Abstract
People involved with criminal justice frequently are exposed to violence and traumatic experiences. This may lead to posttraumatic stress disorder (PTSD); however, no review, to our knowledge, has synthetized findings in this setting. We conducted a systematic review and meta-analysis to estimate prevalence rates of PTSD in prison populations. Original studies in which prevalence rates of PTSD in unselected samples of incarcerated people were reported were systematically searched between 1980 and June 2017. Data were pooled using random-effects meta-analysis, and sources of heterogeneity for prespecified characteristics were assessed by meta-regression. We identified 56 samples comprising 21,099 imprisoned men and women from 20 countries. Point prevalence of PTSD ranged from 0.1% to 27% for male, and from 12% to 38% for female prisoner populations. The random-effects pooled point prevalence was 6.2% (95% confidence interval: 3.9, 9.0) in male prisoners and 21.1% (95% confidence interval: 16.9, 25.6) in female prisoners. The heterogeneity between the included studies was very high. Higher prevalence was reported in samples of female prisoners, smaller studies (n < 100), and for investigations based in high-income countries. Existing evidence shows high levels of PTSD among imprisoned people, especially women. Psychosocial interventions to prevent violence, especially against children and women, and to mitigate its consequences in marginalized communities must be improved. Trauma-informed approaches for correctional programs and scalable PTSD treatments in prisons require further consideration.
Highlights
The size of the prison population has grown worldwide over the last 2 decades
Studies were conducted in 20 countries, of which 14 were classified as high-income country (HIC) in the year of the data collection: Australia (28, 29), Austria (30), Canada (31–34), Chile (35), France (36), Germany (37– 40), Iceland (41), Ireland (42), Netherlands (43), New Zealand (44), Spain (45, 46), Switzerland (47), United Kingdom (48, 49), and United States (50–56); and 7 were low- or middle-income country (LMIC): Brazil (57), Chile (58), China (59), India (21), Iran (60), South Africa (20), and Turkey (61)
The point prevalence of posttraumatic stress disorder (PTSD) was 6% in male prison populations and 21% in female prison populations, the 1-year prevalence rates of PTSD were 10% in male and 26% in female, and the lifetime prevalence estimates of PTSD were 18% in male and 40% in female prison populations. This is the first review of the prevalence of PTSD in prisoners that includes a sufficient number of samples to perform data synthesis, meta-analyses, and quantitative assessment of sources for heterogeneity
Summary
The size of the prison population has grown worldwide over the last 2 decades. In 2015, there were more than 10.3 million people imprisoned (1). Prevalence rates of severe mental disorders are higher in imprisoned people than in the general population: Approximately 4% of those in jails and prisons are estimated to have psychotic illnesses, and greater than 10% of male and 14% of female prisoners are reported to have major depression (2). The prevalence of posttraumatic stress disorder (PTSD) in prison populations is not reliably known, despite several individual reports in which authors have stated PTSD is a major health problem in prisoners because of high rates of exposure to physical, sexual, and emotional violence in imprisoned people over their lifespan (5–7). 90% of the imprisoned people with PTSD were reported to have unmet needs for psychiatric care, including pharmacotherapy and psychological treatment, which is the highest rate among all mental disorders (10). PTSD treatments during imprisonment may have the potential to reduce barriers to complete correctional interventions, improve adherence to medical treatments, and improve the longer-term institutional and community rehabilitation
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