The Effectiveness of Trauma-Focused Interventions in Prison Settings: A Systematic Review and Meta-Analysis

Abstract

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).

Prevalence and risk factors for suicide attempts in prison

“…The importance of access to mental health care and psychosocial treatment (Fazel et al, 2016) is clearly underscored by our data. Mental health services need to be adequately resourced and linked to evidence-based interventions (Malik et al, 2021;Yoon et al, 2017) to address the high level of unmet need among people in prison (Jakobowitz et al, 2017). Targeted strategies aimed at high-risk groups will rely on early identification of risk (Ryland et al, 2020) and should be supplemented by organisational and establishment-wide interventions as part of a whole population approach.…”

Epidemiology, Risk Factors, and Prevention of Suicidal Thoughts and Behaviour in Prisons: A Literature Review

“…A recent randomised controlled trial supports the (cost-)effectiveness of group interpersonal psychotherapy for prisoners with depression ( Johnson et al, 2019 ). Trauma-informed care should also be considered, especially interventions which are tailored to the unique needs of incarcerated women ( Bartlett et al, 2015 ; Malik et al, 2021 ).…”

Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration

“…We specifically recommend that future researchers examine how social and structural trauma may be proximally or distally associated with PTSD-related mental health distress, engagement, and/or HIV/STI/HCV outcomes. In addition, while the efficacy of trauma-informed care for incarcerated populations has been well documented in scholarly literature (68), far less is known regarding how (1) to target recently released women in particular (29); and (2) HIV/STI/HCV prevention services and trauma-informed services should be differently structured and/or delivered based on social and structural trauma histories. Third, results suggest that longer windows of time since release are associated with significantly higher odds of engagement in Transition Clinic health services and as such may serve as a "critical time" for optimal engagement.…”