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Outcomes of psychological therapies for prisoners with mental health problems: a systematic review and meta-analysis

Abstract:

Objective

Prisoners worldwide have substantial mental health needs, but the efficacy of psychological therapy in prisons is unknown. We aimed to systematically review psychological therapies with mental health outcomes in prisoners and qualitatively summarise difficulties in conducting randomized clinical trials (RCTs).

Methods

Prisoners worldwide have substantial mental health needs, but the efficacy of psychological therapy in prisons is unknown. We aimed to systematically review psychological therapies with mental health outcomes in prisoners and qualitatively summarise difficulties in conducting randomized clinical trials (RCTs).

Results

In 37 identified studies, psychological therapies showed a medium effect size (0.50, 95% CI [0.34, 0.66]) with high levels of heterogeneity with the most evidence for CBT and mindfulness-based trials. Studies that used no treatment (0.77, 95% CI [0.50, 1.03]) or waitlist controls (0.71, 95% CI [0.43, 1.00]) had larger effect sizes than those that had treatment-as-usual or other psychological therapies as controls (0.21, 95% CI [0.01, 0.41]). Effects were not sustained on follow-up at 3 and 6 months. No differences were found between group and individual therapy, or different treatment types. The use of a fidelity measure was associated with lower effect sizes. Qualitative analysis identified difficulties with follow-up and institutional constraints on scheduling and implementation of trials.

Conclusions.

CBT and mindfulness-based therapies are modestly effective in prisoners for depression and anxiety outcomes. In prisons with existing psychological therapies, more evidence is required before additional therapies can be recommended.

Publication status:
Published
Peer review status:
Peer reviewed

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Files:
Publisher copy:
10.1037/ccp0000214

Authors


More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Psychiatry
Role:
Author
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Psychiatry
Role:
Author


Publisher:
American Psychological Association
Journal:
Journal of Consulting and Clinical Psychology More from this journal
Volume:
85
Issue:
8
Pages:
783-802
Publication date:
2017-03-01
Acceptance date:
2017-03-27
DOI:
EISSN:
1939-2117
ISSN:
0022-006X


Keywords:
Pubs id:
pubs:687426
UUID:
uuid:27f3e056-152c-462e-ae03-5d21a0c1a6fe
Local pid:
pubs:687426
Deposit date:
2017-03-29

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