The impact of incarceration on health: A global systematic review.

Health outcomes for people released from incarceration are often poor, but it is unclear to what extent these poor outcomes are a result of incarceration or are a consequence of pre-existing morbidity and health risk. We synthesised published evidence regarding the impact of incarceration on physical and mental health. We searched five electronic databases (PsycINFO, CINAHL Complete, Medline, EMBASE, and Campbell Collaboration) for primary research articles measuring at least one health outcome both before and after an episode of incarceration. We screened articles published in any country and placed no restrictions on publication date. We assessed risk of bias using the MethodologicAl STandards for Epidemiological Research (MASTER) scale and conducted a narrative synthesis. Nine studies met the inclusion criteria, seven of which were from the United States. Compared to pre-incarceration, post-incarceration health measures generally indicated reduced substance dependence and increased HIV viral suppression. Changes in mental health-related measures after incarceration were mixed: one study reported an increase in depressive symptoms and another study reported no change in the prevalence of depression, anxiety, psychotic disorders, or personality disorders. The prevalence of physical health conditions did not change substantially from before to after incarceration. The evidence base is sparse, lacks global representation, and is unable to assess causality. Nevertheless, our synthesis of the available evidence suggests that incarceration is associated with both positive and negative health outcomes. Further rigorous and longitudinal research is required, in diverse countries and world regions, to enable causal inference and identify modifiable factors that mediate the impacts of incarceration on specific health outcomes.