Date Published: March 14, 2019
Publisher: Public Library of Science
Author(s): Caroline Gabrysch, Rosemarie Fritsch, Stefan Priebe, Adrian P. Mundt, Monica Uddin.
Data on the course of mental disorders during imprisonment are scarce. Longitudinal studies from high-income Western countries point to improvements of symptoms over time. The aim of the present study was to assess mental disorders and symptoms three years after baseline evaluation at imprisonment and to determine predictors of change in a South American prison context.
Consecutively admitted prisoners in Santiago de Chile were assessed at intake and reassessed after three years using the Mini International Neuropsychiatric Interview and the Symptom-Check-List 90 Revised (SCL-90-R). The global severity index (GSI) was calculated with standard deviations (SD) and compared using paired t-tests. The prevalence of mental disorders at baseline and at follow-up were compared using McNemar tests. Analyses of variance were conducted to evaluate whether prespecified socio-demographic variables and disorders at baseline predicted symptom change at follow-up.
73 (94%) out of 78 prisoners participated. The prevalence of major mental illnesses was lower at follow-up: 47 (64%) at intake vs. 23 (32%) at follow-up had major depression (p<0.001); 22 (30%) at intake vs. 10 (14%) at follow-up had psychosis (p = 0.008). The mean GSI improved from 1.97 (SD 0.65) at intake to 1.16 (SD 0.82) at follow-up (p<0.001). Depression at baseline (F = 9.39; ηp2 = 0.137; β = -0.67; p = 0.003) and working or studying during imprisonment (F = 10.61; ηp2 = 0.152; β = -0.71; p = 0.002) were associated with strong improvement of the GSI at follow-up, whereas psychosis at intake was associated with relatively small symptom improvement (F = 12.11; ηp2 = 0.17; β = 0.81; p = 0.001). In a resource poor prison context in South America, mental health symptoms and disorders improve considerably over three years during imprisonment. This applies especially to people with depression at intake. Offers to work or study during imprisonment may improve mental health outcomes.
The number of imprisoned people has increased worldwide over the past two decades and this is especially pronounced in South American countries . The increase of prison populations is associated with a decreasing number of psychiatric hospital beds in South America . In 2015, there were 247 people imprisoned per 100,000 population in Chile compared to 144 worldwide . Occupancy rates in prisons are above 110% and conditions are poor [1, 3]. The prevalence of severe mental illness among prison populations worldwide is high with one in seven prisoners estimated to have major depression or psychosis . Rates for affective disorders and suicide risk were particularly high in newly admitted prison populations in Chile compared to high-income countries , and mental disorders and symptoms remain frequently unrecognized and untreated.
At three-year follow-up 78 individuals were eligible for participation in the follow-up study. Three did not respond on the third call, one did not give consent and one was ineligible due to acute psychotic symptoms incompatible with the interview. The non-response rate was therefore 3.8% and the refusal rate was 2.5%, adding up to 6.4%. Seventy-three prisoners were included in the follow-up study, of which 37 (51%) had been released from prison at least once since the baseline assessment. All participants in the study completed the MINI, with 72 participants completing the SCL-90-R (data missing for one participant).