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Articles   |    
Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review
Seth J. Prins, M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300166
View Author and Article Information

Mr. Prins is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (e-mail: sjp2154@columbia.edu).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  People with mental illnesses are understood to be overrepresented in the U.S. criminal justice system, and accurate prevalence estimates in corrections settings are crucial for planning and implementing preventive and diversionary policies and programs. Despite consistent scholarly attention to mental illness in corrections facilities, only two federal self-report surveys are typically cited, and they may not represent the extent of relevant data. This systematic review was conducted to develop a broader picture of mental illness prevalence in U.S. state prisons and to identify methodological challenges to obtaining accurate and consistent estimates.

Methods  MEDLINE, PsycINFO, the National Criminal Justice Reference Service, Social Services Abstracts, Social Work Abstracts, and Sociological Abstracts were searched. Studies were included if they were published between 1989 and 2013, focused on U.S. state prisons, reported prevalence of diagnoses and symptoms of DSM axis I disorders, and identified screening and assessment strategies.

Results  Twenty-eight articles met inclusion criteria. Estimates of current and lifetime prevalence of mental illnesses varied widely; however, the range of prevalence estimates for particular disorders was much greater—and tended to be higher—in prisons than in community samples.

Conclusions  Definitions of mental illnesses, sampling strategies, and case ascertainment strategies likely contributed to inconsistency in findings. Other reasons for study heterogeneity are discussed, and implications for public health are explored.

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Figure 1 Prevalence estimates of psychiatric disorder diagnoses from 19 studiesa

a Each diamond (prison) and circle (community) represents an estimate from a single reviewed study. Community estimates are from the Epidemiologic Catchment Area survey, the National Comorbidity Survey, the National Comorbidity Survey Replication, the National Epidemiologic Survey on Alcohol and Related Conditions, and the National Survey on Drug Use and Health. Lines are visual aids for the range of estimates.

Figure 2 Prevalence estimates of psychiatric disorder diagnoses, by gendera

a Each diamond (prison) and circle (community) represents an estimate from a single reviewed study. Community estimates are from the Epidemiologic Catchment Area survey, the National Comorbidity Survey, the National Comorbidity Survey Replication, the National Epidemiologic Survey on Alcohol and Related Conditions, and the National Survey on Drug Use and Health. Lines are visual aids for the range of estimates.

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Table 1Prevalence estimates of mental health problems in prisons and key study characteristics from four reviewed studiesa
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a nr, not reported

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b Percentage of population aged ≥55

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Table 2Prevalence estimates of diagnosed psychiatric disorders in prisons and key study characteristics from 17 reviewed studies
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a MCC, Medical and Classification Center

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b na, not applicable; nr, not reported

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c BDI, Beck Depression Inventory; CIDI, Composite International Diagnostic Interview; DIS, Diagnostic Interview Schedule; HRS, Hamilton Psychiatric Rating Scale of Depression; MINI-Plus, Mini Neuropsychiatric Interview–Plus; MMPI, Minnesota Multiphasic Personality Inventory; RDS, Referral Decision Scale; SCID, Structured Clinical Interview for DSM Disorders

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d ADHD, attention-deficit hyperactivity disorder; OCD, obsessive-compulsive disorder; PTSD, posttraumatic stress disorder

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e Same sample, different articles

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f Same sample, different articles

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g Percentage of HIV-positive women

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Table 3Prevalence estimates of psychiatric symptoms in prisons and key study characteristics from five reviewed studiesa
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a nr, not reported; na, not applicable

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b BDI, Beck Depression Inventory; STAI-S, Speilberger State Anxiety Inventory; CES-D, Center for Epidemiologic Studies Depression Scale; MCMI-III, Millon Clinical Multiaxial Inventory–III

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c All symptoms were current, except for the Conklin study (49), which did not report on recency of symptoms.

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d Not applicable for the STAI-S

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