Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(25)00002-7
Nicole Racine, Shainur Premji
Exposure to adverse childhood experiences (ACEs), including abuse, neglect, and household challenges, have harmful implications for long-term health and mental health outcomes.1 Indeed, ACEs are one of the leading determinants of mental health disorders and are associated with increased health-care use into adulthood.1, 2 ACEs have the potential to infiltrate the family context, having implications for individual children and siblings. Yet, research on ACEs to date has largely focused on the outcomes of individuals rather than taking a family-based approach.
{"title":"Family-wide effects of adverse childhood experiences","authors":"Nicole Racine, Shainur Premji","doi":"10.1016/s2468-2667(25)00002-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00002-7","url":null,"abstract":"Exposure to adverse childhood experiences (ACEs), including abuse, neglect, and household challenges, have harmful implications for long-term health and mental health outcomes.<span><span><sup>1</sup></span></span> Indeed, ACEs are one of the leading determinants of mental health disorders and are associated with increased health-care use into adulthood.<span><span>1</span></span>, <span><span>2</span></span> ACEs have the potential to infiltrate the family context, having implications for individual children and siblings. Yet, research on ACEs to date has largely focused on the outcomes of individuals rather than taking a family-based approach.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"30 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(25)00001-5
Mats Börjesson, Daniel Arvidsson
Regular physical activity is associated with a lower risk of cardiovascular disease and cancer, and with longevity.1 Studies on physical activity and health have initially been based on observational studies with small sample sizes.2 Nowadays, the study quality has improved and includes laboratory-based studies with controlled interventions, albeit with limited external validity, as well as longitudinal studies with hard outcomes such as cardiovascular morbidity. Global recommendations for regular physical activity have been developed based on self-reported exercise levels. Such recommendations typically include the same advice for everyone (ie, 150 min per week of moderate intensity exercise).3
{"title":"Does everyone benefit equally from physical activity?","authors":"Mats Börjesson, Daniel Arvidsson","doi":"10.1016/s2468-2667(25)00001-5","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00001-5","url":null,"abstract":"Regular physical activity is associated with a lower risk of cardiovascular disease and cancer, and with longevity.<span><span><sup>1</sup></span></span> Studies on physical activity and health have initially been based on observational studies with small sample sizes.<span><span><sup>2</sup></span></span> Nowadays, the study quality has improved and includes laboratory-based studies with controlled interventions, albeit with limited external validity, as well as longitudinal studies with hard outcomes such as cardiovascular morbidity. Global recommendations for regular physical activity have been developed based on self-reported exercise levels. Such recommendations typically include the same advice for everyone (ie, 150 min per week of moderate intensity exercise).<span><span><sup>3</sup></span></span>","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"61 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(24)00301-3
Shabeer Syed, Laura D Howe, Rebecca E Lacey, Jessica Deighton, Muhammad Qummer ul Arfeen, Gene Feder, Ruth Gilbert
<h3>Background</h3>Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. We aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.<h3>Methods</h3>We derived a population-based birth cohort in England using linked electronic health records for first-time mothers (aged 14–55 years) with their children (born 2002–18). We followed up the cohort from 1 year before birth up to 18 years after birth across the Clinical Practice Research Datalink GOLD and Aurum databases (primary care), Hospital Episode Statistics (secondary care), and the Office of National Statistics (death registrations) between April 1, 2001, and March 31, 2020. We included six different ACE domains, including child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments, and high-risk presentations of child maltreatment, in the records of the mother or the firstborn in the first 1000 days. The primary outcome was the number of children (aged 5–18 years) with recorded mental health problems per mother. We used adjusted and weighted negative binomial regression models to estimate incidence rate ratios.<h3>Findings</h3>Of 333 048 firstborns and their mothers, 123 573 (37·1%) had any ACEs between 1 year before and 2 years after birth, and 65 941 (19·8%) of all mothers had at least one child with a mental health problem between ages 5 years and 18 years (median follow-up 11·4 years [IQR 9·2–14·1]). Mothers with firstborns with ACEs had 1·71 (95% CI 1·68–1·73) times as many children in total with mental health problems (mean 29·8 children per 100 mothers, 29·4–30·1) compared with mothers without firstborns with ACEs (mean 17·4 children per 100 mothers, 17·3–17·6), translating into a mean difference of 12·3 (95% CI 11·9–12·7) additional children with mental health problems per 100 mothers. These mothers also had increased incidence rates of children with all-cause emergency admissions and mental health-related contacts. There was no significant difference in the risk of mental health problems between firstborn and later-born children.<h3>Interpretation</h3>ACEs in firstborns during the first 1000 days were associated with increased mental health problems and health-care needs in multiple children in the same family. The findings highlight the importance of early identification of vulnerable first-time parents and firstborns and increased policy focus on sustained support beyond the first 1000 days to promote healthier long-term family outcomes. Future evaluations of interventions should include
