Emilian Christina, Al-Juffali Noura, Fazel Seena
Department of Psychiatry, University of Oxford, Oxford, UK.
Department of Psychiatry, University of Oxford, Oxford, UK.
Lancet Public Health. 2025 Feb;10(2):e97-e110. doi: 10.1016/S2468-2667(24)00280-9.
Prison populations have been increasing worldwide. Previous studies suggest that there is a high burden of psychiatric morbidity in people in prison, but, to our knowledge, the last published meta-analysis of prevalence is more than a decade old. We aimed to describe the pooled prevalence of depression, psychosis, bipolar disorder, and schizophrenia spectrum disorders for people who are incarcerated.
In this updated systematic review and meta-analysis, we searched six databases and grey literature published from database inception until Aug 8, 2024, with no language or geographical restrictions. We included primary quantitative studies that reported the prevalence of depression and psychotic disorders in the unselected prison population, based their diagnoses on clinical examination or from interviews and by the use of validated diagnostic instruments, met standardised criteria of the ICD or the Diagnostic and Statistical Manual of Mental Disorders for the diagnoses, and provided pooled prevalences for psychosis in the previous 6 months and clinical depression in the previous 2 weeks to 1 month. We excluded studies that used selected samples or were only qualitative. We investigated bipolar and schizophrenia spectrum disorders as separate diagnostic subcategories. We synthesised studies using random-effects meta-analysis and explored heterogeneity with meta-regression and subgroup analyses. The protocol is registered with PROSPERO, CRD42022378568.
We identified 131 publications reporting the prevalence of mental illness in 58 838 people in prison in 43 countries. We estimated that the prevalence of depression was 12·8% (95% CI 11·1-14·6) and for any psychosis was 4·1% (3·6-4·7). For diagnostic subcategories, we found that the prevalence of bipolar disorder was 1·7% (1·0-2·6) and schizophrenia spectrum disorders was 3·6% (1·3-7·1). Between-study heterogeneity was substantial for these estimates (I 69-97%) with few explanations. However, subgroup analyses revealed that people in prison in low-income and middle-income countries had higher prevalences for depression (16·7% [95% CI 13·6-20·0]) than in high-income countries (10·8% [9·0-13·0]), and that, for people with psychosis who are incarcerated, psychiatrists were less likely to diagnose (3·5% [2·8-4·3]) than were non-psychiatrists (4·7% [3·9-5·5]).
Our study indicates that the prevalence of severe mental illness in people who are incarcerated worldwide is considerable. Meeting the treatment needs of people in prison who have mental ill health remains an ongoing challenge for public mental health. More evidence on how to improve the assessment, treatment, and linkage to services on release, which will require more research-friendly prison services, is now needed.
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全球监狱人口一直在增加。先前的研究表明，监狱中的人群存在较高的精神疾病负担，但据我们所知，上次发表的患病率荟萃分析距今已有十多年。我们旨在描述被监禁人群中抑郁症、精神病、双相情感障碍和精神分裂症谱系障碍的合并患病率。
在这项更新的系统评价和荟萃分析中，我们检索了六个数据库以及从数据库建立至2024年8月8日发表的灰色文献，无语言或地理限制。我们纳入了主要的定量研究，这些研究报告了未经过筛选的监狱人群中抑郁症和精神障碍的患病率，其诊断基于临床检查或访谈，并使用经过验证的诊断工具，符合国际疾病分类（ICD）或《精神疾病诊断与统计手册》的标准化诊断标准，并提供了前6个月精神病和前2周至1个月临床抑郁症的合并患病率。我们排除了使用特定样本或仅为定性研究的研究。我们将双相情感障碍和精神分裂症谱系障碍作为单独的诊断子类别进行调查。我们使用随机效应荟萃分析对研究进行综合，并通过荟萃回归和亚组分析探讨异质性。该方案已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42022378568。
我们识别出131篇报告43个国家58838名监狱人员精神疾病患病率的出版物。我们估计抑郁症的患病率为12.8%（95%置信区间11.1 - 14.6），任何精神病的患病率为4.1%（3.6 - 4.7）。对于诊断子类别，我们发现双相情感障碍的患病率为1.7%（1.0 - 2.6），精神分裂症谱系障碍的患病率为3.6%（1.3 - 7.1）。这些估计值之间的研究间异质性很大（I² 69 - 97%），几乎没有可解释的原因。然而，亚组分析显示，低收入和中等收入国家监狱中的人群抑郁症患病率（16.7% [95%置信区间13.6 - 20.0]）高于高收入国家（10.8% [9.0 - 13.0]），并且对于被监禁的精神病患者，精神科医生的诊断可能性（3.5% [2.8 - 4.3]）低于非精神科医生（4.7% [3.9 - 5.5]）。
我们的研究表明，全球被监禁人群中严重精神疾病的患病率相当高。满足监狱中患有精神疾病人群的治疗需求仍然是公共心理健康面临的持续挑战。现在需要更多关于如何改善评估、治疗以及出狱后与服务机构衔接的证据，这将需要更有利于研究的监狱服务。
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