Fazel and Favril presented a reanalysis of our previously published systematic review and meta-analysis on the prevalence of attention deficit hyperactivity disorder (ADHD) in prison.
The current paper addresses some of the criticisms of Fazel and Favril on our meta-analysis and presents a reanalysis of the data, focusing on adult detained persons.
We conducted a meta—regression on 28 studies (n = 7710) to estimae the pooled prevalence of ADHD.
This reanalysis yielded a pooled estimate of 22.2% for the prevalence of ADHD (95% confidence interval [CI]: 15.7; 28.6), which disagrees with the estimate given by Fazel and Favril (8.3%, 95% CI: 3.8; 12.8).
We argue that the ADHD prevalence provided by Fazel and Favril was an underestimate due to their use of too restrictive exclusion criteria and suboptimal analysis methods. Our reanalysis on detained adults suggests a higher ADHD prevalence, which highlights the need to diagnose and treat ADHD in prison.
Psychosocial rehabilitation in forensic psychiatric services requires sound measurement of patient and staff perceptions of psychosocial function. The recommended World Health Organisation Disability Assessment Schedule 2.0 (WHODAS), designed for this, has not been examined with offender patients.
To examine patient and staff WHODAS ratings of secure hospital inpatients with psychosis, any differences between them and explore associations with other clinical factors.
Seventy-three patients self-rated on the WHODAS after 3 months as inpatients. An occupational therapist interviewed the patient's primary nurse and care team at about the same time (staff ratings). Scores were calculated according to the WHODAS manual. WHODAS scores and interview-rated symptom severity, cognitive measures, daily antipsychotic dose and duration of care were compared.
Patient ratings indicated less disability than staff ratings for total score and for the domains of understanding and communicating, getting along and life activities. Self-care and participation ratings were similar. Patients were more likely to rate themselves as disabled in getting around (mobility). Only one-fifth of patient- and staff- ratings (16, 22%) were similar, while for nearly a third of the patients (23, 32%) self-ratings were higher than staff ratings. More severe positive symptoms were associated with higher self-rated WHODAS disability after accounting for treatment duration, negative symptoms, cognitive score and antipsychotic dose. No variable accounted for the staff/patient differences in ratings.
Our mean WHODAS score findings echoed those in other patient samples—of patient underestimation of disability, linked to severity of symptoms. In this study using the WHODAS for the first time in a forensic mental health secure inpatient service, however, we found that, by comparing individuals, half of the patients reported equivalent or greater disability than did staff. Future research should focus on elucidating from patients what contributes to their self-ratings. Understanding their thought processes in rating may enhance rehabilitation planning.
Previous meta-analyses may have overestimated the prevalence of attention-deficit hyperactivity disorder (ADHD) in prisoners by including data from selected samples.
To estimate the prevalence of ADHD in unselected samples of adults in prison and examine potential sources of heterogeneity by meta-regression and subgroup analyses.
We assessed all studies included in a 2018 systematic review for eligibility and updated the literature search to include studies published up to September 2023.
A total of 11 studies reporting robust diagnostic data on ADHD in 3919 unselected adults in prison were included. In meta-regression, ADHD prevalence did not differ between men and women but it was significantly higher in studies using a two-phase design. In random sampling studies, the pooled prevalence of ADHD was 8.3% (95% CI: 3.8–12.8) which was further halved after the removal of an outlier.
One in 12 adults in prison have been diagnosed with ADHD. Our findings highlight the importance of using clear and consistent inclusion criteria in meta-analyses of prevalence.
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