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

  • Seena Fazel (a1) and Katharina Seewald (a2)

Abstract

Background

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.

Aims

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.

Method

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.

Results

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; P=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 (P=0.008).

Conclusions

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.

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Copyright

COPYRIGHT: © Royal College of Psychiatrists, 2012 

Corresponding author

Seena Fazel, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK. Email: seena.fazel@psych.ox.ac.uk

Footnotes

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K.S. was funded by the German Friedrich-Ebert Stiftung.

Declaration of interest

None.

Footnotes

References

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1 Walmsley, R. World Prison Population List (8th edn). King's College London International Centre for Prison Studies, 2009.
2 Baillargeon, J, Penn, JV, Thomas, CR, Temple, JR, Baillargeon, G, Murray, OJ. Psychiatric disorders and suicide in the nation's largest state prison system. J Am Acad Psychiatry Law 2009; 37: 188–93.
3 Fazel, S, Cartwright, J, Norman-Nott, A, Hawton, K. Suicide in prisoners: a systematic review of risk factors. J Clin Psychiatry 2008; 69: 1721–31.
4 Kariminia, A, Law, M, Butler, T, Corben, SP, Levy, MH, Kaldor, JM, et al. Factors associated with mortality in a cohort of Australian prisoners. Eur J Epidemiol 2007; 22: 417–28.
5 Fazel, S, Yu, R. Psychotic disorders and repeat offending: systematic review and meta-analysis. Schizophr Bull 2011; 37: 800–10.
6 Baillargeon, J, Binswanger, IA, Penn, JV, Williams, BA, Murray, OJ. Psychiatric disorders and repeat incarcerations: the revolving prison door. Am J Psychiatry 2009; 166: 103–9.
7 Fazel, S, Grann, M, Kling, B, Hawton, K. Prison suicide in 12 countries: an ecological study of 861 suicides during 2003–2007. Soc Psychiatry Psychiatr Epidemiol 2011; 46: 191–5.
8 Binswanger, IA, Stern, MF, Deyo, RA, Heagerty, PJ, Cheadle, A, Elmore, JG, et al. Release from prison – a high risk of death for former inmates. N Engl J Med 2007; 356: 57–65.
9 Fazel, S, Danesh, J. Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys. Lancet 2002; 359: 545–50.
10 Priebe, S, Frottier, P, Gaddini, A, Kilian, R, Lauber, C, Martínez-Leal, R, et al. Mental health care institutions in nine European countries, 2002 to 2006. Psychiatr Serv 2008; 59: 570–3.
11 Dressing, H, Kief, C, Salize, H-J. Prisoners with mental disorders in Europe. Br J Psychiatry 2009; 194: 88.
12 Bradley-Engen, MS, Cuddeback, GS, Gayman, MD, Morrissey, JP, Mancuso, D. Trends in state prison admission of offenders with serious mental illness. Psychiatr Serv 2010; 61: 1263–5.
13 Levy, M. Health services for prisoners. BMJ 2011; 342: d351.
14 Moher, D, Tsertsvadze, A. Systematic reviews: when is an update an update? Lancet 2006; 367: 881–3.
15 Saxena, S, Thornicroft, G, Knapp, M, Whiteford, H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; 370: 878–89.
16 Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The, PG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097.
