“Effectiveness of Psychological Interventions in Prison to Reduce Recidivism: a Systematic Review and Meta-Analysis of Randomized Controlled Trials”, 2021 (; backlinks):
Background: Repeat offending, also known as criminal recidivism, in people released from prison has remained high over many decades. To address this, psychological treatments have been increasingly used in criminal justice settings; however, there is little evidence about their effectiveness. We aimed to evaluate the effectiveness of interventions in prison to reduce recidivism after release.
Methods: For this systematic review and meta-analysis, we searched the Cochrane Central Register of Controlled Trials, Embase, Global Health, MEDLINE, PsycINFO, and Google Scholar for articles published from database inception to February 17, 2021, without any language restrictions. We searched for randomized controlled trials (RCTs) that evaluated the effect of psychological interventions, delivered to adolescents and adults during incarceration, on recidivism outcomes after release. We excluded studies of solely pharmacological interventions and of participants in secure psychiatric hospitals or special residential units, or attending therapies mainly delivered outside of the prison setting. We extracted summary estimates from eligible RCTs.
Data were extracted and appraised according to a prespecified protocol, with effect sizes converted to odds ratios. We used a standardized form to extract the effects of interventions on recidivism and estimated risk of bias for each RCT. Planned sensitivity analyses were done by removing studies with fewer than 50 participants. Our primary outcome was recidivism. Data from individual RCTs were combined in a random-effects meta-analysis as pooled odds ratios (ORs) and we explored sources of heterogeneity by comparing effect sizes by study size, control group, and intervention type. The protocol was pre-registered with PROSPERO, CRD42020167228.
Findings: Of 6,345 articles retrieved, 29 RCTs (9,443 participants, 1,104 [11.7%] females, 8,111 [85.9%] males, and 228 [2.4%] unknown) met the inclusion criteria for the primary outcome. Mean ages were 31.4 years (SD 4.9, range 24.5-41.5) for adult participants and 17.5 years (SD 1.9; range 14.6-20.2) for adolescent participants. Race or ethnicity data were not sufficiently reported to be aggregated. Based on two studies, therapeutic communities were associated with decreased rates of recidivism (OR 0.64, 95% CI 0.46-0.91). These risk estimates did not statistically-significantly differ by type of control group and other study characteristics.
If including all 29 RCTs, psychological interventions were associated with reduced reoffending outcomes (OR 0.72, 95% CI 0.56-0.92). However, after excluding smaller studies (<50 participants in the intervention group), there was no statistically-significant reduction in recidivism (OR 0.87, 95% CI 0.68-1.11).
Interpretation: Widely implemented psychological interventions for people in prison to reduce offending after release need improvement. Publication bias and small-study effects appear to have overestimated the reported modest effects of such interventions, which were no longer present when only larger studies were included in analyses. Findings suggest that therapeutic communities and interventions that ensure continuity of care in community settings should be prioritized for future research. Developing new treatments should focus on addressing modifiable risk factors for reoffending.
Funding: Wellcome Trust, Fonds de recherche du Québec—Santé.