Pattern of Psychiatric Morbidity and Substance Abuse among Iraqi Prisoners

Table of contents

1. Introduction

ental health of prisoners is a major issue of public health 1 . Studies show that mental illnesses are high prevalence among the prisoners than the general population 2 . There are a number of important factors which could be help to explain the high rates of mental illnesses among prisoners 3 . The environment of prison and rules regulate daily life inside prison can affect the prisoners mental health 4 . Imprisonment is a significant stressful event in an individual's life 2 . Imprisonment being a form punishment produces significant changes in one's physical, psychological, and social functioning 5 . In the prison, however, basic human values are distorted, contributing to temporary or even irreversible psychological sequelae 6 . In order to survive in the prison, the inmates have to undergo extremely harsh policies and rough conditions of imprisonment. They have to adapt to these frustrations and depravations of life 7 . Prisoners have to reside for years in prison and sometimes for lifelong. It is a big issue facing the mental health workers why mental illness of prisoners deteriorated after imprisonment and they develop psychiatric disorders 8 . Mental disorders prevalence was 5-10 times higher than the general population. A review of literature in 24 countries showed prevalence of depression 10% in male and 14% in female prisoners, and about 4% of psychotic illness in both genders 9 . Severe mental illness prevalence 10-15%, while 2% among general population. Over 50% of prisoners in the United States with mental health problems: state prisoners 56%, federal prisoners 45%, and 64% in local jails 10 . According to WHO, health in prison project, done in clearly indicated that something must be done to improve healthcare in prison 11 . The current study was carried out to find the prevalence of psychiatric morbidity and substance abuse among prisoners in Iraqi.

2. II.

3. Methods and Patients a) Setting and Design

The current study is a cross-sectional study including analytic component. It was carried out in 3 prisons in Baghdad. The data was collected during the period from December, 1 st , 2011 to December, 1 st , 2013.

4. b) Sampling and Study Population

All prisoners, both awaiting trial and sentenced prisoners, both gender were included, using stratified random sampling technique.

5. c) Inclusion criteria

All the prisoners who entered jail during period of study, aged ? 18 years, of both gender, gave informed written consent and accepted to have the interview and participate in this study were included

6. d) Exclusion criteria

Acute medical illness, refused consent, mental retardation, language barriers, different nationality, age >18 years prisoners were excluded e) Data collection tools Socio-demographic variables were collected using an information list filled during interview. Prisoners' Mental status was checked by self-reporting questionnaires (SRQ-20) that was carried by the WHO and used in different countries. The cut-off point of SRQ-20 used by previous studies carried out in Iraq was seven 12 . Prisoners showed scores above cut off point of SRQ-20, were selected for administration of the DSM-IV Structured Interview (SCID) 13 which done by consultant psychiatrist. Information regarding substance abuse was collected through the same interview.

7. f) Definition of variables

Psychiatric morbidity explained by many independent variables. Independent variables were socio-demographic characteristics including; gender, age, marital status, occupation, level of education, smoking habits and duration in prisons.

8. g) Statistical analysis

Analysis and processing of data was conducted by version 19a statistical package for social sciences (SPSS-19). Results are represented by percentages for qualitative variables. Chi-square was used to find the relation between two qualitative variables. P values were calculated to determine associations between sociodemographic factors and mental illness. P ?0.05 was taken as statistically significant.

9. h) Ethical issues

Study was carried out under the agreement of the Iraqi correctional directorate and cooperation with the prisons' health centers. Oral and written consent were taken from the prisoners. Confidentiality was assured to each prisoner.

10. III.

11. Results

Present study assessed the psychiatric morbidity in Iraqi prisoners. The total number of investigated prisoners was 1447. Participation rate 70%. The age range 25-54 years. Mean age 33.9±7.17 years. About 60% of prisoners were below 35 years age, predominantly male 96.2%, married 74.2%, about 75% low education, self-employed free work 50%., majority were lived with their families 96.2%. About 50% of prisoners stay in prison between 5-10 years (Table 1) The prevalence of psychiatric morbidity was high among Iraqi prisoners with nearly three forth of the participants 749 (73.9%). Table 2 shows factors associated with mental illness. The affected participants with psychiatric morbidity were younger age groups (below 35 years) 495 (66.1%), male gender 96%, married 73%, free work occupation 52.5%, low education 77.4%, about half of them was stay in prisons 5-10 years (49.3%), was live within their families (98.5%), smokers (80.4%), substance abusers (50.1%). The age, education, duration of prison, and substance abuse were significantly associated with psychiatric morbidity. Clinical interview by consultant psychiatrist for those with positive SRQ-20 responses (749) (73.9%) of the participants, based on DSM-IV check list was done. Interview showed that; generalized anxiety disorder was 7.2% of psychiatric morbidity, obsessive compulsive disorder 1.5%, panic disorder 4.8%, substance abuse 50.1%, depression 11.9%, psychosis 9.2%, schizophrenia 3.2%, post traumatic stress disorder 1.6%, and personality disorder 10.5% of the psychiatric morbidity among Iraqi prisoners (Table 3). Table 4 show the frequency and percentages of psychiatric morbidity from the total size of the sample, and correlation with the duration of prison. No mental illness 26.1%. Psychiatric morbidity was 73.9% of the total sample including; generalized anxiety disorder 5.3%, panic disorder 3.6%, posttraumatic stress disorder 1.2%, obsessive compulsive disorder 1.1%, substance abuse 37%, depression 8.7%, psychosis 6.8%, schizophrenia 2.4%, and personality disorder 7.8%.

