Background

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.

Methods

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.

Findings

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screened, we identified 34 studies reporting the prevalence of dual disorders among individuals in prison and received unpublished prevalence data for 16 studies, totalling 50 eligible studies and 24 915 people.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).

Interpretation

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.

Funding

Economic and Social Research Council, Agencia Nacional de Investigación y Desarrollo (Chile), and the Wellcome Trust.

中文翻译：

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监狱人口中合并严重精神疾病和药物滥用障碍的患病率：系统评价和荟萃分析

 背景

共病精神疾病和药物滥用障碍与不良的犯罪、社会和健康结果有关。然而，监狱人口并不清楚他们的负担。因此，我们的目的是估计全世界监狱服刑人员共病严重精神疾病和物质使用障碍（双重障碍）的患病率。

 方法

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、刑事司法数据库、Embase、Global Health、Global Index Medicus、IBSS、MEDLINE、NCJRS、PAIS Index、PsycINFO、Russian Science Citation Index、Scielo 、社会服务摘要和 Web of Science）以及灰色文献（Open Gray 和 ProQuest Dissertations &Theses Global），用于报告 1980 年 1 月 1 日至 9 月 25 日期间发表的监狱人口中严重精神疾病和药物滥用障碍患病率的研究，2021年，并联系了相关研究的作者。纳入了对未经选择的成年监狱人口进行的实证研究，这些研究应用了代表性抽样策略和经过验证的诊断仪器，并且报告了双重疾病的患病率或有可以提供相应患病率数据的作者。两名评审员（GB 和 SDL）独立从符合条件的研究中提取数据；如果有的话，提取当前（最多 1 年）和终生患病率。我们寻求概要估计。我们的主要结局是与物质使用障碍共存的非情感性精神病和与物质使用障碍共存的重度抑郁症。我们进行了随机效应荟萃分析，通过荟萃回归探讨了样本间的异质性，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。该研究方案已在 PROSPERO 注册，CRD42020207301。

 发现

在筛选的 11 346 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 项研究未发表的患病率数据，总共 50 项符合条件的研究和 24 915 人。纳入研究的平均质量得分为 7·8 (SD 1·2)。我们发现 3·5% (95% CI 2·2–5·0) 的人目前患有非情感性精神病并伴有任何共病物质使用障碍，这相当于 900 名非情感性精神病患者中的 443 人 (49·2%)，并且9·1% (5·6–13·3) 患有当前重度抑郁症和共病物质使用障碍，占 2143 名重度抑郁症患者中的 1105 人 (51·6%)。样本间异质性较高（ I ² >80%）。与那些没有非情感性精神病的囚犯相比，目前患有非情感性精神病的监狱囚犯更有可能患有药物滥用障碍（OR 1·7，95% CI 1·4–2·2）。患有重度抑郁症的人比没有重度抑郁症的人发生物质使用障碍的几率更高（1·6、1·3–2·0）。

 解释

大约一半患有非情感性精神病或重度抑郁症的监狱囚犯患有药物滥用障碍。应考虑筛查双重疾病并实施综合和可扩展的治疗。

 资金

经济和社会研究理事会、Agencia Nacional de Investigación y Desarrollo（智利）和 Wellcome Trust。