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.

A comparative study was undertaken at two different sites (one urban, one suburban) in Greater London in order to examine whether there was a relationship between publicly available air quality data and the public's perception of air quality. Perceptions of air quality and its role as a potential quality of life indicator was also investigated. A total of 200 people were interviewed in Wood Green and Wimbledon in 1999 and air quality data were obtained simultaneously from the nearest appropriate monitoring station. The study has enabled a comparison between the public's perception of air quality and the actual monitored concentration values. The survey results reveal how seriously the public regards air pollution from road traffic in terms of their quality of life and identifies the attitudes of the public to nuisance from road traffic. The results reveal that the public's perception of air quality is not a reliable indicator of the actual levels of air pollution in their area. The results also revealed that air pollution issues generated as a result of road traffic are of high importance in terms of people's quality of life when compared to other aspects of their quality of life. The study revealed that residents in the urban area (Wood Green) were more disturbed by road traffic than residents in the suburban area (Wimbledon). Out of all the disturbances listed, it was found that residents were more disturbed by vehicle-derived fumes, dust and dirt than other aspects of road traffic related nuisance. The TELETEXT/CEEFAX service on air quality was little used by the public as a means of obtaining information on air pollution.

Background Posttraumatic stress disorder (PTSD) is highly prevalent within prison settings, yet is often unidentified and undertreated. Complex PTSD (CPTSD) has been recently formally recognised in the International Classification of Diseases 11th revision (ICD-11) diagnostic framework but has never been explored in prison settings. We aimed to establish the prevalence of ICD-11 PTSD and CPTSD in a UK prison sample using a validated instrument (the International Trauma Questionnaire). We also explored the associations of these two diagnoses with their traumatic antecedents and psychiatric comorbidities. Method Randomly selected male, sentenced prisoners in a large medium-security prison in south London (N = 221) took part in a clinical interview which assessed PTSD, CPTSD, trauma histories, and comorbid disorders. Multinomial logistic regression was performed to examine differences between those with PTSD or CPTSD, and those without symptoms. Results A total of 7.7% (95% CI 4.5–12) of the male sentenced prisoners met diagnostic criteria for ICD-11 PTSD and 16.7% (95% CI 12.1–22.3) for CPTSD. A diagnosis of PTSD was associated with more recent traumatic exposure, comorbid generalised anxiety disorder, alcohol dependence, and Cluster B personality disorder. A diagnosis of CPTSD was associated with complex trauma exposure antecedents (developmental, interpersonal, repeated, or multiple forms), and comorbid with anxiety, depression, substance misuse, psychosis, and ADHD. Conclusions This study confirms that CPTSD is a very common and comorbid condition in male prisoners. There is an urgent need to develop trauma-informed care in prisons.

Background: Posttraumatic stress disorder (PTSD) is overrepresented in prison relative to community populations and can be difficult to manage in an environment which can inherently exacerbate trauma-related symptomology. Little is known about the effectiveness of trauma-focused interventions in prison and less is known about factors that moderate the effectiveness of these interventions. Aim/Methods: We examined the effectiveness of trauma-focused interventions in prison relative to prison controls using meta-analytic techniques. We further used meta-regression analysis to examine treatment, methodological and participant-level moderators to determine factors that increased the effectiveness of these interventions. Results: From 16 studies eligible for the meta-analysis, we found a small but significant effect size for trauma-focused interventions. Phase 2 trauma processing interventions and interventions delivered individually led to greater reductions in PTSD symptoms. Studies utilizing an active treatment control resulted in smaller effect sizes than those using waitlist or no contact controls. Treatment length, study quality, outcome type, and gender were not significant moderators of treatment effectiveness. Conclusion: Findings from this review are encouraging but should be interpreted with caution. Results suggest that trauma processing therapies, and individual modality trauma-focused interventions can be effective and delivered successfully in prison. However, inadequate comparison groups do not allow a firm conclusion to be drawn. There is a need for high quality Randomized Controlled Trial’s that additionally measure Complex PTSD, utilize a modular treatment approach, and include treatments recommended in the National Institute for health and Care Excellence (NICE) guidelines such as Trauma-focused CBT and Eye Movement Desensitization Reprocessing (EMDR).

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Background Violence is a common problem in prisons. Post-traumatic stress disorder (PTSD), a prevalent disorder in prison populations, has been identified as a risk factor for violent behaviour in community and military populations. Although cross-sectional associations between PTSD and prison violence have been documented, prospective cohort studies are required. Aims To investigate whether PTSD is an independent risk factor for prison violence, and examine the potential role of PTSD symptoms and other trauma sequelae on the pathway from trauma exposure to violent behaviour in prison. Method A prospective cohort study was conducted in a large, medium security prison in London, UK. A random sample of sentenced prisoners arriving into custody (N = 223) took part in a clinical research interview, which assessed trauma histories, mental disorders including PTSD, and other potential sequelae of trauma (anger, emotion dysregulation). Incidents of violent behaviour were measured with prison records covering the 3 months after reception into custody. Stepped binary logistic regression and a series of binary mediation models were performed. Results Prisoners who met current (past month) criteria for PTSD were more likely to engage in violent behaviour during the first 3 months of imprisonment, after adjusting for other independent risk factors. The relationship between lifetime exposure to interpersonal trauma and violent behaviour in custody was mediated by total PTSD symptom severity. Hyperarousal and negatively valenced cognitive and emotional appraisal symptoms were particularly implicated in this pathway. Conclusions The identification and treatment of PTSD has the potential to reduce violence in prison populations.

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The International Law Commission's Draft Articles on State Responsibility attempt to transcend the bilateralist paradigm of international law by distinguishing between injured states and 'third' states. Although not directly injured, the Draft Articles recognize that third states have a legal interest in compliance with 'peremptory norms' and 'obligations to the international community as a whole' by reason of the importance of the rights involved. Although breaches of these obligations often involve serious human rights violations, it is not clear to what extent the Draft Articles accurately reflect human rights law. The progressive development of the Draft Articles in outlining rights and obligations for third states remains controversial, and thus provides a compelling opportunity to discuss the relationship between these two bodies of law. This article helps illustrate the extent to which international law is moving away from a purely bilateral conception of responsibility to accommodate human rights.