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Favril L, Rich JD, Hard J, Fazel S. Mental and physical health morbidity among people in prisons: an umbrella review. Lancet Public Health 2024; 9:e250-e260. [PMID: 38553144 DOI: 10.1016/s2468-2667(24)00023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. METHODS In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre-registered with PROSPERO, CRD42023404827. FINDINGS Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9-12·8) for major depression, 9·8% (6·8-13·2) for post-traumatic stress disorder, and 3·7% (3·2-4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0-26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5-46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0-20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small-study effects. INTERPRETATION People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health. FUNDING Research Foundation-Flanders, Wellcome Trust, National Institutes of Health.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, Ghent, Belgium
| | - Josiah D Rich
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
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Kalebic N, Crole-Rees C, Tomlin J, Berrington C, Popovic I, Forrester A. Variations in services and intervention pathways for traumatic stress in Welsh prisons: A national survey. Med Leg J 2024; 92:50-53. [PMID: 38334710 PMCID: PMC10916347 DOI: 10.1177/00258172231214432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Both Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder are prevalent in prison settings. Both often go undetected and untreated, while prisoners who already suffered previous trauma may be re-traumatised upon imprisonment. The current study aimed to conduct a national survey of all Welsh prisons to gather information about existing services and treatments for traumatic stress. The survey identified variation within Welsh prisons with regard to NICE-recommended evidence-based therapies. It is therefore recommended that there needs to be development of a pathway of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in the prison system which should be achieved through a consensus process of both frontline staff and experts in the field.
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Affiliation(s)
- Natasha Kalebic
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Clare Crole-Rees
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Jack Tomlin
- School of Law and Criminology, University of Greenwich, London, UK
| | - Claudia Berrington
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Isidora Popovic
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Andrew Forrester
- Department of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
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Kaptan SK, Kaya ZM, Akan A. Addressing mental health need after COVID-19: a systematic review of remote EMDR therapy studies as an emerging option. Front Psychiatry 2024; 14:1336569. [PMID: 38250261 PMCID: PMC10799678 DOI: 10.3389/fpsyt.2023.1336569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction The COVID-19 pandemic has been associated with a substantial rise in mental health challenges, prompting a need for accessible and effective therapeutic interventions. This review summarizes the evidence on remote Eye Movement Desensitization and Reprocessing (EMDR) therapy delivered in response to the increased need. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases including PsychINFO, EMBASE, MEDLINE, and Web of Science were searched to identify studies assessing the efficacy of EMDR therapy administered online. Results Sixteen articles meeting the inclusion criteria were selected, involving 1,231 participants across various age groups. Studies covered remote individual and group EMDR sessions and self-administered computerized protocols. Findings indicate promising outcomes in reducing PTSD symptoms, anxiety, and depression. Discussion The analysis of the selected studies demonstrates the feasibility and potential efficacy of online EMDR as an accessible therapeutic option for addressing mental health difficulties, particularly during times of limited in-person interaction. However, the studies revealed limitations such as small sample sizes, absence of control groups, and reliance on self-reported measures.Systematic review registration: The present review was registered on "The International Database to Register Your Systematic Reviews" (INPLASY) with the registration number 2023120018 and DOI number 10.37766/inplasy2023.2.0068.
