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Cited by 985Criminal Justice and Corrections AnalysisPsychopathy, Forensic Psychiatry, Sexual OffendingMental Health Treatment and Access

Severe mental illness in 33 588 prisoners worldwide: systematic review and meta-regression analysis

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Fazel, Seena, Seewald, Katharina·2012·British Journal of Psychiatry
DOI 10.1192/bjp.bp.111.096370
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Abstract

Background: High levels of psychiatric morbidity in prisoners have been documented in many countries, but it is not known whether rates of mental illness have been increasing over time or whether the prevalence differs between low–middle-income countries compared with high-income ones. Aims: To systematically review prevalence studies for psychotic illness and major depression in prisoners, provide summary estimates and investigate sources of heterogeneity between studies using meta-regression. Method: Studies from 1966 to 2010 were identified using ten bibliographic indexes and reference lists. Inclusion criteria were unselected prison samples and that clinical examination or semi-structured instruments were used to make DSM or ICD diagnoses of the relevant disorders. Results: We identified 109 samples including 33 588 prisoners in 24 countries. Data were meta-analysed using random-effects models, and we found a pooled prevalence of psychosis of 3.6% (95% CI 3.1–4.2) in male prisoners and 3.9% (95% CI 2.7–5.0) in female prisoners. There were high levels of heterogeneity, some of which was explained by studies in low–middle-income countries reporting higher prevalences of psychosis (5.5%, 95% CI 4.2–6.8; P =0.035 on meta-regression). The pooled prevalence of major depression was 10.2% (95% CI 8.8–11.7) in male prisoners and 14.1% (95% CI 10.2–18.1) in female prisoners. The prevalence of these disorders did not appear to be increasing over time, apart from depression in the USA ( P =0.008). Conclusions: High levels of psychiatric morbidity are consistently reported in prisoners from many countries over four decades. Further research is needed to confirm whether higher rates of mental illness are found in low- and middle-income nations, and examine trends over time within nations with large prison populations.

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  • Homeless people have trouble obtaining medical care and taking medications because they lack insurance, face transportation barriers, and must deal with competing priorities.

    “Homeless people have difficulty accessing medical care and adhering to medications because of an absence of medical insurance, transportation barriers, and the need to attend to competing priorities.63,86-88”

    From The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations (2014) · cites this paper as [87]

    The Implications and Avenues for future research sections discuss mental-health treatment and treatment adherence among prisoners, not barriers faced by homeless people. Searches for homelessness, insurance, transportation, competing priorities, and medication adherence found no passage addressing the attributed claim; the available passages have no page numbers. (LLM, conf=0.76)

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  10. von Schoenfeld CE, Schneider F, Schroder T, Widmann B, Botthof U, Driessen M. Prevalence of psychiatric disorders, psychopathology, and the need for treatment in female and male prisoners. Nervenarzt 2006; 77: 830. 114
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Authors
Fazel, S., & Seewald, K.
Affiliations
  • Warneford Hospital (GB)
  • University of Konstanz (DE)
Corresponding author
Fazel, Seena
ORCID
Fazel, Seena
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2012-05
Volume
200
Issue
5
Pages
364-373
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.111.096370
OpenAlex
W2119140893
Cited by
985
References
125
Citations by year
2026: 58 · 2025: 59 · 2024: 66 · 2023: 82 · 2022: 90 · 2021: 92 · 2020: 138 · 2019: 77 · 2018: 76 · 2017: 62 · 2016: 61 · 2015: 47 · 2014: 37 · 2013: 27 · 2012: 11
FWCI
20.90
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 2072 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Wellcome Trust (095806)
  • Curtin University of Technology
Topics
  • Social Sciences › Sociology and Political Science › Criminal Justice and Corrections Analysis
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
severe mental illness, prisoners, psychiatric morbidity, psychosis, major depressive disorder, prevalence, low- and middle-income countries, gender differences, temporal trends, prison population
MeSH terms
Adult, Major Depressive Disorder, Female, Humans, Male, Prisoners, Psychotic Disorders, Global Health, Comorbidity, Prevalence

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