https://bulger.co.uk/prison/prisoners_Lancet.pdf

Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys

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

Vulnerability to Psychopathology: A Biosocial Model Marvin Zuckerman. Washington, DC: American Psychological Association. 1999, 535 pp., (hardcover). A great deal has been learned about psychopathology, but still many questions remain. One of the most important questions remaining to be answered is why people are vulnerable to the different variants of psychopathology ? Zuckerman has made this broad question the focus of his new book. It is a book that is remarkable by its scholarship. It provides a compendium of information on the history of mental disorders, and research findings on their course, diagnosis and prevalence, comorbidity, demographic features, genetic and biological characteristics, and social factors, and is punctuated by a strong biological orientation. Zuckerman indicates that his new book was written as a "logical sequel" to his previous book on the Psychobiology of Personality (Zuckerman, 1991). His book, which is divided into eight chapters, provides a review of the wealth of findings on psychopathology. The first cluster of chapters of the book deals with general considerations including diathesis-stress models (chapter 1), and diagnosis (chapter 2); the second cluster, and main body of the book (chapters 3 to 7), describes theory and research on a selected number of specific disorders, and the final concluding chapter is concerned with the prognosis of the future science of psychopathology. In the first chapter we learn that diathesis-stress theories are not monolithic but exhibit great variety. His model extends Paul Meehl's orientation to schizoprhenia to other disorders, and thus focuses on a biological diathesis and social stress (e.g., parenting) that increases risk of disorders. Zuckerman's book largely restricts the term diathesis to genetic and biological factors. As it happens, then, he questions the basis for the notion of cognitive vulnerability. His grounds for this are that the concept of a cognitive predisposition to psychopathology is not empirically well supported, and that it could simply be a "typical expression of a biological disposition" (p. 7), or other "interpersonal" and "developmental" factors (p. 197). For example, he suggests that research has not adequately demonstrated that cognitive factors predict subsequent levels of depression or other disorders, and are not simply state-manifestations of the disorders. These views are challenged by recent research of the Temple-Wisconsin depression project (e.g., Alloy, Abramson, Hogan et al., 2000). Although Zuckerman's book clearly reflects a monumental undertaking of scholarship, its review of the rapidly advancing cognitive literature on psychopathology is dated. Readers who are interested in a cognitively oriented approach to vulnerability to psychopathology will thus need to look for other references (e.g., Alloy & Riskind, in press). Along with his restriction of the concept of vulnerability to biological diathesis, Zuckerman's book pays little attention to methodological issues, and particularly to issues important for cognitively oriented researchers. Readers who are interested in such issues will have to turn to other sources, such as the excellent chapter by Alloy, Abramson, Raniere, & Dyller, (1999). …

Vulnerability to Psychopathology: A Biosocial Model

The multifactor offender readiness model

The authors empirically examined the relations between several psychosocial variables associated with adolescent problem gambling Participants were 2,336 students in Grades 7-13, and all completed a questionnaire regarding gambling activities, gambling severity, perceived social support, drug and alcohol dependence, and various social, emotional, and behavioral problems With respect to gambling severity, 49% of adolescents met the criteria for pathological gambling, and 80% were found to be at risk Psychosocial difficulties associated with problem gambling include poor perceived familial and peer social support, substance use problems, conduct problems, family problems, and parental involvement in gambling and substance use A set of predictor variables that may lead to problem gambling includes having family problems, having conduct problems, being addicted to drugs or alcohol, and being male

Psychosocial variables associated with adolescent gambling.

The paper describes a case-note and interview study of a cross-sectional sample comprising 25% of all women serving a prison sentence in England and Wales. A 5% sample of the male sentenced prison population was used for comparison. Diagnoses were assigned on clinical grounds and an assessment was made of the treatment needs of all 'cases'. The prevalence of psychosis, around 2%, was similar in the two groups but women had higher rates of mental handicap (6% v. 2%), personality disorder (18% v. 10%), neurosis (18% v. 10%) and substance abuse (26% v. 12%). There is a need for closer links between the NHS and prison health services. Women's prisons lack a therapeutic community of the Grendon type, which may be of benefit to a substantial minority of inmates.

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Psychiatric disorder in women serving a prison sentence

The re-building of Holloway prison in the 1970s was based on the assumption that women in prison have high rates ofpsychiatric disorder. Criticism of Holloway was often directed at the unwarranted medicalization of women's criminality and contemporary evidence provided only limited support for the notion that women in prison had higher levels of psychiatric disorder than men. Interpretation of research findings was difficult because none of the studies applied the same methods to comparable groups of women and men in prison. This paper describes a case-note and interview study of a representative, cross-sectional sample comprising 25 per cent of all women serving a prison sentence in England and Wales. A 5 per cent sample of the male sentenced prison population was used for comparison purposes. An assessment was made of the treatment needs, if any, of all women given a diagnosis. The prevalence of psychosis was approximately 2 per cent in both groups. Women had a higher prevalence of mental handicap ilearning difficulties (6 per cent compared to 2 per cent in men), personality disorder ( 18per cent v 10 per cent), neurotic disorders ( 18per cent v 10per cent), and substance abuse (26 per cent v 12 per cent). Despite higher percentage rates for some disorders, women are outnumbered by men in all diagnostic categories. Female and male prisoners with psychosis share many characteristics that make alternative placements difficult, including chronicity, non-compliance with treatment, and recidivism. As the number of women requiring transfer to hospital is small, they could be accommodated by the health service without any significant increase in bed numbers but most had a history of rejection by local psychiatric facilities, suggesting that they would require a specialized service. Whilst in custody, women make greater demands on prison health services, mainly because of higher rates of personality disorder, substance abuse, and neurosis. The Criminal Justice Act 1991 may help some of these women by providing a greater range of non-custodial services but there is also a need to increase the availability of treatment services for some groups of prisoners, particularly those with drug or personality problems.

A criminological and psychiatric survey of women serving a prison sentence

The paper presents the results of a retrospective, self-report survey of pre-arrest drug use in a representative sample of 1751 men serving a prison sentence. Reported drugs used were cannabis (34%), opiates (9%), amphetamine (9%) and cocaine (5%), including 1%‘crack’ users. Pre-arrest injecting was reported by 11% of inmates, including 68% of all opiate users and 57% of amphetamine users.

Drug dependence was reported by 11%, including 7% dependent on opiates, 2% on amphetamines and l% on cocaine. Relative to other drugs, the figure for cocaine is higher than is suggested by a previous clinic survey.

Pre-arrest cannabis use was reported by 54% of black prisoners and 34% of white. White prisoners are more likely to report use of ‘hard’ drugs, drug dependence and injecting, but this masks a higher rate of cocaine use by black prisoners. Opiate use varied between health regions, from 3% of prisoners in the West Midlands to 25% of those from the Mersey region. These findings have implications for service provision and for an understanding of cultural influences on illicit drug use.

Mark Swinton

Papers

Psychiatric disorder in women serving a prison sentence

A criminological and psychiatric survey of women serving a prison sentence

A survey of pre-arrest drug use in sentenced prisoners.

Gambling in young offenders

The ethnic origin of women serving a prison sentence