Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys
Abstract
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 22790 prisoners (mean age 29 years, 18530 [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.
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The prevalences of psychotic illnesses and personality disorders are higher in homeless people in Western countries than in the general population.
“Homeless people in Western countries are substantially more likely to have alcohol and drug dependence than the age-matched general population in those countries, and the prevalences of psychotic illnesses and personality disorders are higher.”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [62]
Alcohol dependence prevalence is many orders of magnitude higher in homeless men and even higher in homeless women compared with community surveys.
“On average, this is many orders of magnitude higher in men and even higher in women compared with community surveys [62,63]”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [62]
The prevalence estimates for psychosis were at least as high as those for depression, a finding in marked contrast from community estimates of these conditions and in other at-risk groups such as prisoners and refugees, in whom depression is more common.
“Second, the prevalence estimates for psychosis were at least as high as those for depression, a finding in marked contrast from community estimates of these conditions [62,63], and in other at-risk groups such as prisoners [64] and refugees [65], in whom depression is more common.”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [62]
The finding that clinically trained interviewers were associated with lower prevalence estimates is consistent with a systematic review of major depressive disorder in prisoners.
“The finding that clinically trained interviewers were associated with lower prevalence estimates is consistent with a systematic review of major depressive disorder in prisoners [64]”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [64]
Community estimates of depression in women range from 7% to 11% for 1-y estimates.
“which range from 7% to 11% for 1-y estimates”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [62]
The prevalence of mental and substance use disorders among prisoners is three to five times higher than that of the general population.
“The prevalence of mental and substance use disorders is three to five times higher than that of the general population.”
From Psychosocial Interventions for Prisoners with Mental and Substance Use Disorders: A Systematic Review (2022) · cites this paper as [1]
Only two studies tested psychosocial interventions for prisoners with severe mental health problems.
“Only two studies had tested psychosocial interventions for prisoners with severe mental health problems, even though their prevalence is high in the prisons. 1”
From Psychosocial Interventions for Prisoners with Mental and Substance Use Disorders: A Systematic Review (2022) · cites this paper as [1]
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- Authors
- Fazel, S., & Danesh, J.
- Affiliations
- Warneford Hospital (GB)
- University of Cambridge (GB)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2002-02
- Volume
- 359
- Issue
- 9306
- Pages
- 545-550
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2058959315
- Cited by
- 2,201
- References
- 73
- Citations by year
- 2026: 39 · 2025: 57 · 2024: 74 · 2023: 59 · 2022: 131 · 2021: 90 · 2020: 131 · 2019: 106 · 2018: 119 · 2017: 155 · 2016: 129 · 2015: 148 · 2014: 110 · 2013: 134 · 2012: 137
- FWCI
- 5.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Sociology and Political Science › Criminal Justice and Corrections Analysis
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- severe mental illness, prisoners, psychosis, major depressive disorder, antisocial personality disorder, personality disorders, prevalence, sex differences, detainees, violent offenders, prison mental health services
- MeSH terms
- Adult, Mental Disorders, Depressive Disorder, Female, Humans, Male, Prisoners, Global Health, Prevalence
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