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Psychosocial treatments for depression in UK Criminal Justice - A Review of the Evidence

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Author(s): Lloyd D Hughes

Journal: Scottish Universities Medical Journal
ISSN 2049-8454

Volume: Epub;
Issue: 1;
Start page: 1;
Date: 2012;
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Keywords: forensic psychiatry | medical ethics | prison medicine

ABSTRACT
Objective: To systematically review the clinical efficacy of psychosocial methods for managing depression in the prison population.Search Strategy: Medline, Embase, CINAHL, Psych Info, Applied Social Sciences Index and Abstracts, Cochrane Library (CENTRAL) and Controlled Clinical Trials.com were searched. Government reports and tertiary sector advisory body publications on the prison service were hand-searched.Selection Criteria: Randomized clinical trials (RCT) of non-drug interventions to treat unipolar depression in the prison population were included if available. In line with the expected low number of RCTs in this area, observational studies [cohort studies, case-control studies and case series] and epidemiological studies where the primary aim of the study was to assess the implementation of non-drug treatment were included.Data Collection and Analysis: One independent reviewer assessed eligibility and trial quality and extracted published data.Results: One study reviewed the current implementation of non-drug interventions in the prison population, concluding that current mental health provision was good. Seven studies reviewing a non-drug intervention for managing depression were included in this review. The form of psychosocial interventions evaluated included group and individual CBT (n=2), art therapy (n=2), group interpersonal therapy (n=1), Iyengar yoga (n=1) and Behavioral Activities Intervention (n=1). A total of 333 patients were included in these reviews in three countries (United States of America, United Kingdom and Iran). The quality of the studies was variable with several studies being pilot studies to investigate the feasibility of an intervention in the prison setting and thus did not have a control arm.Conclusions: The prison population has by definition; a differing set of care and support needs for their depressive disorders. This review has highlighted that there is limited specific evidence for non-drug interventions for depression in the prison population, with only individual and group CBT having an adequate evidence base. However, the lack of evidence should not be assumed to equate with a lack of clinical efficacy. The author advocates further research and financial investment into this area of forensic psychiatry. Such investment will enable primary care physician and psychiatrists working with patients serving custodial sentences to make evidence based medical decisions tailored to their patients needs.
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