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Effectiveness of psychological interventions in prison to reduce recidivism: a systematic review and meta-analysis of randomised controlled trials
The Lancet Psychiatry ( IF 64.3 ) Pub Date : 2021-08-19 , DOI: 10.1016/s2215-0366(21)00170-x
Gabrielle Beaudry 1 , Rongqin Yu 1 , Amanda E Perry 2 , Seena Fazel 1
Affiliation  

Background

Repeat offending, also known as criminal recidivism, in people released from prison has remained high over many decades. To address this, psychological treatments have been increasingly used in criminal justice settings; however, there is little evidence about their effectiveness. We aimed to evaluate the effectiveness of interventions in prison to reduce recidivism after release.

Methods

For this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, Global Health, MEDLINE, PsycINFO, and Google Scholar for articles published from database inception to Feb 17, 2021, without any language restrictions. We searched for randomised controlled trials (RCTs) that evaluated the effect of psychological interventions, delivered to adolescents and adults during incarceration, on recidivism outcomes after release. We excluded studies of solely pharmacological interventions and of participants in secure psychiatric hospitals or special residential units, or attending therapies mainly delivered outside of the prison setting. We extracted summary estimates from eligible RCTs. Data were extracted and appraised according to a prespecified protocol, with effect sizes converted to odds ratios. We used a standardised form to extract the effects of interventions on recidivism and estimated risk of bias for each RCT. Planned sensitivity analyses were done by removing studies with fewer than 50 participants. Our primary outcome was recidivism. Data from individual RCTs were combined in a random-effects meta-analysis as pooled odds ratios (ORs) and we explored sources of heterogeneity by comparing effect sizes by study size, control group, and intervention type. The protocol was pre-registered with PROSPERO, CRD42020167228.

Findings

Of 6345 articles retrieved, 29 RCTs (9443 participants, 1104 [11·7%] females, 8111 [85·9%] males, and 228 [2·4%] unknown) met the inclusion criteria for the primary outcome. Mean ages were 31·4 years (SD 4·9, range 24·5–41·5) for adult participants and 17·5 years (SD 1·9; range 14·6–20·2) for adolescent participants. Race or ethnicity data were not sufficiently reported to be aggregated. If including all 29 RCTs, psychological interventions were associated with reduced reoffending outcomes (OR 0·72, 95% CI 0·56–0·92). However, after excluding smaller studies (<50 participants in the intervention group), there was no significant reduction in recidivism (OR 0.87, 95% CI 0·68–1·11). Based on two studies, therapeutic communities were associated with decreased rates of recidivism (OR 0·64, 95% CI 0·46–0·91). These risk estimates did not significantly differ by type of control group and other study characteristics.

Interpretation

Widely implemented psychological interventions for people in prison to reduce offending after release need improvement. Publication bias and small-study effects appear to have overestimated the reported modest effects of such interventions, which were no longer present when only larger studies were included in analyses. Findings suggest that therapeutic communities and interventions that ensure continuity of care in community settings should be prioritised for future research. Developing new treatments should focus on addressing modifiable risk factors for reoffending.

Funding

Wellcome Trust, Fonds de recherche du Québec – Santé.



中文翻译:

监狱中心理干预减少累犯的有效性:随机对照试验的系统评价和荟萃分析

背景

几十年来,出狱人员的重犯,也称为累犯,一直居高不下。为了解决这个问题,心理治疗越来越多地用于刑事司法环境;然而,几乎没有证据表明它们的有效性。我们旨在评估监狱干预措施的有效性,以减少释放后的累犯。

方法

对于本次系统评价和荟萃分析,我们在 Cochrane 对照试验中心注册库、Embase、Global Health、MEDLINE、PsycINFO 和 Google Scholar 中搜索了从数据库开始到 2021 年 2 月 17 日发表的文章,没有任何语言限制。我们搜索了随机对照试验 (RCT),这些试验评估了在监禁期间提供给青少年和成人的心理干预对释放后累​​犯结果的影响。我们排除了仅对药物干预和安全精神病院或特殊住宅单元的参与者进行的研究,或主要在监狱环境外进行的治疗。我们从符合条件的随机对照试验中提取了汇总估计值。根据预先指定的方案提取和评估数据,将效应大小转换为优势比。我们使用标准化表格来提取干预对累犯的影响以及每项 RCT 的估计偏倚风险。通过删除少于 50 名参与者的研究来进行计划的敏感性分析。我们的主要结果是累犯。来自单个 RCT 的数据在随机效应荟萃分析中作为汇总优势比 (ORs) 进行组合,我们通过比较研究规模、对照组和干预类型的效应大小来探索异质性的来源。该协议已在 PROSPERO 预注册,CRD42020167228。来自单个 RCT 的数据在随机效应荟萃分析中作为汇总优势比 (ORs) 进行组合,我们通过比较研究规模、对照组和干预类型的效应大小来探索异质性的来源。该协议已在 PROSPERO 预注册,CRD42020167228。来自单个 RCT 的数据在随机效应荟萃分析中作为汇总优势比 (ORs) 进行组合,我们通过比较研究规模、对照组和干预类型的效应大小来探索异质性的来源。该协议已在 PROSPERO 预注册,CRD42020167228。

发现

在检索到的 6345 篇文章中,29 篇 RCT(9443 名受试者,1104 名 [11·7%] 女性,8111 名 [85·9%] 男性和 228 名 [2·4%] 未知)符合主要结局的纳入标准。成年参与者的平均年龄为 31·4 岁(SD 4·9,范围 24·5–41·5),青少年参与者的平均年龄为 17·5 岁(SD 1·9;范围 14·6–20·2)。没有充分报告种族或族裔数据以进行汇总。如果包括所有 29 项 RCT,心理干预与减少再犯罪结果相关(OR 0·72,95% CI 0·56–0·92)。然而,在排除较小的研究(干预组<50 名参与者)后,再犯率没有显着降低(OR 0.87,95% CI 0·68–1·11)。基于两项研究,治疗社区与累犯率降低相关(OR 0·64,95% CI 0·46–0·91)。

解释

广泛实施的在押人员心理干预以减少出狱后的犯罪行为需要改进。发表偏倚和小规模研究效应似乎高估了此类干预措施所报告的适度效应,当仅将较大的研究纳入分析时,这些效应不再存在。研究结果表明,在未来的研究中,应优先考虑确保社区环境中护理连续性的治疗性社区和干预措施。开发新的治疗方法应侧重于解决可改变的再犯罪风险因素。

资金

Wellcome Trust, Fonds de recherche du Québec – Santé。

更新日期:2021-08-20
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