17 O'Keefe, ML, Schnell, MJ. Offenders with mental illness in the correctional system. J Offender Rehabil 2007; 45: 81–104.
18 Steadman, HJ, Osher, FC, Robbins, PC, Case, B, Samuels, S. Prevalence of serious mental illness among jail inmates. Psychiatr Serv 2009; 60: 761–5.
19 Kanyanya, IM, Othieno, CJ, Ndetei, DM. Psychiatric morbidity among convicted male sex offenders at Kamiti Prison, Kenya. E Afr Med J 2007; 84: 151–5.
20 Kugu, N, Akyuz, G, Dogan, O. Psychiatric morbidity in murder and attempted murder crime convicts: a Turkey study. Forensic Sci Int 2008; 175: 107–12.
21 Fazel, S, Grann, M. Psychiatric morbidity among homicide offenders: a Swedish population study. Am J Psychiatry 2004; 161: 2129–31.
22 Fazel, S, Hope, T, O'Donnell, I, Piper, M, Jacoby, R. Health of elderly male prisoners: worse than the general population, worse than younger prisoners. Age Ageing 2001; 30: 403–7.
23 Ajiboye, PO, Yussuf, AD, Issa, BA. Current and lifetime prevalence of mental disorders in a juvenile borstal institution in Nigeria. Res J Med Sci 2009; 3: 26–30.
24 Morgan, RD, Fisher, WH, Duan, NH, Mandracchia, JT, Murray, D. Prevalence of criminal thinking among state prison inmates with serious mental illness. Law Human Behav 2010; 34: 324–36.
25 Lamb, HR, Weinberger, EL, Marsh, SJ, Gross, HB. Treatment prospects for persons with severe mental illness in an urban county jail. Psychiatr Serv 2007; 58: 782.
26 Segagni Lusignani, G, Giacobone, C, Pozzi, F, Dal Canton, F, Alecci, P, Carra, G. Disturbi mentali in una casa circondariale: uno studio di prevalenza [Mental disorders in a local prison: a prevalence study]. NÓOS 2006; 1: 23–34.
27 Fazel, S, Bains, P, Doll, H. Substance abuse and dependence in prisoners: a systematic review. Addiction 2006; 101: 181–91.
28 Goff, A, Rose, S, Purves, D. Does PTSD occur in sentenced prison populations? A systematic literature review. Crim Behav Mental Health 2007; 17: 152–62.
29 Abdalla-Filho, E, De Souza, PA, Tramontina, JF, Taborda, JGV. Mental disorders in prisons. Curr Opin Psychiatry 2010; 23: 463–6.
30 Falissard, B, Loze, J-Y, Gasquet, I, Duburc, A, de Beaurepaire, C. Prevalence of mental disorders in French prisons for men. BMC Psychiatry 2006; 6: 33.
31 The World Bank. How we Classify Countries: Country and Lending Groups. The World Bank, 2011 (http://data.worldbank.org/about/country-classifications/country-and-lending-groups).
32 Patsopoulos, NA, Evangelou, E, Ioannidis, JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 2008; 37: 1148–57.
33 Sweeting, MJ, Sutton, AJ, Lambert, PC. What to add to nothing? Use and avoidance of continuity corrections in meta-analysis of sparse data. Stat Med 2004; 23: 1351–75.
34 Ioannidis, JPA, Patsopoulos, NA, Evangelou, E. Uncertainty in heterogeneity estimates in meta-analyses. BMJ 2007; 335: 914–6.
35 Higgins, JPT, Thompson, SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–58.
36 Higgins, JPT, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–60.
37 Ioannidis, JPA, Patsopoulos, NA, Rothstein, HR. Reasons or excuses for avoiding meta-analysis in forest plots. BMJ 2008; 336: 1413–5.
38 Egger, M, Smith, GD, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–34.
