The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis.
The prevalence of comorbid serious mental illnesses and substance use disorders in prison populations: a systematic review and meta-analysis.
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DOI：
10.1016/s2468-2667(22)00093-7
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发表时间：
2022-06
影响因子：
50
通讯作者：
Mundt, Adrian P.
中科院分区：
文献类型：
--
作者：
Baranyi, Gergo;Fazel, Seena;Langerfeldt, Sabine Delhey;Mundt, Adrian P.
共病精神疾病和物质使用障碍与不良的犯罪，社会和健康结果有关。然而，他们的负担在监狱人口中并不可靠。因此，我们的目的是估计世界各地监狱中共患严重精神疾病和物质使用障碍（双重障碍）的患病率。在本系统综述和荟萃分析中，我们检索了15个电子数据库（ASSIA，CAB Abstracts，Criminal Justice Database，Embase，Global Health，Global Index Medicus，IBSS，MEDLINE，NCJRS，PAIS Index，PsycINFO，Russian Science Citation Index，Scielo，Social Services Abstracts，和Web of Science）和灰色文献（Open Grey和ProQuest Dissertations & Theses Global）报告了1月1日之间发表的监狱人口中严重精神疾病和物质使用障碍的患病率的研究，1980年和2021年9月25日，并联系了相关研究的作者。纳入了对10岁以上成年监狱人口进行的实证研究，这些研究采用了代表性抽样策略和经验证的诊断工具，报告了双重疾病的患病率，或有作者可以提供相应的患病率数据。两名审查员（GB和SDL）独立地从合格的研究中提取数据;提取当前（长达1年）和终生患病率（如果可用）。我们寻求汇总估计数。我们的主要结果是共病的非情感性精神病与物质使用障碍和共病的重性抑郁症与物质使用障碍。我们进行了一项随机效应荟萃分析，用荟萃回归探讨了样本间异质性，并计算了比值比（OR），以评估精神障碍和物质使用障碍之间的双向关系。使用标准工具评估偏倚风险。研究方案已在PROSPERO注册，CRD 42020207301。在筛选的11346份记录中，我们确定了34项报告监狱中个人双重疾病患病率的研究，并收到了16项研究的未发表患病率数据，共计50项合格研究和24915人。 纳入研究的平均质量评分为7.8（SD 1.2）。我们发现，3.5%（95%CI 2.2 - 5.0）目前有非情感性精神病与任何共病的物质使用障碍，占443（49.2%）的900人非情感性精神病，和9.1%（5.6 - 13.3）例患者目前患有重性抑郁症和共病的物质使用障碍，占2143例重性抑郁症患者中的1105例（51.6%）。样本间异质性较高（I2>80%）。目前患有非情感性精神病的囚犯与没有精神病的囚犯相比，更有可能患有物质使用障碍（OR 1.7，95%CI 1.4 - 2.2）。患有抑郁症的人比没有抑郁症的人有更高的物质使用障碍的几率（1.6，1.3 - 2.0）。大约一半的非情感性精神病或重度抑郁症囚犯患有共病物质使用障碍。应考虑筛查双重疾病，并实施综合和可扩展的治疗。经济和社会研究理事会、国家研究和发展委员会（智利）和惠康信托基金。
Comorbid mental illnesses and substance use disorders are associated with adverse criminal, social, and health outcomes. Yet, their burden is not reliably known among prison populations. We therefore aimed to estimate the prevalence of comorbid serious mental illnesses and substance use disorders (dual disorders) among people in prison worldwide. In this systematic review and meta-analysis, we searched 15 electronic databases (ASSIA, CAB Abstracts, Criminal Justice Database, Embase, Global Health, Global Index Medicus, IBSS, MEDLINE, NCJRS, PAIS Index, PsycINFO, Russian Science Citation Index, Scielo, Social Services Abstracts, and Web of Science) and the grey literature (Open Grey and ProQuest Dissertations & Theses Global) for studies reporting the prevalence of serious mental illnesses and substance use disorders in prison populations published between Jan 1, 1980, and Sept 25, 2021, and contacted the authors of relevant studies. Empirical studies among unselected adult prison populations that applied representative sampling strategies and validated diagnostic instruments, and either reported the prevalence of dual disorders or had authors who could provide prevalence data in correspondence, were included. Two reviewers (GB and SDL) independently extracted data from the eligible studies; both current (up to 1 year) and lifetime prevalence were extracted, if available. We sought summary estimates. Our primary outcomes were comorbid non-affective psychosis with substance use disorders and comorbid major depression with substance use disorders. We conducted a random-effects meta-analysis, explored between-sample heterogeneity with meta-regression, and calculated odds ratios (ORs) to assess bidirectional relationships between mental and substance use disorders. Risk of bias was assessed by use of a standard tool. The study protocol was registered with PROSPERO, CRD42020207301. Of 11 346 records screened, we identified 34 studies reporting the prevalence of dual disorders among individuals in prison and received unpublished prevalence data for 16 studies, totalling 50 eligible studies and 24 915 people. The mean quality score of included studies was 7·8 (SD 1·2). We found that 3·5% (95% CI 2·2–5·0) had current non-affective psychosis with any comorbid substance use disorder, representing 443 (49·2%) of 900 people with non-affective psychosis, and 9·1% (5·6–13·3) had current major depression and comorbid substance use disorders, representing 1105 (51·6%) of 2143 people with major depression. Between-sample heterogeneity was high (I2>80%). People in prison with current non-affective psychosis were significantly more likely to have substance use disorders compared with those without (OR 1·7, 95% CI 1·4–2·2). People with major depression had higher odds of substance use disorders than those without (1·6, 1·3–2·0). Around half of the prison population with non-affective psychosis or major depression have a comorbid substance use disorder. Consideration should be given to screening for dual disorders and implementing integrated and scalable treatments. Economic and Social Research Council, Agencia Nacional de Investigación y Desarrollo (Chile), and the Wellcome Trust.