Prevalence of types of adverse childhood experiences in forensic male patient populations: A systematic review and meta-analysis

Background

Exposure to early trauma has long been recognised as a risk factor for poor mental health outcomes and offending behaviour. Nevertheless, insight into the early lives of males accessing forensic mental health services remains limited.

Objective

This review sought to synthesise evidence on, and report the combined prevalence estimates of, adverse childhood experiences (ACE) in male forensic (non-prison) populations.

Methods

A systematic literature search of seven databases was conducted to identify peer-reviewed articles reporting the prevalence of direct ‘childhood maltreatment’ ACEs and indirect ‘household’ ACEs in males accessing forensic mental health services. Random effects models were generated to determine pooled prevalence rates.

Results

Overall, 19 papers were included, representing 25 predominantly western samples (n = 16,353 participants). The majority (69 %) of articles were appraised as low quality, though no significant differences in prevalence estimates based on quality were found. Despite being of lesser focus, highest pooled prevalence estimates were obtained for parental separation (51.9 %, 95 % CI: 42–61 %), emotional neglect (42.7 %, 95 % CI: 29–57 %) and household substance abuse (38.6 %, 95 % CI: 31–47 %). High heterogeneity was apparent for all ACEs.

Conclusion

In consideration of the incongruity between the types of ACEs most commonly investigated and those most pervasive in treatment-seeking male forensic populations, the need to attend to a range of early adversities in both research and clinical practice is indicated. Several implications and avenues for future research are discussed.