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      Shedding Light on “the Hole”: A Systematic Review and Meta-Analysis on Adverse Psychological Effects and Mortality Following Solitary Confinement in Correctional Settings

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          Abstract

          Objectives

          To systematically review and meta-analyze the psychological effects and mortality rate in inmates having been exposed to solitary confinement in correctional settings.

          Methods

          PubMed, PsycINFO, Web of Science, and Google Scholar were searched using keywords describing solitary confinement in combination with keywords for psychological or mortality outcomes. Eligible case-control studies for the systematic review met an operational definition for solitary confinement and evaluated outcomes after exposure to such confinement. Studies presenting statistical data which allowed to compute standardized mean differences for symptom scales or odds ratio for mortality were further meta-analyzed using random-effects models.

          Results

          Systematic review identified 13 studies for inclusion, with a total sample of 382,440 inmates (23% having been exposed to solitary confinement). Higher quality evidence showed solitary confinement was associated with an increase in adverse psychological effects, self-harm, and mortality, especially by suicide. Meta-analysis of five studies (n = 4,517) showed a standardized mean difference of 0.45 for general psychological symptomatology, which increased to 0.51 upon outlier exclusion. Small to moderate significant effects were observed for mood, psychotic, and hostility symptoms specifically. In addition, meta-analysis of two mortality studies (n = 243,050) showed a trend for a moderate effect for mortality by any or unnatural causes (i.e., suicide, homicide, overdose, and accidents).

          Conclusions

          Analyses showed that solitary confinement is associated with the psychological deterioration of inmates. This effect appears to be beyond that of general incarceration or presence of prior mental illness. Thus, solitary confinement may pose significant harm for inmates. Still, further studies are required to show that exposure to SC can increase risk of post-release death. Finally, add-on treatments and alternatives to solitary confinement that could alleviate the associated psychological harm are discussed.

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          Meta-analysis: recent developments in quantitative methods for literature reviews.

          R. Rosenthal, M R DiMatteo (2001)
          We describe the history and current status of the meta-analytic enterprise. The advantages and historical criticisms of meta-analysis are described, as are the basic steps in a meta-analysis and the role of effect sizes as chief coins of the meta-analytic realm. Advantages of the meta-analytic procedures include seeing the "landscape" of a research domain, keeping statistical significance in perspective, minimizing wasted data, becoming intimate with the data summarized, asking focused research questions, and finding moderator variables. Much of the criticism of meta-analysis has been based on simple misunderstanding of how meta-analyses are actually carried out. Criticisms of meta-analysis that are applicable are equally applicable to traditional, nonquantitative, narrative reviews of the literature. Much of the remainder of the chapter deals with the processes of effect size estimation, the understanding of the heterogeneity of the obtained effect sizes, and the practical and scientific importance of the effect sizes obtained.
          Article 0 comments Cited 367 times – based on 0 reviews     Review now
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            Mental Health Issues in Long-Term Solitary and “Supermax” Confinement

            Craig Haney (2003)
            Article 0 comments Cited 91 times – based on 0 reviews     Review now
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              The Effects of Solitary Confinement on Prison Inmates: A Brief History and Review of the Literature

              Peter Scharff Smith (2006)
              Article 0 comments Cited 53 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Psychiatry
                Journal ID (iso-abbrev): Front Psychiatry
                Journal ID (publisher-id): Front. Psychiatry
                Title: Frontiers in Psychiatry
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-0640
                Publication date (Electronic): 19 August 2020
                Publication date Collection: 2020
                Volume: 11
                Electronic Location Identifier: 840
                Affiliations
                [1] 1Research Center, Institut universitaire en santé mentale de Montréal , Montreal, QC, Canada
                [2] 2Departement of Psychiatry and Addictology, University of Montreal , Montreal, QC, Canada
                [3] 3Faculty of Nursing, University of Montreal , Montreal, QC, Canada
                [4] 4Institut national de psychiatrie légale Philippe-Pinel , Montreal, QC, Canada
                Author notes

                Edited by: Athanassios Douzenis, National and Kapodistrian University of Athens, Greece

                Reviewed by: Panagiotis Ferentinos, National and Kapodistrian University of Athens, Greece; Peter Andiné, University of Gothenburg, Sweden

                *Correspondence: Alexandre Dumais, alexandre.dumais@ 123456umontreal.ca

                This article was submitted to Forensic Psychiatry, a section of the journal Frontiers in Psychiatry

                Article
                DOI: 10.3389/fpsyt.2020.00840
                PMC ID: 7468496
                PubMed ID: 32973582
                SO-VID: 2e5548f6-da5f-4548-aaf4-76e3cd3584ee
                Copyright © Copyright © 2020 Luigi, Dellazizzo, Giguère, Goulet and Dumais
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 17 June 2020
                Date accepted : 03 August 2020
                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 84, Pages: 11, Words: 5849
                Categories
                Subject: Psychiatry
                Subject: Systematic Review

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: solitary confinement,segregation,inmates,symptom,mental health,mortality,meta-analysis,systematic review
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: solitary confinement, segregation, inmates, symptom, mental health, mortality, meta-analysis, systematic review

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