{"title":"Adverse childhood experiences in firstborns and mental health risk and health-care use in siblings: a population-based birth cohort study of half a million children in England","authors":"Shabeer Syed, Laura D Howe, Rebecca E Lacey, Jessica Deighton, Muhammad Qummer ul Arfeen, Gene Feder, Ruth Gilbert","doi":"10.1016/s2468-2667(24)00301-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00301-3","url":null,"abstract":"<h3>Background</h3>Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. We aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.<h3>Methods</h3>We derived a population-based birth cohort in England using linked electronic health records for first-time mothers (aged 14–55 years) with their children (born 2002–18). We followed up the cohort from 1 year before birth up to 18 years after birth across the Clinical Practice Research Datalink GOLD and Aurum databases (primary care), Hospital Episode Statistics (secondary care), and the Office of National Statistics (death registrations) between April 1, 2001, and March 31, 2020. We included six different ACE domains, including child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments, and high-risk presentations of child maltreatment, in the records of the mother or the firstborn in the first 1000 days. The primary outcome was the number of children (aged 5–18 years) with recorded mental health problems per mother. We used adjusted and weighted negative binomial regression models to estimate incidence rate ratios.<h3>Findings</h3>Of 333 048 firstborns and their mothers, 123 573 (37·1%) had any ACEs between 1 year before and 2 years after birth, and 65 941 (19·8%) of all mothers had at least one child with a mental health problem between ages 5 years and 18 years (median follow-up 11·4 years [IQR 9·2–14·1]). Mothers with firstborns with ACEs had 1·71 (95% CI 1·68–1·73) times as many children in total with mental health problems (mean 29·8 children per 100 mothers, 29·4–30·1) compared with mothers without firstborns with ACEs (mean 17·4 children per 100 mothers, 17·3–17·6), translating into a mean difference of 12·3 (95% CI 11·9–12·7) additional children with mental health problems per 100 mothers. These mothers also had increased incidence rates of children with all-cause emergency admissions and mental health-related contacts. There was no significant difference in the risk of mental health problems between firstborn and later-born children.<h3>Interpretation</h3>ACEs in firstborns during the first 1000 days were associated with increased mental health problems and health-care needs in multiple children in the same family. The findings highlight the importance of early identification of vulnerable first-time parents and firstborns and increased policy focus on sustained support beyond the first 1000 days to promote healthier long-term family outcomes. Future evaluations of interventions should include ","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"27 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reflections on the tobacco-free generation: methodological challenges and global implications","authors":"Sergi Trias-Llimós, Ariadna Feliu, Esteve Fernández","doi":"10.1016/s2468-2667(25)00004-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00004-0","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"7 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(24)00278-0
Naomi Q P Tan, Renu S Nargund, Elisa E Douglas, Maria A Lopez-Olivo, Paul J Resong, Sayaka Ishizawa, Sara Nofal, Kate Krause, Robert J Volk, Iakovos Toumazis
<h3>Background</h3>Personalised risk-based screening (PRBS) can enhance the efficiency of cancer screening programnes, but little is known about support for its implementation among the general public and health-care professionals. We aimed to summarise the acceptability and perceptions of PRBS for breast, cervical, colorectal, lung, and prostate cancer screening among these groups.<h3>Methods</h3>We conducted a systematic review and meta-analysis of original research studies reporting on breast, cervical, colorectal, lung, and prostate cancer screening; personalised risk assessments to guide PRBS; and the acceptability of and receptibility towards these approaches among the general public, health-care professionals, or both. We searched MEDLINE, Embase, Cochrane Central, PsycINFO, and CINAHL Plus for articles published between Jan 1, 2010, and April 30, 2024. Studies not reporting on the outcomes of interest and with insufficient data for analysis were excluded. Six reviewers independently screened articles, and risk of bias was assessed using the Mixed Methods Appraisal Tool. Qualitative data were analysed thematically. Quantitative data were analysed with use of random-effects meta-analysis for outcomes that had at least two studies. The study protocol was registered at PROSPERO, CRD42022354287.