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Cited by 294Criminal Justice and Corrections AnalysisMental Health Treatment and AccessPsychopathy, Forensic Psychiatry, Sexual Offending

Severe mental illness and substance use disorders in prisoners in low-income and middle-income countries: a systematic review and meta-analysis of prevalence studies

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Baranyi, Gergő, Scholl, Carolin, Fazel, Seena, Patel, Vikram, Priebe, Stefan, Mundt, Adrian P·2019·The Lancet Global Health
DOI 10.1016/s2214-109x(18)30539-4PMC PMC6419715
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Abstract

BACKGROUND: Although more than two thirds of the world's incarcerated individuals are based in low-income and middle-income countries (LMICs), the burden of psychiatric disorders in this population is not known. This review provides estimates for the prevalence of severe mental illness and substance use disorders in incarcerated individuals in LMICs. METHODS: For this systematic review and meta-analysis, we searched 17 electronic databases to identify prevalence studies of psychiatric disorders in prison populations in LMICs, published between January, 1987, and May, 2018. We included representative studies from general prison samples, providing information about four major psychiatric diagnoses: psychosis, major depression, alcohol use disorders, and drug use disorders. We pooled data from studies using random-effects meta-analyses and assessed the sources of heterogeneity by meta-regression. We extracted general population estimates from the Global Burden of Diseases 2016 database to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42015020905. FINDINGS: We identified 23 publications reporting prevalence estimates of severe mental illness and substance use disorders for 14 527 prisoners from 13 LMICs. In this population, the estimated pooled 1 year prevalence rates for psychosis were 6·2% (95% CI 4·0-8·6), 16·0% (11·7-20·8) for major depression, 3·8% (1·2-7·6) for alcohol use disorders, and 5·1% (2·9-7·8) for drug use disorders. We noted increased prevalence at prison intake and geographic variations for substance use disorders. For alcohol use disorders, prevalence was higher in the southeast Asian region than in the eastern Mediterranean region; and drug use disorders were more prevalent in the eastern Mediterranean region than in Europe. Prevalence ratios indicated substantially higher rates of severe mental illness and substance use disorders among prisoners than in the general population (the prevalence of non-affective psychosis was on average 16 times higher, major depression and illicit drug use disorder prevalence were both six times higher, and prevalence of alcohol use disorders was double that of the general population). INTERPRETATION: The prevalence of major psychiatric disorders is high in prisoners in LMIC compared with general populations. As these findings are likely to reflect unmet needs, the development of scalable interventions should be a public health priority in resource-poor settings. FUNDING: CONICYT of the Chilean government and the Wellcome Trust.

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  • The high loads of depression symptoms in this sample are unusually high compared to people experiencing incarceration elsewhere.

    “This is unusually high compared to people experiencing incarceration elsewhere (Baranyi et al., 2019).”

    From The profile and psychological effects of torture of Palestinians detained in Israeli prisons after 7th October 2023 (2025) · cites this paper as Baranyi et al., 2019

    The Results report major-depression prevalence among prisoners in 13 low- and middle-income countries, providing a benchmark for people incarcerated elsewhere. They do not assess depression symptoms in the citing study’s sample or establish that its level is unusually high; major-depression prevalence is also not the same measure as symptom burden. (LLM, conf=0.82)

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Authors
Baranyi, G., Scholl, C., Fazel, S., Patel, V., Priebe, S., & Mundt, A. P.
Affiliations
  • University of Edinburgh (GB)
  • University of Oxford (GB)
  • Harvard University (US)
  • Queen Mary University of London (GB)
  • Universidad San Sebastián (CL)
Corresponding author
Mundt, Adrian P
ORCID
Venue
The Lancet Global Health
Publisher
Elsevier BV
Published
2019-04
Volume
7
Issue
4
Pages
e461-e471
ISSN
2214-109X (ISSN-L)
DOI
10.1016/s2214-109x(18)30539-4
PMC
PMC6419715
OpenAlex
W2922447317
Cited by
294
References
10
Citations by year
2026: 24 · 2025: 46 · 2024: 50 · 2023: 50 · 2022: 58 · 2021: 25 · 2020: 29 · 2019: 11
FWCI
7.89
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Global Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
Funders
  • Comisión Nacional de Investigación Científica y Tecnológica
  • Fondo Nacional de Desarrollo Científico y Tecnológico (1160260)
  • Wellcome Trust (202836/Z/16/Z)
Topics
  • Social Sciences › Sociology and Political Science › Criminal Justice and Corrections Analysis
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
Keywords
severe mental illness, substance use disorders, prisoners, incarceration, low- and middle-income countries, psychosis, major depressive disorder, alcoholism, drug use disorders, prevalence ratio, prison mental health
MeSH terms
Mental Disorders, Developing Countries, Humans, Poverty, Prisoners, Global Health, Prevalence, Substance-Related Disorders

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