Post-traumatic Stress Disorder in Prisoners’ Offspring: A Systematic Review and Meta-analysis

BACKGROUND: Parental incarceration can produce serious effects on the offspring’s mental health. The presence of Post-Traumatic Stress Disorder (PTSD) in prisoners’ offspring is understudied and the few literature data showed heterogeneous evidence, with some studies suggesting that about 25% of prisoners’ offspring have PTSD and other reporting much lower prevalence rates around 2-3%. There is no systematic review and meta-analysis about PTSD in prisoners’ offspring. OBJECTIVES: The present systematic review and meta-analysis aimed to provide a first quantitative synthesis of the prevalence of the PTSD diagnosis in prisoners’ offspring. Moderator variables of the effect sizes were assessed, including offspring’s and parents’ gender, offspring’s generational cohort (children/adolescents versus adults), reasons for parental incarceration (political/war versus crime), and country type (Western versus Non-Western countries). METHODS: A systematic review and a meta-analysis were conducted according to the PRISMA guidelines. Studies were included if they assessed the presence of a PTSD diagnosis in child, adolescent or adult offspring of prisoners through a diagnostic classification system, a clinician-administered interview or a self-report questionnaire, if they reported data necessary to calculate the effect sizes or the authors were available to provide them. Studies might have been based upon any design except review, single-case, case series, and case reports. Outcomes might have been measured at any time after parental incarceration. Parental imprisonment was defined as any kind of custodial confinement of a parent by the criminal justice system, including being held as a prisoner of war or for political reasons. Independent reviewers searched published/unpublished studies through electronic databases and additional sources and extracted the data. A random-effect meta-analysis was carried out by calculating the effect sizes as event rates. Heterogeneity was examined by the I(2) and the Q statistics. Moderators were assessed through meta-regressions. RESULTS: Six studies (2512 participants) were included. Fifteen percent of prisoners’ offspring had PTSD, as shown by a significant mean effect size of 0.14 without evidence of publication bias (95% CI: 0.081 – 0.249, p< 0.001). There were no significant differences on the mean effect sizes between the studies on adults and those on children/adolescents [Q((1)) = 0.00, p = .999], between the studies on parents incarcerated for political/war reasons and those for crime [Q((1)) = 0.00, p = .979], and between the studies conducted in Western and non-Western countries [Q((1)) = 0.854, p = .355]. While offspring’s gender was not related to the effect sizes [β = -0.01, 95% CI: -0.02 – 0.02, p = .452], parents’ gender was significantly and positively associated with the effect sizes suggesting that in studies with higher percentages of incarcerated mothers, the prevalence of offspring’s PTSD was higher [β = 0.01, 95% CI: 0.0 – 0.01, p = .019]. CONCLUSION: PTSD is a serious mental health condition among prisoners’ offspring, particularly when mothers are incarcerated. The present findings point out the importance of thorough assessment and timely intervention/prevention strategies implemented by professionals of mental health settings and detention systems. The cross-sectional design of the studies does not allow causal conclusions to be drawn about the effect of parental incarceration as a risk factor for PTSD. Other variables related to parental incarceration may explain these findings. This limitation points out the importance of further longitudinal research.