Aims
The aims were to (1) estimate the prevalence of alcohol and drug use disorders in prisoners on reception to prison and (2) estimate and test sources of between study heterogeneity.

Methods
Studies reporting the 12-month prevalence of alcohol and drug use disorders in prisoners on reception to prison from 1 January 1966 to 11 August 2015 were identified from seven bibliographic indexes. Primary studies involving clinical interviews or validated instruments leading to DSM or ICD diagnoses were included; self-report surveys and investigations that assessed individuals more than 3 months after arrival to prison were not. Random-effects meta-analysis and subgroup and meta-regression analyses were conducted. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results
In total, 24 studies with a total of 18 388 prisoners across 10 countries were identified. The random-effects pooled prevalence estimate of alcohol use disorder was 24% [95% confidence interval (CI) = 21–27], with very high heterogeneity (I2 = 94%). These ranged from 16 to 51% in male and 10–30% in female prisoners. For drug use disorders, there was evidence of heterogeneity by sex, and the pooled prevalence estimate in male prisoners was 30% (95% CI = 22–38; I2 = 98%; 13 studies; range 10–61%) and, in female prisoners, was 51% (95% CI = 43–58; I2 = 95%; 10 studies; range 30–69%). On meta-regression, sources of heterogeneity included higher prevalence of drug use disorders in women, increasing rates of drug use disorders in recent decades, and participation rate.

Conclusions
Substance use disorders are highly prevalent in prisoners. Approximately a quarter of newly incarcerated prisoners of both sexes had an alcohol use disorder, and the prevalence of a drug use disorder was at least as high in men, and higher in women.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/add.13877

Substance use disorders in prisoners: an updated systematic review and meta‐regression analysis in recently incarcerated men and women

Objective To synthesize evidence on the prevalence of mental disorders in adolescents in juvenile detention and correctional facilities and examine sources of heterogeneity between studies. Method Electronic databases and relevant reference lists were searched to identify surveys published from January 1966 to October 2019 that reported on the prevalence of mental disorders in unselected populations of detained adolescents. Data on the prevalence of a range of mental disorders (psychotic illnesses, major depression, attention-deficit/hyperactivity disorder [ADHD], conduct disorder, and posttraumatic stress disorder [PTSD]) along with predetermined study characteristics were extracted from the eligible studies. Analyses were reported separately for male and female adolescents, and findings were synthesized using random-effects models. Potential sources of heterogeneity were examined by meta-regression and subgroup analyses. Results Forty-seven studies from 19 countries comprising 28,033 male and 4,754 female adolescents were identified. The mean age of adolescents assessed was 16 years (range, 10–19 years). In male adolescents, 2.7% (95% CI 2.0%–3.4%) had a diagnosis of psychotic illness; 10.1% (95% CI 8.1%–12.2%) major depression; 17.3% (95% CI 13.9%–20.7%) ADHD; 61.7% (95% CI 55.4%–67.9%) conduct disorder; and 8.6% (95% CI 6.4%–10.7%) PTSD. In female adolescents, 2.9% (95% CI 2.4%–3.5%) had a psychotic illness; 25.8% (95% CI 20.3%–31.3%) major depression; 17.5% (95% CI 12.1%–22.9%) ADHD; 59.0% (95% CI 44.9%–73.1%) conduct disorder; and 18.2% (95% CI 13.1%–23.2%) PTSD. Meta-regression found higher prevalences of ADHD and conduct disorder in investigations published after 2006. Female adolescents had higher prevalences of major depression and PTSD than male adolescents. Conclusion Consideration should be given to reviewing whether health care services in juvenile detention can address these levels of psychiatric morbidity.

An Updated Systematic Review and Meta-regression Analysis: Mental Disorders Among Adolescents in Juvenile Detention and Correctional Facilities

In this article, the authors provide a narrative review of the mounting evidence base on personality disorder in childhood and adolescence. Topics covered include diagnostic validity, prevalence, developmental issues, comorbidity, risk and protective factors, and treatment. Novel indicated prevention and early intervention programs for borderline personality disorder in adolescence are given special priority. To conclude, directions for future research are provided.

/pdf/personality-disorder-in-childhood-and-adolescence-comes-of-3716kuzle4.pdf

Personality Disorder in Childhood and Adolescence comes of Age: a Review of the Current Evidence and Prospects for Future Research

Objective: This study examined prevalence rates of psychiatric disorders among young offenders after they were incarcerated for nine months. Methods: A total of 790 youths were surveyed, including a significant proportion of females (N=140, 18%), nine months after incarceration. The Structured Clinical Interview for DSM-IV with portions of the Diagnostic Interview for Children and Adolescents and the Structured Interview for DSM-IV Personality were used. Results: Even when conduct disorder and oppositional defiant disorder were excluded, 88% of males and 92% of females had a psychiatric disorder (including substance use disorder); more than 80% of offenders met criteria for some type of substance use disorder. Gender differences were found for anxiety disorders (males 26%, females 55%, p<.01), marijuana dependence (males 32%, females 24%, p=.04), marijuana abuse (males 19%, females 11%, p=.04), and stimulant dependence (males 25%, females 44%, p<.01). Conclusions: Despite nine months of incarceration, young offenders continued to show high levels of psychiatric and substance use disorders. (Psychiatric Services 60:838–841, 2009)

https://ps.psychiatryonline.org/doi/pdf/10.1176/ps.2009.60.6.838

Prevalence of and Gender Differences in Psychiatric Disorders Among Juvenile Delinquents Incarcerated for Nine Months