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Affiliation(s)
- Safa Kemal Kaptan
- Assistant Professor, Department of Psychology, Boğaziçi University, İstanbul, Türkiye
- Honorary Fellow of the Institute of Teaching and Learning at the University of Manchester, Manchester, United Kingdom
| | - Zehra Merve Kaya
- Visiting Scholar, Department of Psychology, Boğaziçi University, İstanbul, Türkiye
- Licensed Clinical Psychologist, Chicago, State of Illinois, IL, United States
| | - Ayşe Akan
- Assistant Professor, Department of Psychology, Boğaziçi University, İstanbul, Türkiye
- Registered Clinical Psychologist, Health and Care Professions Council (HCPC), London, United Kingdom
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Every-Palmer S, Ross B, Flewett T, Rutledge E, Hansby O, Bell E. Eye movement desensitisation and reprocessing (EMDR) therapy in prison and forensic services: a qualitative study of lived experience. Eur J Psychotraumatol 2023; 14:2282029. [PMID: 38010818 PMCID: PMC10993806 DOI: 10.1080/20008066.2023.2282029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is common in people with serious mental illness who come into contact with the criminal justice system. Little evidence exists on EMDR treatment in forensic mental health, with no prior qualitative research exploring lived experience perspectives.Objective: This qualitative study recruited adult forensic mental health patients with PTSD and psychotic disorders, predominantly schizophrenia, who had received EMDR as part of a clinical trial, either in prison or in hospital. We sought to understand their experiences of EMDR therapy while receiving forensic care.Method: Ten in-depth, semi-structured qualitative interviews were undertaken and analysed using thematic analysis. We used an inductive, realist approach, reporting the experiences, meanings, and reality of the participants.Results: Five overarching themes were identified. First, severe trauma was ubiquitous and participants felt Seriously Messed Up by their traumatic experiences, with debilitating and enduring PTSD symptoms contributing to offending and psychosis ('giving the voices something to feed on'). Second, EMDR was regarded with Early Scepticism. Third, the therapy itself was initially emotionally taxing and Not Easy but participants generally felt safe and persevered. Fourth, they were often surprised and delighted by results (And it Worked!), describing significant symptom reduction and personal transformation. Lastly, EMDR Fits the Forensic Setting, bringing empowerment in a place perceived as disempowering. People reported changes that increased their hope in a violence-free future.Conclusions: The limited research on EMDR in forensic mental health is unfortunate given how common PTSD is in mentally unwell offenders and its potential to impede recovery and contribute to further offending. This first qualitative study found participants experienced positive transformative change, extending beyond symptom reduction. Themes support previously published quantitative outcomes showing EMDR to be safe and effective in this cohort. EMDR was well suited to a forensic setting and was seen as an empowering therapy.Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12618000683235.Study registration: The study was registered on the Australia and New Zealand Clinical Trials Network, registration number ACTRN12618000683235 (registered prospectively, 24 April 2018), https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id = 374682.
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Affiliation(s)
- Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Brigit Ross
- Mental Health, Addiction and Intellectual Disability Services, Te Whatu Ora Health New Zealand, Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Tom Flewett
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Eoghan Rutledge
- Mental Health, Addiction and Intellectual Disability Services, Te Whatu Ora Health New Zealand, Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Oliver Hansby
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
- Mental Health, Addiction and Intellectual Disability Services, Te Whatu Ora Health New Zealand, Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Facer-Irwin E, Blackwood N, Bird A, MacManus D. Trauma, post-traumatic stress disorder and violence in the prison population: prospective cohort study of sentenced male prisoners in the UK. BJPsych Open 2023; 9:e47. [PMID: 36866723 PMCID: PMC10044336 DOI: 10.1192/bjo.2022.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Violence is a common problem in prisons. Post-traumatic stress disorder (PTSD), a prevalent disorder in prison populations, has been identified as a risk factor for violent behaviour in community and military populations. Although cross-sectional associations between PTSD and prison violence have been documented, prospective cohort studies are required. AIMS To investigate whether PTSD is an independent risk factor for prison violence, and examine the potential role of PTSD symptoms and other trauma sequelae on the pathway from trauma exposure to violent behaviour in prison. METHOD A prospective cohort study was conducted in a large, medium security prison in London, UK. A random sample of sentenced prisoners arriving into custody (N = 223) took part in a clinical research interview, which assessed trauma histories, mental disorders including PTSD, and other potential sequelae of trauma (anger, emotion dysregulation). Incidents of violent behaviour were measured with prison records covering the 3 months after reception into custody. Stepped binary logistic regression and a series of binary mediation models were performed. RESULTS Prisoners who met current (past month) criteria for PTSD were more likely to engage in violent behaviour during the first 3 months of imprisonment, after adjusting for other independent risk factors. The relationship between lifetime exposure to interpersonal trauma and violent behaviour in custody was mediated by total PTSD symptom severity. Hyperarousal and negatively valenced cognitive and emotional appraisal symptoms were particularly implicated in this pathway. CONCLUSIONS The identification and treatment of PTSD has the potential to reduce violence in prison populations.