39 Andersen, HS, Sestoft, D, Lillebaek, T, Gabrielsen, G, et al. Prevalence of ICD-10 psychiatric morbidity in random samples of prisoners on remand. Int J Law Psychiatry 1996; 19: 61–74.
40 Bartholomew, AA, Brain, LA, Douglas, AS, Reynolds, WS. A medico-psychiatric diagnostic review of remanded (without a request for a psychiatric report) male minor offenders. Med J Aust 1967; 1: 267.
41 Birmingham, L, Mason, D, Grubin, D. Prevalence of mental disorder in remand prisoners: consecutive case study. BMJ 1996; 313: 1521–4.
42 Bland, RC, Newman, SC, Dyck, RJ, Orn, H. Prevalence of psychiatric disorders and suicide attempts in a prison population. Can J Psychiatry 1990; 35: 407–13.
43 Bluglass, R. A Psychiatric Study of Scottish Convicted Prisoners. University of St Andrews, 1966.
44 Brinded, PMJ, Stevens, I, Mulder, RT, Fairley, N, Malcolm, F, Wells, JE. Christchurch Prisons Psychiatric Epidemiology Study: methodology and prevalance rates for psychiatric disorder. Crim Behav Ment Health 1999; 9: 131–43.
45 Brooke, D, Taylor, C, Gunn, J, Maden, A. Point prevalence of mental disorder in unconvicted male prisoners in England and Wales. BMJ 1996; 313: 1524–7.
46 Bulten, B. Gevangen Tussen Straf en Zorg [Caught between Punishment and Care]. Kluwer Academic Publishers, 1998.
47 Cooke, DJ. Psychological Disturbance in the Scottish Prison System: Prevalence, Precipitants, and Policy. Scottish Office, 1994.
48 Daniel, AE, Robins, AJ, Reid, JC, Wilfley, DE. Lifetime and six-month prevalence of psychiatric disorders among sentenced female offenders. Bull Am Acad Psychiatry Law 1988; 16: 333–42.
49 Davidson, M, Humphreys, MS, Johnstone, EC, Owens, DGC. Prevalence of psychiatric morbidity among remand prisoners in Scotland. BMJ 1995; 167: 545–8.
50 Denton, B. Psychiatric morbidity and substance dependence among women prisoners: an Australian study. Psychiatry Psychol Law 1995; 2: 173–7.
51 DiCataldo, F, Greer, A, Profit, WE. Screening prison inmates for mental disorder: an examination of the relationship between mental disorder and prison adjustment. Bull Am Acad Psychiatry Law 1995; 23: 573–5.
52 Eyestone, LL. An epidemiological study of attention-deficit hyperactivity disorder and depression in a male prison population. Bull Am Acad Psychiatry Law 1994; 22: 181–93.
53 Faulk, M. A psychiatric study of men serving a sentence in Winchester prison. Med Sci Law 1976; 16: 244.
54 Gibson, LE, Holt, JC, Fondacaro, KM, Tang, TS, Powell, TA, Turbitt, EL. An examination of antecedent traumas and psychiatric comorbidity among male inmates with PTSD. J Traum Stress 1999; 12: 473–84.
55 Gunn, J, Maden, A, Swinton, M. Treatment needs of prisoners with psychiatric disorders. BMJ 1991; 303: 338–41.
56 Gunn, J, Robertson, G, Dell, S, Way, C. Psychiatric Aspects of Imprisonment. Academic Press, 1978.
57 Guy, E, Platt, JJ, Zwerling, I, Bullock, S. Mental health status of prisoners in an urban jail. Crim Justice Behav 1985; 12: 29–53.
58 Haapasalo, J. Vankien lapsuuden kaltoinkohtelu kaytosonogelmat ja aikuisian psyykkiset hairiot truama [Childhood maltreatment, behavioral problems and mental disorders among adult prisoners]. Psykologia 2000; 35: 45–57.
59 Harper, D, Barry, D. Estimated prevalence of psychiatric disorder in a prison population. Abs Crim Pen 1979; 19: 237–42.
