By Kat Ford a, Mark A. Bellis b, Karen Hughes, Natasha Judd a, Emma R. Barton

The relationship between parent and child adverse childhood experience (ACE) exposure remains underexplored, particularly within justice-involved samples. Objective: The objective of the study was to examine the intergenerational continuity of ACEs within a UK prison population. Participants: 294 males aged 18–69 years in a Welsh prison, with father-reported data for 671 children they had fathered. Methods: A face-to-face ACE questionnaire measured exposure to 10 ACE types. For each child they had fathered participants were asked to report their child’s gender, age, and their exposure before the age of 18 to the same ACE types, except having a household member incarcerated. Findings: Paternal ACE exposure was found to increase the risk of child ACE exposure, both to multiple ACEs and individual ACE types. Compared to children of fathers with no ACEs, those of fathers with 4+ were almost three times more likely to have been exposed to 2–3 ACEs and six times more likely to be exposed to 4+ ACEs. The risk of a child residing in a household where mental illness was present was 7.4 times higher where their father had 4+ ACEs. Conclusion: Findings highlight the need for prevention interventions to break the intergenerational continuity of ACEs. Further research is needed to explore what protects against the intergenerational continuity of ACEs. Criminal justice systems and wider services need to ensure that they support those incarcerated alongside their families who are at high risk of ACEs and consequently poorer education, health, and criminal justice outcomes. 

Child Protection and Practice Volume 3, December 2024, 100053

By, Louis Favril,, Josiah D Rich, Jake Hard, and Seena Fazel

   Summary Background People who experience incarceration are characterised by poor health profiles. Clarification of the disease burden in the prison population can inform service and policy development. We aimed to synthesise and assess the evidence regarding the epidemiology of mental and physical health conditions among people in prisons worldwide. Methods In this umbrella review, five bibliographic databases (Web of Science, PubMed, PsycINFO, Embase, and Global Health) were systematically searched from inception to identify meta-analyses published up to Oct 31, 2023, which examined the prevalence or incidence of mental and physical health conditions in general prison populations. We excluded meta-analyses that examined health conditions in selected or clinical prison populations. Prevalence data were extracted from published reports and study authors were contacted for additional information. Estimates were synthesised and stratified by sex, age, and country income level. The robustness of the findings was assessed in terms of heterogeneity, excess significance bias, small-study effects, and review quality. The study protocol was pre registered with PROSPERO, CRD42023404827. Findings Our search of the literature yielded 1909 records eligible for screening. 1736 articles were excluded and 173 full-text reports were examined for eligibility. 144 articles were then excluded due to not meeting inclusion criteria, which resulted in 29 meta-analyses eligible for inclusion. 12 of these were further excluded because they examined the same health condition. We included data from 17 meta-analyses published between 2002 and 2023. In adult men and women combined, the 6-month prevalence was 11·4% (95% CI 9·9–12·8) for major depression, 9·8% (6·8–13·2) for post-traumatic stress disorder, and 3·7% (3·2–4·1) for psychotic illness. On arrival to prison, 23·8% (95% CI 21·0–26·7) of people met diagnostic criteria for alcohol use disorder and 38·9% (31·5–46·2) for drug use disorder. Half of those with major depression or psychotic illness had a comorbid substance use disorder. Infectious diseases were also common; 17·7% (95% CI 15·0–20·7) of people were antibody-positive for hepatitis C virus, with lower estimates (ranging between 2·6% and 5·2%) found for hepatitis B virus, HIV, and tuberculosis. Meta-regression analyses indicated significant differences in prevalence by sex and country income level, albeit not consistent across health conditions. The burden of non-communicable chronic diseases was only examined in adults aged 50 years and older. Overall, the quality of the evidence was limited by high heterogeneity and small study effects. Interpretation People in prisons have a specific pattern of morbidity that represents an opportunity for public health to address. In particular, integrating prison health within the national public health system, adequately resourcing primary care and mental health services, and improving linkage with post-release health services could affect public health and safety. Population-based longitudinal studies are needed to clarify the extent to which incarceration affects health.

Lancet Public Health 2024; 9: e250–60