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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 3  |  Page : 122-127

Depression in prison population: Demographic and clinical predictors


1 Department of Clinical Services, Neuropychiatric Hospital, Abeokuta, Ogun State, Nigeria
2 Community Psychiatric Service, Abeokuta, Ogun State, Nigeria
3 Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria

Date of Web Publication29-Sep-2017

Correspondence Address:
Adetunji Obadeji
Department of Psychiatry, Ekiti State University/Ekiti State University Teaching Hospital, PMB 5535, Ado-Ekiti, Ekiti State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfsm.jfsm_32_16

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  Abstract 

Studies have shown that mental illnesses are more common among the prison population than the general population. However, most studies in this environment had only looked at nonspecific psychiatric morbidities. The objective of this study was to assess the prevalence of major depressive disorder, its associated sociodemographic and clinical variables in a population of inmates in Nigeria. Institution-based cross-sectional study was conducted among 196 prisoners consisting of 136 awaiting trials (AT) and 60 convicted inmates (CI). Simple random sampling technique was used to select the study participants. Data were collected using a structured interviewer-administered questionnaire. Depression was assessed with the depression module of the Structured Clinical Interview Schedule for Axis 1 Diagnostic Statistical Manual-IV (DSM-IV) Disorders. The diagnosis was made according to the DSM-IV criteria and severity assessed with the Montgomery–Asberg Depression Rating Scale (MADRS). Forty-one (30.1%) of AT compared with 21 (35.0%) of the CI were depressed. The mean total MADRS score for AT was 23.90 standard deviation (SD) ±7.97 while the mean total MADRS score for the convicted was 25.50 SD ± 8.70, P= 0.479. Unlike the general population, there were no sociodemographic predictors of depression. Among the ATs, depression was associated with the presence of physical complaints, having a chronic illness and family history of psychiatric illness among the CI. The prevalence of depression among prisoners was found to be high and associated with clinical variables. Due attention needs to be given to address the mental health needs of the prisoners.

Keywords: Clinical, depression, inmates, Nigeria, Prisoners, sociodemographic


How to cite this article:
Majekodunmi OE, Obadeji A, Oluwole LO, Oyelami RO. Depression in prison population: Demographic and clinical predictors. J Forensic Sci Med 2017;3:122-7

How to cite this URL:
Majekodunmi OE, Obadeji A, Oluwole LO, Oyelami RO. Depression in prison population: Demographic and clinical predictors. J Forensic Sci Med [serial online] 2017 [cited 2017 Oct 23];3:122-7. Available from: http://www.jfsmonline.com/text.asp?2017/3/3/122/215811


  Introduction Top


Imprisonment, like other forms of incarceration, is a significant stressful event in an individual's life.[1],[2] Imprisonment being a form punishment produces significant changes in one's physical, psychological, and social functioning. Despite our ability to cope and adapt as humans, traumatic incidents may change a person's biopsychosocial balance to such an extent that the memory of a particular negative event overshadows all other experiences and affects the ability to cope with reality.[3] In the prison, however, basic human values are distorted, contributing to temporary or even irreversible psychological sequelae. These complications vary from mood disorders such as depression, substance-related disorders, personality disorders, and psychotic disorders.[4],[5] Invariably, the management of the risk factors for the development of such conditions is related to the effectiveness of the rehabilitation programs in the prison.[6] Although evidence suggests that imprisonment conditions can lead to anxiety, depression, self-harming or other aggressive behavior, obsessions, psychoactive substance abuse, and suicide, there is no agreement in the literature on the causal relationship between confinement and development psychological disorders.[6],[7],[8],[9]

Stress and depression are two major psychological problems among the prison population.[2],[3],[6],[10],[11] Often time, episodes of depression usually follow the experience of sudden or prolonged stressful events.[3],[11] Majority of times, newly admitted inmates suffer from depression for a period of time as a result of trauma or stress of the new environment; this often increases the risk of self-harm and suicide among them with attendant cost.[12],[13],[14]

Research has estimated that between 16% and 64% of individuals who are incarcerated or have a history of involvement in the criminal justice system suffer from mental disorders.[15],[16],[17],[18],[19],[20] Factors such as low education, long duration of stay in the prison, low to no satisfaction with prison services, and place of location of the prison were other factors significantly associated with psychological distress among prisoners.[17],[18],[19],[20] In developing countries, on the other hand, the prevalence of depression is higher in prison population.[7],[18],[20] Among this population, depression has been shown to be significantly associated with age, marital status, place of living, the presence of comorbidities, the lack of religious practice, and not having visitors among others, while age is a protective factor among incarcerated women.[7],[18],[21],[22]

This study is aimed at looking at the prevalence of major depressive disorder and its sociodemographic and clinical predictors among inmates of a prison population in Nigeria.