<h3>Findings</h3>Our search identified 4491 unique records. After screening, 63 studies were included in our analysis, of which 36 (57%) included the general public, 21 (33%) included health-care professionals, and six (11%) included both. The majority of studies focused on breast cancer screening (43 [68%] studies), and were from North America (28 [44%]) and Europe (28 [44%]). Qualitative findings were analysed thematically, and the extracted quantitative findings were synthesised under the following topics: acceptability and perceptions of personalised risk assessments among the general public; acceptability and perceptions of PRBS among the general public; acceptability and perceptions of PRBS among health-care professionals; and barriers and facilitators to PRBS implementation among health-care professionals. The general public and health-care professionals generally found PRBS acceptable, but they needed more information about how risk was calculated and the accuracy of risk scores. Additionally, both groups were cautious about reducing screening frequencies for individuals at low risk and cited barriers such as the time and resources needed to implement an effective PRBS programme. The pooled estimate for acceptability of PRBS was 78% (95% CI 66–88) among the general public and 86% (64–99) among health-care professionals.<h3>Interpretation</h3>The general public and health-care professionals both viewed personalised risk assessments as providing valuable information and PRBS as a logical next step to increase the quality of patient care and improve cancer mortality. However, implementation barriers at the public, health-care professional, and syst
{"title":"Acceptability and perceptions of personalised risk-based cancer screening among health-care professionals and the general public: a systematic review and meta-analysis","authors":"Naomi Q P Tan, Renu S Nargund, Elisa E Douglas, Maria A Lopez-Olivo, Paul J Resong, Sayaka Ishizawa, Sara Nofal, Kate Krause, Robert J Volk, Iakovos Toumazis","doi":"10.1016/s2468-2667(24)00278-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00278-0","url":null,"abstract":"<h3>Background</h3>Personalised risk-based screening (PRBS) can enhance the efficiency of cancer screening programnes, but little is known about support for its implementation among the general public and health-care professionals. We aimed to summarise the acceptability and perceptions of PRBS for breast, cervical, colorectal, lung, and prostate cancer screening among these groups.<h3>Methods</h3>We conducted a systematic review and meta-analysis of original research studies reporting on breast, cervical, colorectal, lung, and prostate cancer screening; personalised risk assessments to guide PRBS; and the acceptability of and receptibility towards these approaches among the general public, health-care professionals, or both. We searched MEDLINE, Embase, Cochrane Central, PsycINFO, and CINAHL Plus for articles published between Jan 1, 2010, and April 30, 2024. Studies not reporting on the outcomes of interest and with insufficient data for analysis were excluded. Six reviewers independently screened articles, and risk of bias was assessed using the Mixed Methods Appraisal Tool. Qualitative data were analysed thematically. Quantitative data were analysed with use of random-effects meta-analysis for outcomes that had at least two studies. The study protocol was registered at PROSPERO, CRD42022354287.<h3>Findings</h3>Our search identified 4491 unique records. After screening, 63 studies were included in our analysis, of which 36 (57%) included the general public, 21 (33%) included health-care professionals, and six (11%) included both. The majority of studies focused on breast cancer screening (43 [68%] studies), and were from North America (28 [44%]) and Europe (28 [44%]). Qualitative findings were analysed thematically, and the extracted quantitative findings were synthesised under the following topics: acceptability and perceptions of personalised risk assessments among the general public; acceptability and perceptions of PRBS among the general public; acceptability and perceptions of PRBS among health-care professionals; and barriers and facilitators to PRBS implementation among health-care professionals. The general public and health-care professionals generally found PRBS acceptable, but they needed more information about how risk was calculated and the accuracy of risk scores. Additionally, both groups were cautious about reducing screening frequencies for individuals at low risk and cited barriers such as the time and resources needed to implement an effective PRBS programme. The pooled estimate for acceptability of PRBS was 78% (95% CI 66–88) among the general public and 86% (64–99) among health-care professionals.<h3>Interpretation</h3>The general public and health-care professionals both viewed personalised risk assessments as providing valuable information and PRBS as a logical next step to increase the quality of patient care and improve cancer mortality. However, implementation barriers at the public, health-care professional, and syst","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"18 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(25)00017-9
No Abstract
{"title":"Thank you to The Lancet Public Health's reviewers in 2024","authors":"","doi":"10.1016/s2468-2667(25)00017-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00017-9","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"36 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(24)00299-8
Tesfa Mekonen Yimer, Eva Hoch, Benedikt Fischer, Danielle Dawson, Wayne Hall
Cannabis consumption is legally prohibited in most countries in the world. Several countries are legalising cannabis for adult consumption. It is important to monitor the public health effects of these policy changes. In this paper, we summarise the evidence to date on the legalisation of adult non-medical cannabis use in Canada and the USA. We describe regulatory models for cannabis legalisation, changes in cannabis products and pricing, effects on the illicit cannabis market, changes in cannabis use, and changes in cannabis-related physical and mental health harms. We discuss the challenges in assessing the effects of cannabis legalisation on public health outcomes and emphasise the importance of continuous and rigorous monitoring of adverse health effects to inform the design of public health policies and regulations.
