PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours.

PURPOSE: Prevalence rates of PTSD are higher in the prison population than in the community. We sought to systematically review the extent to which this disorder is associated with other mental health disorders and problematic suicidal or aggressive behaviours in the prison population. METHODS: Studies reporting a relationship between PTSD and comorbid mental disorders and/or problematic behaviours in imprisoned adolescent and adult populations were identified from four bibliographic indexes. Primary studies involving clinical interviews, validated instruments leading to DSM or ICD diagnoses, or validated self-report questionnaires such as the PTSD checklist were included. Random-effects meta-analysis was conducted where possible. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS: This review identified 36 studies, with a combined sample of 9594 participants, (6478 male and 2847 female prisoners) from 11 countries. Thirty-four of the identified studies employed a cross-sectional design. We identified significant associations between PTSD and comorbid mental disorders including depression (OR = 3.4, 95% confidence interval (CI): 2.3-4.9), anxiety (OR = 2.9, 95% confidence interval (CI): 1.8-4.7) and substance use (OR = 1.9, 95% confidence interval (CI): 1.5-2.4). We also identified significant associations between PTSD and suicidality (OR = 3, 95% confidence interval (CI): 2.4-3.8) and aggressive behaviours (this latter finding was not subject to meta-analysis). Significant methodological heterogeneity was identified between studies. CONCLUSIONS: High rates of psychiatric comorbidity among prisoners with PTSD, and links to suicidal behaviour, self-harm and aggressive behaviour, provide further support for the need for trauma-informed treatment approaches in prisons. However, significant gaps in the current evidence were apparent. In particular, a lack of large, longitudinal studies meant that the temporal relationships between PTSD and relevant outcomes cannot currently be determined.

Emotional detachment in psychopathy: Involvement of dorsal default-mode connections.

Criminal psychopathy is defined by emotional detachment [Psychopathy Checklist - Revised (PCL-R) factor 1], and antisocial behaviour (PCL-R factor 2). Previous work has associated antisocial behaviour in psychopathy with abnormalities in a ventral temporo-amygdala-orbitofrontal network. However, little is known of the neural correlates of emotional detachment. Imaging studies have indicated that the 'default-mode network' (DMN), and in particular its dorsomedial (medial prefrontal - posterior cingulate) component, contributes to affective and social processing in healthy individuals. Furthermore, recent work suggests that this network may be implicated in psychopathy. However, no research has examined the relationship between psychopathy, emotional detachment, and the white matter underpinning the DMN. We therefore used diffusion tensor imaging (DTI) tractography in 13 offenders with psychopathy and 13 non-offenders to investigate the relationship between emotional detachment and the microstructure of white matter connections within the DMN. These included the dorsal cingulum (containing the medial prefrontal - posterior cingulate connections of the DMN), and the ventral cingulum (containing the posterior cingulate - medial temporal connections of the DMN). We found that fractional anisotropy (FA) was reduced in the left dorsal cingulum in the psychopathy group (p = .024). Moreover, within this group, emotional detachment was negatively correlated with FA in this tract portion bilaterally (left: r = -.61, p = .026; right: r = -.62, p = .023). These results suggest the importance of the dorsal DMN in the emotional detachment observed in individuals with psychopathy. We propose a 'dual-network' model of white matter abnormalities in the disorder, which incorporates these with previous findings.