60 Herrman, H, McGorry, P, Mills, J, Singh, B. Hidden severe psychiatric morbidity in sentenced prisoners – an Australian study. Am J Psychiatry 1991; 148: 236–9.
61 Hurley, W, Dunne, MP. Psychological distress and psychiatric morbidity in women prisoners. Aust N Z J Psychiatry 1991; 25: 461–70.
62 Hyde, P, Seiter, R. The Prevalence of Mental Illness among Inmates in the Ohio Prison System. Department of Mental Health and the Ohio Department of Rehabilitation and Correction Interdepartmenal Planning and Oversight Committee for Psychiatric Services to Corrections, 1987.
63 James, JF, Gregory, D, Jones, RK, Rundell, OH. Psychiatric morbidity in prisons. Hosp Comm Psychiatry 1980; 31: 674.
64 Jordan, BK, Schlenger, WE, Fairbank, JA, Caddell, JM. Prevalence of psychiatric disorders among incarcerated women: II. Convicted felons entering prison. Arch Gen Psychiatry 1996; 53: 513–9.
65 Joukamaa, M. Psychiatric morbity among finnish prisoners with special reference to sociodemographic factors – results of the health survey of finnish prisoners (WATTU project). Forensic Sci Int 1995; 73: 85–91.
66 Joukamaa, M. Mental health of Finnish prisoners – results of a survey. J Forensic Psychiatr 1993; 4: 261–71.
67 Krefft, KM, Brittain, TH. A prisoner assessment survey: screenings of a municipal prison population. Int J Law Psychiatry 1983; 6: 113–24.
68 Levander, S, Svalenius, H, Jensen, J. Psykiska skador vanliga bland interner [Common psychiatric disorders among inmates]. Lakartidningen 1997; 94: 46–50.
69 Maden, A, Taylor, C, Brooke, D, Gunn, J. Mental Disorder in Remand Prisoners. Home Office Research and Planning Unit, 1996.
70 Maden, T, Swinton, M, Gunn, J. Psychiatric disorder in women serving a prison sentence. Br J Psychiatry 1994; 164: 44–54.
71 Mohan, D, Scully, P, Collins, C, Smith, C. Psychiatric disorder in an Irish female prison. Crim Behav Ment Health 1997; 7: 229–35.
72 Motiuk, L, Porporino, F. The Prevalence, Nature and Severity of Mental Health Problems among Federal Male Inmates in Canadian Penitentiaries. Research and Statistics Branch, Correctional Service, 1992.
73 Neighbors, H, Williams, D, Gunnings, T, Lipscomb, W, Broman, C, Lepkowski, J. The Prevalence of Mental Disorder in Michigan Prisons. Michigan Department of Corrections, 1987.
74 van Panhuis, P. De Psychotische Patient in de TBS [The Psychotic Patient in the TBS]. Gouda Quint, 1997.
75 Powell, TA, Holt, JC, Fondacaro, KM. Prevalence of mental illness among inmates in a rural state. Law Human Behav 1997; 21: 427–38.
76 Poythress, N, Hoge, S, Bonnie, R, Monahan, J, Eisenberg, M, Feucht-Haviar, T. The competence-related abilities of women criminal defendants. J Am Acad Psychiatry Law 1998; 26: 215–22.
77 Rasmussen, K, Storsaeter, O, Levander, S. Psychiatric disorders in a Norwegian prison population. Nord Psykiatr Suppl 1998; 41: 79–80.
78 Robertson, G. Correlates of crime among women offenders. Med Sci Law 1990; 30: 165–74.
79 Robins, R, Reiger, D. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. The Free Press, 1991.
80 Roesch, R. Mental health interventions in pretrial jails. In Psychology and Law: Advances in Research (eds Davies, GM, Lloyd-Bostock, S, McMurran, M & Wilson, C): 520–31. De Greuter, 1995.
