SummaryBackgroundAlthough more than two thirds of the world's incarcerated individuals are based in low-income and middle-income countries (LMICs), the burden of psychiatric disorders in this population is not known. This review provides estimates for the prevalence of severe mental illness and substance use disorders in incarcerated individuals in LMICs.MethodsFor this systematic review and meta-analysis, we searched 17 electronic databases to identify prevalence studies of psychiatric disorders in prison populations in LMICs, published between January, 1987, and May, 2018. We included representative studies from general prison samples, providing information about four major psychiatric diagnoses: psychosis, major depression, alcohol use disorders, and drug use disorders. We pooled data from studies using random-effects meta-analyses and assessed the sources of heterogeneity by meta-regression. We extracted general population estimates from the Global Burden of Diseases 2016 database to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42015020905.FindingsWe identified 23 publications reporting prevalence estimates of severe mental illness and substance use disorders for 14 527 prisoners from 13 LMICs. In this population, the estimated pooled 1 year prevalence rates for psychosis were 6·2% (95% CI 4·0–8·6), 16·0% (11·7–20·8) for major depression, 3·8% (1·2–7·6) for alcohol use disorders, and 5·1% (2·9–7·8) for drug use disorders. We noted increased prevalence at prison intake and geographic variations for substance use disorders. For alcohol use disorders, prevalence was higher in the southeast Asian region than in the eastern Mediterranean region; and drug use disorders were more prevalent in the eastern Mediterranean region than in Europe. Prevalence ratios indicated substantially higher rates of severe mental illness and substance use disorders among prisoners than in the general population (the prevalence of non-affective psychosis was on average 16 times higher, major depression and illicit drug use disorder prevalence were both six times higher, and prevalence of alcohol use disorders was double that of the general population).InterpretationThe prevalence of major psychiatric disorders is high in prisoners in LMIC compared with general populations. As these findings are likely to reflect unmet needs, the development of scalable interventions should be a public health priority in resource-poor settings.FundingCONICYT of the Chilean government and the Wellcome Trust.

People involved with criminal justice frequently are exposed to violence and traumatic experiences. This may lead to posttraumatic stress disorder (PTSD); however, no review, to our knowledge, has synthetized findings in this setting. We conducted a systematic review and meta-analysis to estimate prevalence rates of PTSD in prison populations. Original studies in which prevalence rates of PTSD in unselected samples of incarcerated people were reported were systematically searched between 1980 and June 2017. Data were pooled using random-effects meta-analysis, and sources of heterogeneity for prespecified characteristics were assessed by meta-regression. We identified 56 samples comprising 21,099 imprisoned men and women from 20 countries. Point prevalence of PTSD ranged from 0.1% to 27% for male, and from 12% to 38% for female prisoner populations. The random-effects pooled point prevalence was 6.2% (95% confidence interval: 3.9, 9.0) in male prisoners and 21.1% (95% confidence interval: 16.9, 25.6) in female prisoners. The heterogeneity between the included studies was very high. Higher prevalence was reported in samples of female prisoners, smaller studies (n < 100), and for investigations based in high-income countries. Existing evidence shows high levels of PTSD among imprisoned people, especially women. Psychosocial interventions to prevent violence, especially against children and women, and to mitigate its consequences in marginalized communities must be improved. Trauma-informed approaches for correctional programs and scalable PTSD treatments in prisons require further consideration.

China's rapid urbanization has led to an increasing level of exposure to air pollution and a decreasing level of exposure to vegetation among urban populations. Both trends may pose threats to psychological well-being. Previous studies on the interrelationships among greenness, air pollution and psychological well-being rely on exposure measures from remote sensing data, which may fail to accurately capture how people perceive vegetation on the ground. To address this research gap, this study aimed to explore relationships among neighbourhood greenness, air pollution exposure and psychological wellbeing, using survey data on 1029 adults residing in 35 neighbourhoods in Guangzhou, China. We used the Normalized Difference Vegetation Index (NDVI) and streetscape greenery (SVG) to assess greenery exposure at the neighbourhood level, and we distinguished between trees (SVG-tree) and grasses (SVG-grass) when generating streetscape greenery exposure metrics. We used two objective (PM2.5 and NO2 concentrations) measures and one subjective (perceived air pollution) measure to quantify air pollution exposure. We quantified psychological well-being using the World Health Organization Well-Being Index (WHO-5). Results from multilevel structural equation models (SEM) showed that, for parallel mediation models, while the association between SVG-grass and psychological well-being was completely mediated by perceived air pollution and NO2, the relationship between SVG-tree and psychological well-being was completely mediated by ambient PM2.5, NO2 and perceived air pollution. None of three air pollution indicators mediated the association between psychological well-being and NDVI. For serial mediation models, measures of air pollution did not mediate the relationship between NDVI and psychological well-being. While the linkage between SVG-grass and psychological well-being scores was partially mediated by NO2-perceived air pollution, SVG-tree was partially mediated by both ambient PM2.5-perceived air pollution and NO2-perceived air pollution. Our results suggest that street trees may be more related to lower air pollution levels and better mental health than grasses are. Response to Reviewers: Responses to Reviewer #1 Reviewer comment 1: I don't want to be a stickler, but I cannot agree with your reasoning that specifying both serial and parallel mediation components is a bad thing because it would decrease the degrees of freedom. First of all, the epidemiological reality is complex and probably involves all sorts of mediation components working together. Second, more complex models with fewer df may actually suffer from an artificial increase in model fit measures, hence the parsimony-adjusted model fit measures like the PNFI (

