychiatry and other relevant journals by hand, and discussed and corresponded with authors.5, 6, 7, 8, 9,

Study and baseline characteristics

62 relevant surveys, reported in 66 publications, included a total of 22 790 prisoners of whom 18 530 (81%) were men. In 47 surveys (12 859 prisoners) that included information on age, weighted mean age of prisoners was 29 years. 2568 (26%) of 9776 prisoners were charged with, or convicted of, violent offences (27 surveys included these data). These baseline characteristics varied little by disorder. The studies were from Australia (598 prisoners),18, 39, 50, 52, 61, 69 Canada (3196),5, 27, 37,

Discussion

Our results suggest that typically about one in seven prisoners in western countries have psychotic illnesses or major depression (disorders that might be risk factors for suicide),80 and about one in two male prisoners and about one in five female prisoners have antisocial personality disorders. These findings might have several implications.

First, they indicate that the risks of having serious psychiatric disorders are substantially higher in prisoners than in the general population. Compared

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