81 Schoemaker, D, VanZessen, G. Psychische Stoornissen bij Gedetineerden [Psychiatric Disorders in Prisoners]. Trimbos-Instituut, 1997.
82 Schuckit, MA, Hermann, G, Schuckit, JJ. Importance of psychiatric illness in newly arrested prisoners. J Nerv Ment Dis 1977; 165: 118–25.
83 Simpson, A, Brinded, P, Laidlaw, T, Fairley, N, Malcolm, F. The National Study of Psychiatric Morbidity in New Zealand Prisons. Department of Corrections, 1999.
84 Smith, C, O'Neill, H, Tobin, J, Walshe, D, Dooley, E. Mental disorders detected in an Irish prison sample. Crim Behav Ment Health 1996; 6: 177–83.
85 Swank, GE, Winer, D. Occurence of psychiatric disorder in a county jail population. Am J Psychiatry 1976; 133: 1331–3.
86 Teplin, LA. Psychiatric and substance abuse disorders among male urban jail detainees. Am J Public Health 1994; 84: 290–3.
87 Teplin, LA, Abram, KM, McClelland, GM. Prevalence of psychiatric disorders among incarcerated women: I. Pretrial jail detainees. Arch Gen Psychiatry 1996; 53: 505–12.
88 Washington, P, Diamond, RJ. Prevalence of mental illness among women incarcerated in five California county jails. Res Community Ment Health 1985; 5: 33–41.
89 Watt, F, Tomison, A, Torpy, D. The prevalence of psychiatric disorder in a male remand population: a pilot study. J Forensic Psychiatr 1993; 4: 75–83.
90 Wilkins, J, Coid, J. Self-mutilation in female remanded prisoners: I. An indicator of severe psychopathology. Crim Behav Ment Health 1991; 1: 247–67.
91 Agbahowe, SA, Ohaeri, JU, Ogunlesi, AO, Osahon, R. Prevalence of psychiatric morbidity among convicted inmates in a nigerian prison community. E Afr Med J 1998; 75: 19–26.
92 Fido, AA, al-Jabally, M. Presence of psychiatric morbidity in prison population in Kuwait. Ann Clin Psychiatry 1993; 5: 107–10.
93 Ghubash, R, El-Rufaie, O. Psychiatric morbidity among sentenced male prisoners in Dubai: transcultural perspectives. J Forensic Psychiatr 1997; 8: 440–6.
94 Hurwitz, S, Christiansen, K. Criminology (2nd edn). George Allen & Unwin, 1983.
95 Arnab, B, Prativa, S, Ray, TK. Persons with major psychiatric illness in prisons – a three years study. J Indian Med Assoc 2009; 107: 14.
96 Assadi, SM, Noroozian, M, Pakravannejad, M, Yahyazadeh, O, Aghayan, S, Shariat, SV, et al. Psychiatric morbidity among sentenced prisoners: prevalence study in Iran. Br J Psychiatry 2006; 188: 159–64.
97 Bermúdez, CE, Romero Mendoza, MP, Rodríguez Ruiz, EM, Durand-Smith, AL, Saldívar Hernández, GJ. Female depression and substance dependence in the Mexico City penitentiary system. Salud Ment 2007; 30: 53–61.
98 Bulten, E, Nijman, H, van der Staak, C. Psychiatric disorders and personality characteristics of prisoners at regular prison wards. Int J Law Psychiatry 2009; 32: 115–9.
99 Butler, T, Allnutt, S. Mental Illness among New South Wales Prisoners. NSW Correction Health Service, 2003.
100 Curtin, K, Monks, S, Wright, B, Duffy, DM, Linehan, SA, Kennedy, HG. Psychiatric morbidity in male remanded and sentenced committals to Irish prisons. Ir J Psychol Med 2009; 26: 169–73.
101 Dudeck, M, Kopp, D, Kuwert, P. Prevalence of psychiatric disorders in prisoners with a short imprisonment: results from a prison in north Germany. Psychiatr Prax 2009; 36: 219.