  Materials and Methods Top


Study design

A cross-sectional study design was employed in this study. The study population was the entire population of inmates (convicted and awaiting trial ORIGINAL ARTICLE inmates) at the Federal prison, Abeokuta, southwest Nigeria.

Study population

The sample size was calculated using the statistical formula for studying proportions with a population <10,000.[23] Selection of individuals was done based on the inmates' prison status of either “AT” or “convicted.” At the time of this study, there were a total of about 517 male inmates in the prison. One hundred and fifty-eight of these men were convicted while the remaining 359 were AT. There were ten female inmates at the time of the study and these were all excluded from the main study because of their limited number. The calculated numbers of participants were 178; however, a total of 196 inmates were interviewed. This was divided using probability proportional to size between AT and convicted inmates (CI) in the ratio 2.27:1 which then gives 136 and 60, respectively. Individuals were then selected by simple random sampling method using a table of random numbers.

Data collection

A pro forma was developed to assess the sociodemographic and clinical variables. The presence of depression was assessed with the Structured Clinical Interview Schedule for Axis 1 Diagnostic Statistical Manual-IV (DSM-IV) Disorders (SCID) – a semi-structured instrument for axis one diagnosis. The diagnosis of depression was made with the fourth edition of the DSM-IV by American Psychiatric Association (1994). The SCID has been used extensively in Nigeria.[24],[25] The instrument has been shown to have a good reliability for categorical construct for DSM-IV diagnoses and good standard validity.[24] The screening and diagnostic module on depression were used in this study. The severity of the depression was quantified using Montgomery–Asberg Depression Rating Scale (MADRS). It includes ten commonly occurring symptoms. The ratings are based on a clinical interview, which moves from broad questions about symptoms to more detailed ones, which permit ratings of severity. The scores interpretation guide is as follows: 0–6 = normal/recovered, 7–19 = mild depression, 20–34 = moderate depression, and 35–60 = severe depression.

The sociodemographic, forensic, and medical history questionnaire, which was administered by qualified nurses in the prison clinic, was translated into Yoruba and backtranslated to ensure equivalence of meaning. The translated questionnaire was studied and approved by two of the researchers, a forensic psychiatrist and a general psychiatrist who were conversant with both languages. The researchers administered the main instrument-SCID in the English Language. However, for respondents who did not understand the English language, this segment of the interview was conducted in the Yoruba language, which is widely spoken in the south-western Nigeria, where the current study is located.

Exclusion criteria

The exclusion criteria were inmates who had a debilitating physical illness, past treatment for mental illness. Individuals that did not understand either of these languages were excluded from the study.

Ethical consideration

The research protocol of this study was reviewed and approved by the Research Ethics Committee of Neuropsychiatric Hospital, Aro, Abeokuta. In addition, permission to conduct the study was obtained from the Assistant Controller of Prisons, Ogun state command, Abeokuta. Before the data collection, the participants were gathered in groups at a rehabilitation room at the prison where a brief explanation regarding the purpose and procedure of the study was given to the participants. Each participant was ensured of their confidentiality and right to withdraw from the study at any time during the process. A written informed consent was obtained from all the individuals before data collection.

Data analysis

The collected data were analyzed using statistical software, the Social Package for Social Sciences Version 19.0 (IBM Corp., Armonk, NY, USA). Descriptive statistic was computed to summarize participants' demographic information and to calculate the percentage of occurrence. Differences between the groups were examined for statistical significance using Chi-square test for qualitative variables and t-test for quantitative variables. The level of significance was set at <0.05.