{"title":"The adverse public health effects of non-medical cannabis legalisation in Canada and the USA","authors":"Tesfa Mekonen Yimer, Eva Hoch, Benedikt Fischer, Danielle Dawson, Wayne Hall","doi":"10.1016/s2468-2667(24)00299-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00299-8","url":null,"abstract":"Cannabis consumption is legally prohibited in most countries in the world. Several countries are legalising cannabis for adult consumption. It is important to monitor the public health effects of these policy changes. In this paper, we summarise the evidence to date on the legalisation of adult non-medical cannabis use in Canada and the USA. We describe regulatory models for cannabis legalisation, changes in cannabis products and pricing, effects on the illicit cannabis market, changes in cannabis use, and changes in cannabis-related physical and mental health harms. We discuss the challenges in assessing the effects of cannabis legalisation on public health outcomes and emphasise the importance of continuous and rigorous monitoring of adverse health effects to inform the design of public health policies and regulations.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"12 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(25)00008-8
Julia Rey Brandariz, Mónica Pérez-Ríos, Alberto Ruano-Ravina, Isabelle Soerjomataram
No Abstract
{"title":"Reflections on the tobacco-free generation: methodological challenges and global implications – Authors’ reply","authors":"Julia Rey Brandariz, Mónica Pérez-Ríos, Alberto Ruano-Ravina, Isabelle Soerjomataram","doi":"10.1016/s2468-2667(25)00008-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00008-8","url":null,"abstract":"No Abstract","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"25 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(25)00016-7
Feb 4 marks World Cancer Day—an opportunity to raise awareness about cancer and to reflect on the latest trends, challenges, and hopes. Acknowledging that cancer is not simply a medical diagnosis, but rather a unique personal story, the World Cancer Day campaign places people at the centre and calls for a people-centred approach to cancer.
{"title":"Cancer screening: putting people at the centre","authors":"","doi":"10.1016/s2468-2667(25)00016-7","DOIUrl":"https://doi.org/10.1016/s2468-2667(25)00016-7","url":null,"abstract":"Feb 4 marks <span><span>World Cancer Day</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>—an opportunity to raise awareness about cancer and to reflect on the latest trends, challenges, and hopes. Acknowledging that cancer is not simply a medical diagnosis, but rather a unique personal story, the World Cancer Day campaign places people at the centre and calls for a people-centred approach to cancer.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"77 2 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/s2468-2667(24)00280-9
Christina Emilian, Noura Al-Juffali, Seena Fazel
Background
Prison populations have been increasing worldwide. Previous studies suggest that there is a high burden of psychiatric morbidity in people in prison, but, to our knowledge, the last published meta-analysis of prevalence is more than a decade old. We aimed to describe the pooled prevalence of depression, psychosis, bipolar disorder, and schizophrenia spectrum disorders for people who are incarcerated.
Methods
In this updated systematic review and meta-analysis, we searched six databases and grey literature published from database inception until Aug 8, 2024, with no language or geographical restrictions. We included primary quantitative studies that reported the prevalence of depression and psychotic disorders in the unselected prison population, based their diagnoses on clinical examination or from interviews and by the use of validated diagnostic instruments, met standardised criteria of the ICD or the Diagnostic and Statistical Manual of Mental Disorders for the diagnoses, and provided pooled prevalences for psychosis in the previous 6 months and clinical depression in the previous 2 weeks to 1 month. We excluded studies that used selected samples or were only qualitative. We investigated bipolar and schizophrenia spectrum disorders as separate diagnostic subcategories. We synthesised studies using random-effects meta-analysis and explored heterogeneity with meta-regression and subgroup analyses. The protocol is registered with PROSPERO, CRD42022378568.