102 Duffy, D, Linehan, S, Kennedy, HG. Psychiatric morbidity in the male sentenced Irish prisons population. Ir J Psychol Med 2006; 23: 54–62.
103 Fotiadou, M, Livaditis, M, Manou, I, Kaniotou, E, Xenitidis, K. Prevalence of mental disorders and deliberate self-harm in Greek male prisoners. Int J Law Psychiatry 2006; 29: 68–73.
104 Gunter, TD, Arndt, S, Wenman, G, Allen, J, Loveless, P, Sieleni, B, et al. Frequency of mental and addictive disorders among 320 men and women entering the Iowa prison system: use of the MINI-Plus. J Am Acad Psychiatry 2008; 36: 27–34.
105 Linehan, SA, Duffy, DM, Wright, B, Curtin, K, Monks, S, Kennedy, HG. Psychiatric morbidity in a cross-sectional sample of male remanded prisoners. Ir J Psychol Med 2005; 22: 128–32.
106 Parsons, S, Walker, L, Grubin, D. Prevalence of mental disorder in female remand prisons. J Forensic Psychiatr 2001; 12: 194–202.
107 Piselli, M, Elisei, S, Murgia, N, Quartesan, R, Abram, KM. Co-occurring psychiatric and substance use disorders among male detainees in Italy. Int J Law Psychiatry 2009; 32: 101–7.
108 Ponde, PP, Cruz Freire, AC, Santos Mendonca, MS. The prevalence of mental disorders in detainees in the city of Salvador, Bahia, Brazil. J Forensic Sci 2011; 56: 679–82.
109 Sharma, A, Nijhawan, M, Sharma, DK, Sushil, CS. Psychosocial and psychiatric aspect of criminal behavior. Indian J Psychiatr 2010; 52: S37.
110 Stompe, T, Brandstätter, N, Ebner, N, Fischer-Danzinger, D. Psychiatric disorders in prison inmates [Psychiatrische Störungen bei Haftinsassen]. J Neurol Neurochir Psychiatr 2010; 11: 20–3.
111 Vicens, E, Tort, V, Dueñas, RM, Muro, Á, Pérez-Arnau, F, Arroyo, JM, et al. The prevalence of mental disorders in Spanish prisons. Crim Behav Ment Health 2011; 21: 321–32.
112 Trestman, RL, Ford, J, Zhang, W, Wiesbrock, V. Current and lifetime psychiatric illness among inmates not identified as acutely mentally ill at intake in Connecticut's jails. J Am Acad Psychiatry Law 2007; 35: 490–500.
113 von Schoenfeld, CE, Schneider, F, Schroder, T, Widmann, B, Botthof, U, Driessen, M. Prevalence of psychiatric disorders, psychopathology, and the need for treatment in female and male prisoners. Nervenarzt 2006; 77: 830.
114 Watzke, S, Ullrich, S, Marneros, A. Gender- and violence-related prevalence of mental disorders in prisoners. Eur Arch Psychiatry Clin Neurosci 2006; 256: 414–21.
115 Wright, B, Duffy, D, Curtin, K, Linehan, S, Monks, S, Kennedy, HG. Psychiatric morbidity among women prisoners newly committed and amongst remanded and sentenced women in the Irish prison system. Ir J Psychol Med 2006; 23: 47–53.
116 Zahari, MM, Hwan Bae, W, Zainal, NZ, Habil, H, Kamarulzaman, A, Altice, FL. Psychiatric and substance abuse comorbidity among HIV seropositive and HIV seronegative prisoners in Malaysia. Am J Drug Alcohol Abuse 2010; 36: 31–8.
117 Zoccali, R, Muscatello, MR, Bruno, A, Cambria, R, Cavallaro, L. Mental disorders and request for psychiatric intervention in an Italian local jail. Int J Law Psychiatry 2008; 31: 447–50.
118 Alevizopoulus, G, Igoumenou, A. Mental health problems in male prisoners in Greece and their relation to the criminal history. Int J Law Psychiatry, in press.
119 World Health Organization. Women's Health in Prison. WHO, 2009.
