Description of sample
The median age was 37 years old (quartiles interval 28 – 47). The median length of imprisonment was 9 months (quartiles interval 4 – 21). About half the prisoners (49%) were in prison for at least the second time. 28% of prisoners had seen a children's judge before the age of 18; 28% reported childhood ill-treatment; 29% mentioned that a close member of their family had been in prison at some time. Finally, 16% had a history of hospitalization for psychiatric reasons.
Inter-rater agreement for psychiatric diagnoses
As explained above, each prisoner received diagnoses from two clinicians. It is thus possible to estimate measurement error from inter-rater disagreement for the total sample of interviews.
For the CGIs score, the weighted Cohen's Kappa is equal to 0.91. Cohen's Kappa is equal to 0.87 for major depressive disorders; 0.53 for manic/hypo-manic episode; 0.68 for bipolar disorders; 0.76 for panic disorder; 0.79 for agoraphobia; 0.78 for post traumatic stress disorder; 0.77 for generalized anxiety; 0.91 for alcohol dependence; 0.95 for drug dependence; 0.76 for psychotic disorders, 0.64 for schizophrenia. All these values correspond to a "good" or "excellent" agreement [
12].
Severity and prevalence of diagnoses
According to the consensual CGIs, 13.3% of subjects were rated as "Normal, not at all ill", 16.2% were rated as "Borderline mentally ill", 14,5% as "Mildly ill", 20.5 as "Moderately ill", 22.9% as "Markedly ill", 10.2% as "Severely ill" and 2.4% "Among the most extremely ill patients". About 22% of prisoners were notified to the medical team of the prison (with the agreement of the prisoner, patients already followed for psychiatric reasons were not notified).
Table
1 presents current prevalence estimates (at the time of interview) of DSM-IV psychiatric disorders among patients for whom the consensus CGIs score is at least equal to 5 ("Markedly ill", "Severely ill" or "Among the most extremely ill patients"). It should be noted that for certain DSM-IV diagnoses (Bipolar disorder is the main example), the patient may not necessarily present symptoms at the time of interview, a history of depressive and/or manic episodes is sufficient for the diagnosis.
Table 1
Prevalence estimates (with standard deviations) of DSMIV diagnoses.
Mood disorders
| | 21.4 (3.9) | 30.4 (5.2) | 28.0 (4.5) | 28.6 (4.6) |
| Major depressive disorder | 17.9 (3.8) | 26.1 (5.2) | 24.0 (4.6) | 22.9 (4.1) |
| Dysthymic disorder | 3.2 (1.2) | 7.0 (2.0) | 4.8 (1.5) | 1.5 (0.5) |
| Bipolar I or II disorder (lifetime) | 2.0 (0.4) | 3.9 (0.8) | 3.1 (0.7) | 1.3 (1.0) |
| Manic/hypomanic episode | 2.1 (0.6) | 7.5 (2.5) | 3.6 (1.0) | 4.2 (4.2) |
Anxiety disorders
| | 21.2 (4.3) | 31.4 (5.5) | 29.4 (5.2) | 24.0 (4.1) |
| Panic disorder WaWA | 3.7 (1.4) | 6.7 (2.3) | 5.1 (1.7) | 3.9 (1.5) |
| Agoraphobia WHoPD | 6.6 (2.0) | 12.0 (3.6) | 10.0 (3.0) | 10.8 (3.4) |
| Social phobia | 6.8 (1.7) | 12.5 (3.0) | 11.0 (2.6) | 8.8 (2.1) |
| Obsessive compulsive disorder | 3.7 (1.2) | 7.9 (2.9) | 5.5 (2.0) | 5.7 (1.8) |
| Post traumatic stress disorder | 9.7 (3.5) | 15.8 (4.8) | 14.2 (4.3) | 6.6 (2.1) |
| Generalized anxiety disorder | 12.0 (2.1) | 19.6 (3.0) | 17.7 (2.7) | 15.4 (2.1) |
Substance-Related dis. Disorders
| | 14.0 (2.8) | 20.8 (3.4) | 19.1 (3.3) | 14.1 (2.6) |
| Alcohol dependence | 9.4 (1.9) | 12.9 (2.4) | 11.7 (2.3) | 8.7 (1.7) |
| Drug dependence | 10.8 (2.5) | 16.2 (2.7) | 14.6 (2.6) | 8.9 (2.0) |
Psychotic disorders
| | 12.1 (3.0) | 19.2 (5.0) | 17.0 (4.6) | 17.3 (4.5) |
| Schizophrenia | 3.8 (1.0) | 8.0 (2.6) | 6.2 (1.8) | 11.9 (4.0) |
| Brief psychotic or Schizophreniform dis. | 0 | 0.2 (0.2) | 0.2 (0.2) | 0.3 (0.2) |
| Schizoaffective disorder | 1.0 (0.4) | 2.7 (1.1) | 2.6 (1.1) | 0.9 (0.4) |
| Delusional disorder | 2.4 (0.6) | 6.3 (1.8) | 5.3 (1.6) | 0.3 (0.2) |
At least one disorder
| | 27.4 (4.5) | 37.7 (5.1) | 35.9 (5.0) | 33.9 (4.8) |
As mentioned above, four series of diagnoses are obtained. A "both clinicians" diagnosis corresponds to patients for whom both clinicians independently made the same diagnosis, an "at least one clinician" diagnosis corresponds to patients for whom at least one clinician made the diagnosis; there are also a series of consensus diagnoses and the MINI diagnoses.
For schizophrenia, this yields: 3.8% for the "both clinicians" diagnosis, 8.0% for the "at least one clinician" diagnosis, 6.2% for the consensus diagnosis and 11.9% for the diagnosis derived from the MINI. For major depressive disorder the results are respectively 17.9%, 26.1%, 24.0% and 22.9%. Obviously, the rates for "both clinicians" are lower than those for "at least one clinician", and the same is true for the "consensus" rates. However all MINI diagnoses rates are lower than the "consensus" rates except for schizophrenia and manic/hypomanic disorders.
For practical reasons (meetings with a judge or a lawyer, etc.) or because of refusal, only 57% of selected prisoners participated in the interview. It is important to discuss the possible influence of such missing data on the prevalence estimates reported here. Under a hypothesis of prevalence estimates twice as high in the 43% of prisoners that did not respond, the prevalence of a "both clinicians" major depressive disorders would rise from 17.9% to 26%, the prevalence of drug dependence and schizophrenia would rise from 10.8% to 15.4% and from 3.8% to 5.4% respectively. In a hypothesis of prevalence estimates twice as low in the group of non-participants, the prevalence of major depressive disorders would fall to 14%, the prevalence of drug dependence would fall to 8.5% and that of schizophrenia to 3%.