  Results Top


A total of 196 inmates were interviewed for the study; comprising 136 AT and 60 (CI). Their ages ranged between 15 and 70 years with mean age of 32.82 years (standard deviation [SD] ±10.46). The mean age for the AT inmates was 31.07 years (SD ± 10.0) and for CI was 36.78 years (SD ± 10.3). The difference between their mean age was statistically significant (t = 3.629 P= <0.001).

Diagnosis and severity of depression

As shown in [Table 1], 41 (30.1%) of AT compared with 21 (35.0%) of the convicted respondents were depressed as assessed with SCID. This difference was however not statistically significant (χ2 = 0.453, P= 0.509). Using MADRS, among the ATs, 6 (14.6%), 32 (78.0%) and 3 (7.3%) had mild, moderate, and severe depression, respectively, while 4 (19.0%), 15 (71.4%), and 2 (9.5%) of the convicted had mild, moderate, and severe depression, respectively. The mean total MADRS score for AT was 23.90 SD ± 7.97 while the mean total MADRS score for the convicted was 25.50 SD ± 8.70 (t = 0.713, P= 0.479).
Table 1: Diagnosis and severity of depression

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Depression and sociodemographic variables

[Table 2] shows the relationship between depression and sociodemographic variables. In both AT and CI, similar pattern of prevalence was observed across age groups with relatively higher prevalence in those above 30 years; however, this was not statistically significant P> 0.05. Of ATs, about one-third (33.0%) of those who were Christians and a quarter of those who were Muslims were depressed as against 29.4% of Christians and 42.3% of Muslim of CI. The association between depression and religion was not significant in both groups. Similarly, there was no significant relationship between marital status, employment, educational status, and depression in both groups.
Table 2: Depression in relation to some sociodemographic variables

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Diagnosis of depression and clinical history

As shown in [Table 3], 35 (36.5%) of the AT inmates with physical complaints had depression as against 6 (15.0%) of those without physical complaints (χ2 = 6.147, P= 0.014). On the other hand, a similar relationship was not observed between the presence of physical complaints and depression among CTs (χ2 = 1.832, P= 0.279). Among AT, over half (52.2%) of those who had one chronic illness or the other had depression compared with about a quarter of those without any chronic illness, and this was significant (χ2 = 6.378, P= 0.023). For CI, the relationship between the presence of chronic medical illness and depression was not significant (χ2 = 3.297, P= 0.143). Of the AT inmates who had a family history of psychiatric illness, 7 (53.9%) as against 34 (27.6) of those without history had depression (χ2 = 3.834, P= 0.062). Likewise, 4 (80.0%) of CI who had family history of psychiatric illness as against 1 (20.0%) of those without family history of psychiatric illness had depression, and this was significant (χ2 = 3.834, P= 0.046).
Table 3: Diagnosis of depression and clinical history

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Depression and type of offense committed

[Table 4] shows the relationship between the types of offense committed and depression. With the exception of nonviolent offenses, similar proportions were depressed across different types of offense committed. Among the CI, a similar pattern was observed across the types of offense committed. The type of offense committed did not predict depression in both groups (P > 0.05).
Table 4: Depression and type of offense committed

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  Discussion Top


The study looked at the prevalence of depression and its sociodemographic and clinical predictors in a sample of a prison population. The sample consists of 136 AT and sixty CI. The age of the participants ranged between 15 and 70 years with a mean of 32.82 years. This finding was in keeping with what was earlier reported by Fatoye et al.[5] in a prison in Ilesa, Nwaopara and Stanley [7] in Port Harcourt maximum prison and Armiya'u et al.[18] in Jos, all in Nigeria. The relative younger mean age in this study also substantiates the fact that majority of the prisoner are of younger age similar to other findings.[5],[6],[7],[18],[19] In comparison with the AT, the mean age of the CI was significantly higher than the AT. This is rather not unusual in this environment because of the slow criminal justice system. More often than not, a person would have spent several years before he or she is finally convicted of an offense and besides the CI would have spent longer period compared to their AT counterparts.