120 Skeem, J, Manchak, S, Peterson, J. Correctional policy for offenders with mental illness: creating a new paradigm for recidivism reduction. Law Hum Behav 2011; 35: 110–26.
121 Fraser, A, Møller, L, van den Bergh, B. The health of prisoners. Lancet 2011; 377: 2002.
122 Lohner, J, Konrad, N. Risk factors for self-injurious behaviour in custody: problems of definition and prediction. Int J Prison Health 2007; 3: 135–61.
123 Pratt, D, Appleby, L, Piper, M, Webb, R, Shaw, J. Suicide in recently released prisoners: a case-control study. Psychol Med 2010; 40: 827–35.
124 Bird, SM. Changes in male suicides in Scottish prisons: 10-year study. Br J Psychiatry 2008; 192: 446–9.
125 Home Office. Probation Statistics England and Wales 2002. Home Office Research, Development and Statistics Directorate, 2004.
126 Langan, P, Lewin, D. Recidivism of Prisoners Released in 1994. Bureau of Justice Statistics, 2002 (http://bjs.ojp.usdoj.gov/index.cfm?ty=pbdetail&iid=1134).
127 Fazel, S, Baillargeon, J. The health of prisoners. Lancet 2011; 377: 956–65.
128 Morrissey, JP, Fagan, JA, Cocozza, JJ. New models of collaboration between criminal justice and mental health systems. Am J Psychiatry 2009; 166: 1211–4.
129 Hassan, L, Birmingham, L, Harty, MA, Jones, P, King, C, Lathlean, J, et al. Prospective cohort study of mental health during imprisonment. Br J Psychiatry 2011; 198: 37–42.
130 Prince, M, Patel, V, Saxena, S, Maj, M, Maselko, J, Phillips, MR, et al. No health without mental health. Lancet 2007; 370: 859–77.
131 McGrath, J, Saha, S, Welham, J, El Saadi, O, MacCauley, C, Chant, D. A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Medicine 2004; 2: 13.
132 Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, et al. The epidemiology of major depressive disorder. JAMA 2003; 289: 3095–105.
133 Torrey, E, Kennard, A, Eslinger, D, Lamb, R, Pavle, J. More Mentally Ill Persons are in Jails and Prisons than Hospitals: A Survey of the States. Treatment Advocacy Center, 2010.
134 Wilper, AP, Woolhandler, S, Boyd, JW, McCormick, D, Bor, DH, Himmelstein, DU, et al. The health and health care of US prisoners: results of a nationwide survey. Am J Public Health 2009; 99: 666–72.
135 Higgins, JPT. Commentary: heterogeneity in meta-analysis should be expected and appropriately quantified. Int J Epidemiol 2008; 37: 1158–60.
136 Singh, D. Publication bias–a reason for the decreased research output in developing countries. S Afr Psychiatr Rev 2006; 9: 153–5.
137 Cheniaux, E, Landeira-Fernandez, J, Versiani, M. The diagnoses of schizophrenia, schizoaffective disorder, bipolar disorder and unipolar depression: interrater reliability and congruence between DSM-IV and ICD-10. Psychopathology 2009; 42: 293–8.
138 Parker, G. Classifying depression: should paradigms lost be regained? Am J Psychiatry 2000; 157: 1195–203.
139 Fazel, S, Gulati, G, Linsell, L, Geddes, JR, Grann, M. Schizophrenia and violence: systematic review and meta-analysis. PLoS Med 2009; 6: e1000120.
140 Raimer, B, Stobo, J. Health care delivery in the texas prison system: the role of academic medicine. JAMA 2004; 292: 485–9.
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Severe mental illness in 33 588 prisoners worldwide: systematic review and meta-regression analysis

