Researcher; Forensic and Neurodevelopmental Sciences Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England.
Professor of Mental Health; School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland.
Psychol Med. 2022 Oct;52(13):2794-2804. doi: 10.1017/S0033291720004936. Epub 2021 Jan 12.
Posttraumatic stress disorder (PTSD) is highly prevalent within prison settings, yet is often unidentified and undertreated. Complex PTSD (CPTSD) has been recently formally recognised in the International Classification of Diseases 11th revision (ICD-11) diagnostic framework but has never been explored in prison settings. We aimed to establish the prevalence of ICD-11 PTSD and CPTSD in a UK prison sample using a validated instrument (the International Trauma Questionnaire). We also explored the associations of these two diagnoses with their traumatic antecedents and psychiatric comorbidities.
Randomly selected male, sentenced prisoners in a large medium-security prison in south London ( = 221) took part in a clinical interview which assessed PTSD, CPTSD, trauma histories, and comorbid disorders. Multinomial logistic regression was performed to examine differences between those with PTSD or CPTSD, and those without symptoms.
A total of 7.7% (95% CI 4.5-12) of the male sentenced prisoners met diagnostic criteria for ICD-11 PTSD and 16.7% (95% CI 12.1-22.3) for CPTSD. A diagnosis of PTSD was associated with more recent traumatic exposure, comorbid generalised anxiety disorder, alcohol dependence, and Cluster B personality disorder. A diagnosis of CPTSD was associated with complex trauma exposure antecedents (developmental, interpersonal, repeated, or multiple forms), and comorbid with anxiety, depression, substance misuse, psychosis, and ADHD.
This study confirms that CPTSD is a very common and comorbid condition in male prisoners. There is an urgent need to develop trauma-informed care in prisons.
创伤后应激障碍（PTSD）在监狱环境中高度普遍，但往往未被识别和治疗不足。复杂创伤后应激障碍（CPTSD）最近已在国际疾病分类第 11 版（ICD-11）诊断框架中得到正式承认，但从未在监狱环境中进行过探讨。我们旨在使用经过验证的工具（国际创伤问卷）在英国监狱样本中确定 ICD-11 PTSD 和 CPTSD 的患病率。我们还探讨了这两种诊断与创伤前因和精神共病之间的关联。
伦敦南部一所大型中等安全监狱的随机选择的男性服刑囚犯（n=221）参加了临床访谈，该访谈评估了 PTSD、CPTSD、创伤史和共病障碍。使用多项逻辑回归分析来检查患有 PTSD 或 CPTSD 与没有症状的人之间的差异。
总共 7.7%（95%CI 4.5-12）的男性服刑囚犯符合 ICD-11 PTSD 的诊断标准，16.7%（95%CI 12.1-22.3）符合 CPTSD 的诊断标准。PTSD 的诊断与近期创伤暴露、共患广泛性焦虑症、酒精依赖和 B 群人格障碍有关。CPTSD 的诊断与复杂的创伤前因（发展性、人际间、反复性或多种形式）有关，且与焦虑症、抑郁症、物质使用障碍、精神病和注意力缺陷多动障碍共病。
这项研究证实 CPTSD 在男性囚犯中是一种非常常见且共病的情况。迫切需要在监狱中开发以创伤为中心的护理。