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Affiliation(s)
- Emma Facer-Irwin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Nigel Blackwood
- HMP Wandsworth, South London & Maudsley NHS Foundation Trust, UK; and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Annie Bird
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Deirdre MacManus
- HMP Wandsworth, South London and Maudsley NHS Trust, UK; Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and London and South East NHS Veterans' Mental Health Service, Camden and Islington NHS Trust, UK
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Duan W, Wang Z, Yang C, Ke S. Are risk-need-responsivity principles golden? A meta-analysis of randomized controlled trials of community correction programs. JOURNAL OF EXPERIMENTAL CRIMINOLOGY 2023:1-24. [PMID: 36644318 PMCID: PMC9825096 DOI: 10.1007/s11292-022-09550-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Objectives Using meta-analysis to determine the effect size of the recidivism rate of participants in community correction programs that are conducted entirely in community settings. Methods Following the Preferred Reported Items for Systematic Reviews and Meta-analyses (PRISMA), 25 qualified studies contributed 35 independent effect sizes. Results Full participation in a program significantly reduced the recidivism rate. Participant age was a significant moderator of heterogeneity. Those aged over 18 have lower recidivism rates. Interventions that fully follow the Risk-Need-Responsivity (RNR) design principles achieved similar results to those that did not. Recidivism rates increase more than 12 months after the program ends. Conclusions The effectiveness of community correctional programs varies depending on the participant's age. The RNR principles are not golden. The above factors should be carefully considered when conducting intervention design in the future. Results should be interpreted with caution due to the literature's high heterogeneity and low quality. Supplementary Information The online version contains supplementary material available at 10.1007/s11292-022-09550-w.
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Affiliation(s)
- Wenjie Duan
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Zichuan Wang
- School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Caiyun Yang
- Department of Sociology, School of Philosophy and Law & Political Science, Shanghai Normal University, Xuhui District, 100 Guilin Road, Shanghai, 200234 China
| | - Shuting Ke
- Department of Sociology, School of Philosophy and Law & Political Science, Shanghai Normal University, Xuhui District, 100 Guilin Road, Shanghai, 200234 China
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Fovet T, Villa C, Belet B, Carton F, Bauer T, Buyle-Bodin S, D’Hondt F, Bouchard JP. Le psychotraumatisme en milieu pénitentiaire. ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2022. [DOI: 10.1016/j.amp.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Favril L, Shaw J, Fazel S. Prevalence and risk factors for suicide attempts in prison. Clin Psychol Rev 2022; 97:102190. [PMID: 36029609 DOI: 10.1016/j.cpr.2022.102190] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/28/2022] [Accepted: 08/03/2022] [Indexed: 11/18/2022]
Abstract
Suicidal behaviour represents a substantial burden of morbidity and mortality in prisons worldwide. We aimed to synthesise the evidence on prevalence and risk factors for suicide attempts during incarceration. In this systematic review and meta-analysis, we searched four bibliographic databases for studies (published up to May 31, 2022) reporting on adults sampled from the general prison population who attempted suicide while incarcerated and an unselected comparison group. A total of 20 studies comprising 19,882 individuals (6.5% women) in 20 countries were eligible for inclusion. The pooled prevalence of suicide attempts during incarceration was 8.6% (95% CI 6.1-11.2) in men and 12.2% (95% CI 7.1-17.2) in women. Across all 36 risk factors studied, the strongest associations were found for suicidal ideation, previous self-harm, and markers of psychiatric morbidity. Prison-related risk factors included solitary confinement, victimisation, and poor social support while incarcerated. Sensitivity analyses indicate that risk factors for near-lethal suicide attempts are similar to those for suicide attempts more generally. In addition to providing a synthesis of previous work, our systematic review highlights several key limitations of the extant literature, which provide directions for future research.
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Affiliation(s)
- Louis Favril
- Faculty of Law and Criminology, Ghent University, Ghent, Belgium.