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

  • Seena Fazel (a1) and Katharina Seewald (a2)
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Reply to Fazel and Sewald Severe Mental Illness in 33588 prisoners

Michael Fitzgerald, Consultant Child & Adult Psychiatrist
21 July 2012

Dear Editors,

Fazel and Sewald [1] make useful comments on psychosis and major depression in prisoners. The more serious mental disorders in prisoners responsible for much of imprisonment and re-offending are ADHD and it's comorbidities. It is time researchers focusing on mental disorder in prisoners focus on the common ADHD [2] and comorbidities and not exclusively on the rarer "severe mental illness" that is "psychosis and major depression". The major focus of forensic psychiatry is very out of date now and indeed excessively narrow in assessing prisoners.[3]

References:

1. Fazel S. Sewald K. Severe mental illness in 33588 prisoners worldwide: Systematic review and meta regression analysis. Br. J. Psychiatry 2012; 200: 364/378

2. Curran S. Fitzgerald M. Attention Deficit Hyper Activity Disorder in prison population. American Journal of Psychiatry 1999; 156: 1664/1665

3. Fitzgerald M. Young, Violent and Dangerous To Know. Nova Science:New York 2010

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Conflict of interest: None declared

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Severe mental illness in prisoners worldwide

David J. Vinkers, Psychiatrist
24 June 2012

To the editor,

With much interest, we read the review article by Fazel and Seewald in the May issue of The Journal (1). The authors conclude that severe mental illness is more prevalent in prisoners in low- and middle-income countries than in high-income countries. This may be related to fewer opportunities and services for diverting offenders to health services, a stronger relationship between mental illness and criminality, and different socio-cutural factors, e.g. poorer legal representation for the mentally ill in low- and middle-income countries. We examined in an earlier study the relationship between mental illness and criminality in pre-trial reported Antillean defendants in the Netherlands and the Netherlands Antilles (2). Defendants who are suspectedto suffer from mental illness are pre-trial examined by a psychiatrist or psychologist both in the Netherlands and the Netherlands Antilles, before diversion to mental health services takes place. We found no significant difference in prevalence of psychotic disorders among pre-trial reported Antillean suspects in the Netherlands and the Netherlands Antilles (14.4 %vs. 15.1 %) and no significant difference in the prevalence of defendants deemed unaccountable due to a mental disorders (3.9 % vs. 4.0 %). There was, however, a much lower registered crime rate of Antilleans in the Netherlands Antilles than the Netherlands (11 vs. 113 offences per year per 1000 persons; p < 0.001) and a much higher rate of pre-trial reports in the Netherlands Antilles than the Netherlands (74 vs. 8 per 1000 Antillean defendants; p < 0.001). Antilleans living in the Netherlands Antilles thus have a low crime rate and a high pre-trial report rate when indicted of a crime as compared with Antilleans in the Netherlands, indicating that they are more frequently suspected to suffer from a mental illness. This finding is in line with the earlier formulatedrule of thumb that the frequency of mental illness is higher in countries with low crime rates (3,4). Indeed, the low- and middle-income countries included in the review of Fazel and Seewald have a combined prison population rate of 77 per 100,000, considerably less than the worldwide prison population rate of 145 per 100,000 (5). The higher prevalence of severe mental illness in prisoners in low- and middle-income countries maybe explained by lower rates of crime and imprisonment. If so, the relationship between mental illness and crime is not stronger in low- and middle- income countries, but weaker in high-income countries.

1. Fazel S, Seewald K. Severe mental illness in 33 588 prisoners worldwide: systematic review and meta-regression analysis. Br J Psychiatry2012; 200: 364-73.2. Vinkers DJ, Heytel FG, Matroos GM, Hermans KM, Hoek HW. Pre-trial psychiatric reports on Antillean suspected offenders in the Netherlands and on the Dutch Antilles. Tijdschr Psychiatr 2010; 52: 745-52.3. Large M, Smith G, Swinson N, Shaw J, Nielssen O. Homicide due to mentaldisorder in England and Wales over 50 years. Br J Psychiatry 2008; 193: 130-3.4. Coid J. The epidemiology of abnormal homicide and murder followed by suicide. Psychol Med 1983; 13: 855-6.5. Walmsley R. (2010). World Prison Population List?(8th ed.). International Centre for Prison Studies, Kings College: London. http://www.apcca.org/stats/8th%20Edition%20(2009).pdf

David J. Vinkers, MD, PhDNetherlands Institute for Forensic Psychiatry and Psychology, the Netherlandsd.vinkers@dji.minjus.nl.

Micha van de Vorst, MScPsychiaters Maatschappij Antillen, Curacao.

Hans W. Hoek, MD, PhDParnassia Bavo Psychiatric Institute, The Hague, the Netherlands.Department of Psychiatry, University Medical Center Groningen, University of Groningen, the Netherlands.Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States.

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Conflict of interest: None declared

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