This study examines the relationship between DSM-cluster B personality disorders (PDs) and psychopaths according to Hare's criteria as detected by the Psychopathy Checklist (PCL:SV) in 299 violent offenders To clarify some contradictions among several previous studies on this issue, individual cluster B PDs were looked at alone, excluding any cases of comorbidity with other PDs of this cluster We found highly significant relationships between antisocial and borderline PD and Factor II of the PCL and a highly significant correlation between narcissistic PD and Factor I of the PCL These results were to be expected from the theoretical basis of the development of the PCL and provide a contribution to the construct validity of the PCL, which until now has not been validated on such a large sample in Germany Copyright © 2007 John Wiley & Sons, Ltd

/pdf/the-relationship-between-dsm-iv-cluster-b-personality-35t4af4ec1.pdf

The relationship between DSM‐IV cluster B personality disorders and psychopathy according to Hare's criteria: clarification and resolution of previous contradictions

The current study investigated the prevalence of mental disorders among incarcerated juvenile offenders in Germany and sought to identify clinically relevant subgroups. In sum, 149 newly incarcerated male juvenile delinquents (M age = 19 years) were included. Diagnostic tools included the German version of the Structured Clinical Interview for DSM-IV and the Psychopathy Checklist-Screening Version. The most prevalent diagnoses in the sample included conduct disorders (81%), Cluster B personality disorders (up to 62%), and substance-related disorders (up to 60%). Moreover, psychopathic features were found among 21% of the participants. Cluster analysis distinguished three subgroups among this group of young offenders. The most problematic consisted of juveniles with multiple psychopathology, including antisocial traits, personality pathology, higher scores on the Psychopathy Checklist, as well as multiple substance abuse. Study outcomes are discussed in light of their implications for the development of effective treatment for juvenile offenders.

The Prevalence of Mental Disorders in a German Sample of Male Incarcerated Juvenile Offenders

Zusammenfassung 34 inhaftierte Gewaltstraftäter wurden mit zwei verschiedenen strukturierten Interviews untersucht, nämlich mit der Psychopathie-Checkliste (PCL-SV) nach Hare und dem SKID-II für DSM-IV. Die Anzahl der Persönlichkeitsstörungen nach DSM-IV war außerordentlich hoch (mehr als 90 % der Probanden wiesen mindestens eine Persönlichkeitsstörung auf)21 % der Probanden in der Stichprobe wurden der Gruppe der »high-scorer« gemäß den Kautelen der P C L S V zugewiesen, 47 % wurden als »moderate-scorer« diagnostiziert. Ein Vergleich beider Untersuchungsinstrumente ergab eine negative Korrelation zwischen dem Summenscore des P C L S V mit dem Cluster C nach DSM-IV, aber eine positive Korrelation zwischen PCL-Score und dem DSM-IV Cluster B. Es lagen hochpositive Korrelationen zwischen PCL-Score und der antisozialen Persönlichkeitsstörung (Total-, Factor 1und Factor 2-Scores) sowie der narzisstischen Persönlichkeitsstörung (Totalund Factor 1-Scores) vor, während sich keine Korrelationen zwischen PCL-Score und der Borderline-Persönlichkeitsstörung zeigen ließen. Die Studienergebnisse unterstützen damit das Konzept, dass die Psychopathie einem speziellen Subtyp der antisozialen Persönlichkeitsstörung entspricht.

Psychopathie und Persönlichkeitsstörungen. Beziehungen der »Psychopathie-Checkliste« nach Hare zu der Klassifikation der DSM-IV bei Gewaltstraftätern

Zusammenfassung. Theoretischer Hintergrund: Therapiemotivation spielt fur den Verlauf und Erfolg von Behandlungsmasnahmen eine entscheidende Rolle. Fragestellung: Deshalb wurde der Frage nachgegangen, mit welchen psychischen Merkmalen (Psychische Belastung, Personlichkeit) die Therapiemotivation bei jungen Haftlingen zusammenhangt. Methode: Es wurden 217 mannliche Inhaftierte des Jugendvollzuges bezuglich der psychischen Befindlichkeit (KASSL, BSI), der Personlichkeit (NEO-FFI; SKID-II Fragebogen), haftspezifischer Variablen und der Therapiemotivation (TMSF) untersucht. Ergebnisse: Die Ergebnisse zeigen einen Zusammenhang zur Therapiemotivation fur die Variablen Erwartung der Therapiewirksamkeit, psychische Belastung, Neurotizismus sowie fur dependente, depressive, schizotypische, negativistische und Borderline-Personlichkeitsanteile. Schlussfolgerungen: Inhaftierte des Jugendvollzuges sind bzgl. intramuraler Behandlung nicht prinzipiell unmotiviert. Die Therapiemotivation bei Inhaftierten hangt jedoch nu...

Denis Köhler

Papers

The Prevalence of Mental Disorders in a German Sample of Male Incarcerated Juvenile Offenders

Psychopathie und Persönlichkeitsstörungen. Beziehungen der »Psychopathie-Checkliste« nach Hare zu der Klassifikation der DSM-IV bei Gewaltstraftätern

Therapiemotivation, Psychische Belastung und Persönlichkeit bei Inhaftierten des Jugendvollzuges