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
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Johnson KA, Hunt T, Puglisi LB, Maeng D, Epa-Llop A, Elumn JE, Nguyen A, Leung A, Chen R, Shah Z, Wang J, Johnson R, Chapman BP, Gilbert L, El-Bassel N, Morse DS. Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration. Front Psychiatry 2022; 13:867445. [PMID: 35693964 PMCID: PMC9186377 DOI: 10.3389/fpsyt.2022.867445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND U.S. women recently released from incarceration experience significantly higher rates of trauma and exacerbation of mental health conditions, and the period following release has been identified as a window of heightened risk for mental health distress and human immunodeficiency virus (HIV), sexually transmitted infections (STI) and hepatitis C (HCV) transmissions. Despite these vulnerabilities, and an urgent need for supports, optimal engagement strategies remain unclear. WORTH Transitions is a program made up of two evidence-based interventions focused on improving the health of women returning to the community from incarceration with substance use disorders. Combining the two was designed to reduce HIV/STIs/HCV risks and increase overall health treatment engagement using a community health worker led intervention. METHODS We examined associations between trauma, mental health symptomology, and HIV/STI/HCV outcomes among women who engaged in the WORTH Transitions intervention (N = 206) Specifically, bivariate and longitudinal multivariate models were created to examine associations between trauma and mental health distress (defined as depressive and PTSD symptoms), on (1) types of engagement in HIV/STIs/HCV prevention and behavioral health services; and (2) HIV/STIs/HCV risk outcomes. The women who engaged in the intervention were 18 years and older and some were White, Black and other racial or ethnic minority. RESULTS PTSD symptomology and being a Black or indigenous woman of color was significantly (p = 0.014) associated with individual or group session engagement. Neither trauma nor PTSD symptoms were associated with higher HIV/STIs/HCV risks. Instead, relative to those who did not engage in HIV/STI/HCV risky behaviors, PTSD symptomology (p = 0.040) was associated with more than 3-fold increase in the probability of being lost to follow up (relative risk ratio = 3.722). CONCLUSION Given the impact of PTSD-related symptoms on driving both engagement in HIV/STIs/HCV prevention services and intervention attrition among women leaving incarceration, physical and behavioral health interventions must be both overtly trauma- and mental health-informed. As was the case with WORTH Transitions, physical and behavioral health services for this population must include intentional and active support of the forms of treatment participants endorse to ensure maximal engagement.
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Affiliation(s)
- Karen A Johnson
- University of Alabama School of Social Work, Tuscaloosa, AL, United States
| | - Timothy Hunt
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Lisa B Puglisi
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States.,Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Daniel Maeng
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Amali Epa-Llop
- Department of Medicine, University of Rochester School of Medicine, Rochester, NY, United States
| | - Johanna E Elumn
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, United States.,Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Antoinette Nguyen
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Ashley Leung
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Rachel Chen
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Zainab Shah
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Jiayi Wang
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Rachel Johnson
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Benjamin P Chapman
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States
| | - Louisa Gilbert
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University School of Social Work, New York, NY, United States
| | - Diane S Morse
- Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States.,Department of Medicine, University of Rochester School of Medicine, Rochester, NY, United States
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Favril L. Epidemiology, Risk Factors, and Prevention of Suicidal Thoughts and Behaviour in Prisons: A Literature Review. Psychol Belg 2021; 61:341-355. [PMID: 34900324 PMCID: PMC8622377 DOI: 10.5334/pb.1072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/19/2021] [Indexed: 12/21/2022] Open
Abstract
Suicide is a global public health concern that affects all echelons of society, albeit not equally so. Compared with adults in the general population, incarcerated offenders are at increased risk to consider, attempt, and die by suicide, which represents a substantial burden of morbidity and mortality in prisons worldwide. This review synthesises recent literature pertaining to the epidemiology, risk factors, and prevention of suicidal thoughts and behaviour among prisoners, and outlines a framework which emphasises the interplay between individuals (importation) and their surroundings (deprivation). The available evidence suggests that prison-specific stressors may exacerbate risk of suicide in an already vulnerable population characterised by complex health and social care needs. Emerging data point to differential mechanisms through which prisoners come to think about suicide and subsequently progress to suicidal behaviour. As risk of suicide is determined by a complex web of synergistically interacting factors, its management and prevention demands a cross-sectoral policy and service response that includes targeted interventions aimed at high-risk prisoners in combination with population strategies that promote the health and wellbeing of all people in prison.
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Affiliation(s)
- Louis Favril
- Institute for International Research on Criminal Policy, Faculty of Law and Criminology, Ghent University, BE
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