On the whole, about a third of the inmates had major depression; however, the prevalence of depression was slightly higher among CI than those AT. This may be due to long stay in hostile prison environment characterized by marked affective isolation, permanent surveillance, lack of intimacy, repeated frustration, together with restriction of movement and spaces for exercises, high control, absence of intimacy and a proper place to sleep, guilt for being absent from raising and educating their children, their right to the social importance of work, identity loss, stigma, and social discrimination that impairs prospect for working outside the criminal context.[18],[20],[26] Nevertheless, the prevalence reported in this study is relatively lower than 37% reported by Nwaopara and Stanley in Port Harcourt, southern Nigeria,[7] but higher than what was reported by Agbahowe et al. in Benin, southern Nigeria,[20] but similar to 30.8% reported by Armiya'u et al., north-central Nigeria [18] and 29% reported by Assadi et al.[27] in Iran. There are several reasons to explain these variations in the prevalence of depression among prison population; first is the difference in methodological issues such as instrument used and sampling techniques. Other factors such as the location of the studies, the nature of the prison, duration of stay in the prison, and the offense committed were of major importance.[28],[29]

When compared with the general population, the prevalence of 32% reported in this study is quite high, even higher than what was reported among people with chronic disorders such as HIV/AIDS, cancers, or diabetes.[22],[24],[30],[31] The relatively high rate of depression and other psychiatric morbidity in prison population however may be related to several factors: the widespread misconception that all people with mental disorders are a danger to the public, the general intolerance of many societies to difficult or disturbing behavior, the failure to promote treatment, care, and rehabilitation, and above all, the lack of or poor access to mental health services in many countries.[32],[33] Besides, many of these disorders may be present before admission to prison, and this may be further worsened by the stress of imprisonment.

In this study, there was no significant association between sociodemographic variables and depression among the inmates. Contrary to expectation, the disruption in family structure resulting from loss of contact with family members did not significantly associate with depression among those who were married. The fact that all the respondents in this study were men may have accounted for this. Similarly, with the exception of the place of abode, Nwaopara and Stanley in their study did not find any significant association with sociodemographic variables.[7] However, some studies looking at psychological distress and psychiatric morbidity have reported an association between psychological distress or psychiatric morbidity and sociodemographic variables among prisoners.[18],[19],[29] In this study, quite an appreciable number of inmates with primary education and below were depressed. Similarly, Ibrahim et al.[19] reported that nearly 70% of those with moderate to severe mental disorders in their study had only primary education. In the general population and patients population, on the other hand, depression was found to be associated with some sociodemographics; specifically age, gender, marital, and employment status.[22],[24],[34] The fact that no female was included in this study and fewer numbers of females in other Nigerian studies may have been responsible for the absence of a relationship between gender and depression as mostly reported in the general population and patients' population. Most of the inmates with the diagnosis of depression tend to have a polygamous family background. This, however, did not attain statistical significance in both groups.

Among AT, the presence of physical complaints and chronic medical illness were associated with the presence of depression. Depression is an illness that frequently accompanies other conditions, especially chronic diseases, alcohol and drug use.[22],[35] Prevalence rates for depressive disorders among patients with somatic disease are often substantial. There is frequently difficulty in diagnosing depression in primary health services.[35],[36],[38] In prison population, similar factors that predisposed to depression may also predispose physical illness; furthermore, the presence of physical illness may also predispose to depression. The family history of psychiatric illness was also associated with depression among AT but not among the CI. This is not an unusual finding as this possibly corroborates the genetic predisposition to depression; however, the observation among CI may be due to their small size. No aspect of forensic variables significantly predicted depression among inmates. However, a lower rate of depression was observed among those inmates with nonviolent offenses compared to other groups. The fact that they have the foreknowledge of the judgment may explain this.


  Conclusion Top


The prevalence of major depression among prisoners was found to be high, indicating they are highly vulnerable to depressive illness compared to the general population. Addressing mental health needs of the prisoners will not only benefit the prisoners and their rehabilitation but also the larger community too. This will go a long way in improving the degree to which they adjust to community life, which may, in turn, reduce the likelihood that they will return to prison. Our study shows a high level of association between depression and somatic problems among detainees.

Acknowledgments

The authors would like to acknowledge the staff Federal prison, Abeokuta, for their dedicated and cooperation during the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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