Findings
We identified 131 publications reporting the prevalence of mental illness in 58 838 people in prison in 43 countries. We estimated that the prevalence of depression was 12·8% (95% CI 11·1–14·6) and for any psychosis was 4·1% (3·6–4·7). For diagnostic subcategories, we found that the prevalence of bipolar disorder was 1·7% (1·0–2·6) and schizophrenia spectrum disorders was 3·6% (1·3–7·1). Between-study heterogeneity was substantial for these estimates (I2 69–97%) with few explanations. However, subgroup analyses revealed that people in prison in low-income and middle-income countries had higher prevalences for depression (16·7% [95% CI 13·6–20·0]) than in high-income countries (10·8% [9·0–13·0]), and that, for people with psychosis who are incarcerated, psychiatrists were less likely to diagnose (3·5% [2·8–4·3]) than were non-psychiatrists (4·7% [3·9–5·5]).
Interpretation
Our study indicates that the prevalence of severe mental illness in people who are incarcerated worldwide is considerable. Meeting the treatment needs of people in prison who have mental ill health remains an ongoing challenge for public mental health. More evidence on how to improve the assessment, treatment, and linkage to services on release, which will require more research-friendly prison services, is now needed.
Funding
None.
{"title":"Prevalence of severe mental illness among people in prison across 43 countries: a systematic review and meta-analysis","authors":"Christina Emilian, Noura Al-Juffali, Seena Fazel","doi":"10.1016/s2468-2667(24)00280-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00280-9","url":null,"abstract":"<h3>Background</h3>Prison populations have been increasing worldwide. Previous studies suggest that there is a high burden of psychiatric morbidity in people in prison, but, to our knowledge, the last published meta-analysis of prevalence is more than a decade old. We aimed to describe the pooled prevalence of depression, psychosis, bipolar disorder, and schizophrenia spectrum disorders for people who are incarcerated.<h3>Methods</h3>In this updated systematic review and meta-analysis, we searched six databases and grey literature published from database inception until Aug 8, 2024, with no language or geographical restrictions. We included primary quantitative studies that reported the prevalence of depression and psychotic disorders in the unselected prison population, based their diagnoses on clinical examination or from interviews and by the use of validated diagnostic instruments, met standardised criteria of the ICD or the Diagnostic and Statistical Manual of Mental Disorders for the diagnoses, and provided pooled prevalences for psychosis in the previous 6 months and clinical depression in the previous 2 weeks to 1 month. We excluded studies that used selected samples or were only qualitative. We investigated bipolar and schizophrenia spectrum disorders as separate diagnostic subcategories. We synthesised studies using random-effects meta-analysis and explored heterogeneity with meta-regression and subgroup analyses. The protocol is registered with PROSPERO, CRD42022378568.<h3>Findings</h3>We identified 131 publications reporting the prevalence of mental illness in 58 838 people in prison in 43 countries. We estimated that the prevalence of depression was 12·8% (95% CI 11·1–14·6) and for any psychosis was 4·1% (3·6–4·7). For diagnostic subcategories, we found that the prevalence of bipolar disorder was 1·7% (1·0–2·6) and schizophrenia spectrum disorders was 3·6% (1·3–7·1). Between-study heterogeneity was substantial for these estimates (<em>I</em><sup>2</sup> 69–97%) with few explanations. However, subgroup analyses revealed that people in prison in low-income and middle-income countries had higher prevalences for depression (16·7% [95% CI 13·6–20·0]) than in high-income countries (10·8% [9·0–13·0]), and that, for people with psychosis who are incarcerated, psychiatrists were less likely to diagnose (3·5% [2·8–4·3]) than were non-psychiatrists (4·7% [3·9–5·5]).<h3>Interpretation</h3>Our study indicates that the prevalence of severe mental illness in people who are incarcerated worldwide is considerable. Meeting the treatment needs of people in prison who have mental ill health remains an ongoing challenge for public mental health. More evidence on how to improve the assessment, treatment, and linkage to services on release, which will require more research-friendly prison services, is now needed.<h3>Funding</h3>None.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"10 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143083488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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