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Substance use disorders are among the most common health problems of people involved with the criminal justice system. Scaling up addiction services in prisons is a global public health and human rights challenge, especially in poorly resourced countries. We systematically reviewed the prevalence of substance use in prison populations in low- and middle-income countries. We searched for studies reporting prevalence rates of nicotine, alcohol, illicit drug, and injection drug use during imprisonment in unselected samples of imprisoned people in low- and middle-income countries. Data meta-analysis was conducted and sources of heterogeneity were examined by meta-regression. Prevalence of nicotine use during imprisonment ranged from 5% to 87%, with a random-effects pooled estimate of 56% (95% confidence interval (CI): 45, 66) with significant geographical heterogeneity. Alcohol use varied from 1% to 76% (pooled prevalence, 16%, 95% CI: 9, 25). Approximately one-quarter of people (25%; 95% CI: 17, 33; range, 0–78) used illicit drugs during imprisonment. The prevalence of injection drug use varied from 0% to 26% (pooled estimate, 1.6%, 95% CI: 0.8, 3.0). Lifetime substance use was investigated in secondary analyses. The high prevalence of smoking in prison suggests that policies regarding smoking need careful review. Furthermore, the findings underscore the importance of timely, scalable, and available treatments for alcohol and illegal drug use by people involved with the criminal justice system.

Poor neighborhood conditions are associated with lower levels of physical activity for older adults but socio-ecological models posit that physical activity depends on both environmental and individual factors. Older adults' ability to overcome environmental barriers to physical activity may partially rely on cognitive resources. However, evidence on the moderating role of these cognitive resources in the associations between environmental barriers and physical activity is still lacking. We analyzed cross-national and longitudinal data on 28,876 adults aged 50 to 96 years as part of the SHARE. Lack of access to services and neighborhood nuisances were used as indicators of poor neighborhood conditions. Delayed recall and verbal fluency were used as indicators of cognitive resources. Confounder-adjusted generalized estimation equations were conducted to test associations between neighborhood conditions and selfreported moderate physical activity, as well as the moderating role of cognitive resources. Results showed that poor neighborhood conditions reduced the odds of engagement in physical activity. Cognitive resources robustly reduced the adverse influence of poor neighborhood conditions on physical activity. Participants with lower cognitive resource scores showed lower odds of engaging in physical activity when neighborhood conditions were poorer, whereas these conditions were not related to this engagement for participants with higher cognitive resource scores. These findings suggest that cognitive resources can temper the detrimental effect of poor neighborhood conditions on physical activity. Public policies should target both individual and environmental factors to tackle the current pandemic of physical inactivity more comprehensively.

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In the face of unprecedented biodiversity loss, the belief that conservation goals can be met could play an important role in ensuring they are fulfilled. We asked conservationists how optimistic they felt about key biodiversity outcomes over the next 10 years; 2341 people familiar with conservation in 144 countries responded. Respondents expressed optimism that enabling conditions for conservation would improve but felt pressures would continue, and the state of biodiversity was unlikely to get better. Respondents with greater general optimism about life, at early‐career stages, and working in practice and policy (compared to academia) reported higher conservation optimism. But most of our biodiversity and conservation status indicators were not associated with conservation optimism. Unbounded optimism without appropriate action would be misguided in the face of growing threats to biodiversity. However, supporting those struggling to see the light at the end of the tunnel could help sustain efforts to overcome these threats.