12. Discussions

The psychiatric disorders prevalence among Iraqi prisoners within the current study was 73.9%. Significant statistical correlation of psychiatric disorders was found with; age (P<0.001), education (P=0.004), duration of imprisonment (P=0.016), and substance abuse (P<0.001). The prison is a correctional institute in which prisoners have restricted liberty, autonomy, and communication with family and friends. This can be devastating to some prisoners leading to disturbance in their physical, psychological and social status. current study prevalence is higher than many studies carried out across manycountries and cultures like; Mweene MT (2016) in Zambia (29.8%) 3 , Maruf (2015) in Bangladesh (57.2%) 14 , Ibrahim (2015) in Ghana (50%) 15 , Sepehrmanesh Z (2014) in Iran (43.4%) 1 , Armiya'u (2013) in Nigeria (57%) 16 , Mundt A P (2013) in Chile (26.6%) 17 , Kumar V (2013) in India (33%) 18 .

Current study prevalence of mental disorder is less than many studies; Ibrahim E M (2014) Egypt (92.9%) 11 , Saha S K (2014) West Bengal (84%) 19 , Chan L G (2013) Singapore (88.3%) 20 , Goyal S K (2011) India (80.2%) 21 .

The prevalence of the current study is nearly synonymous to these studies; Ayirolimeethal (2014) India (68.6%) 22 , Andreoli S B (2014) Brazil (68.9%) 23 , and Linda and Teplin (1997) America (75 %) 1 .

Differences in prevalence rates could partly be explained by differences in sampled populations, methodological issues and classification systems. High prevalence could be due to prison circumstances and long period of isolation, and mental health requirements were recognized less by mental health workers.

This study conclude that mental health services of prisoners required more attention to enhance the level of mental health of prisoners and staff of prison, and concentrated on the role of workers in mental health including specialist psychiatrists, clinical psychologist, mental health nurses and social counselors for early detection and proper management of psychiatric illness among prisoners.

Figure 1. Table 1 :
1
Sociodemographic characteristics of Iraqi prisoners participate in the study Below 5 yrs Duration of Prison 5 yrs -10 yrs More than 10 yrs Total (1013) P
No. % No. % No. % No. %
25 yrs -29 yrs 123 34.5 163 45.7 70 19.6 356 35.1
30 yrs -34 yrs 22 8.3 132 49.8 111 41.8 265 26.2
Age Groups 35 yrs -39 yrs 40 yrs -44 yrs 9 34 5.7 32.9 88 65 55.7 61.9 61 6 38.6 5.7 158 105 15.6 10.4 0.000
45 yrs -49 yrs 3 2.9 57 54.8 44 42.3 104 10.2
50 yrs -54 yrs 2 8 1 4 22 88 25 2.5
Gender Male Female 182 11 18.6 28.2 489 17 50.2 43.5 303 11 31.1 28.2 974 39 96.2 3.8 0.331
Single 47 30.7 56 36.6 50 32.6 153 15.1
Marital Status Married 127 16.8 386 51.3 239 31.7 752 74.2 0.000
Divorced 19 17.6 64 59.2 25 23.1 108 10.7
Employed 30 14.0 104 48.6 80 37.3 214 21.2
Occupation Unemployed 50 17.4 167 58.4 69 24.1 286 28.2 0.001
Free Work 113 22.0 235 45.8 165 32.1 513 50.6
Illiterate 51 32.9 59 38.06 45 29.0 155 15.3
Primary 84 32.4 120 46.33 55 21.2 259 25.6
Education Intermediate 34 9.42 206 57.06 121 33.5 361 35.6 0.000
Secondary 14 7.9 108 61.01 55 31.0 177 17.5
University 10 16.4 13 21.3 38 62.2 61 6.0
Living Circumstances Live with family Live Alone 187 6 18.7 37.5 498 8 50 50 312 2 31.2 12.5 997 16 98.5 1.5 0.095
Total 193 19% 506 50% 314 31% 1013 100%
Figure 2. Table 2 :
2
SRQ responses Total (1013)
Negative (264) No. % Positive (749) No. % No. % P value
25 yrs -29 yrs 75 28.4 281 37.5 356 35.1
Age Group 30 yrs -34 yrs 51 19.3 214 28.6 265 26.2
35 yrs -39 yrs 40 yrs -44 yrs 53 39 20.1 14.8 105 66 14 8.8 158 105 15.6 10.4 0.000
45 yrs -49 yrs 33 12.5 71 9.5 104 10.2
50 yrs -54 yrs 13 4.9 12 1.6 25 2.5
Gender Male Female 255 9 96.6 3.4 719 30 96 4 974 39 96.2 3.8 0.665
Marital Status Single 36 13.6 117 15.6 153 15.1
Married 205 77.7 547 73.0 752 74.2 0.310
Divorced 23 8.7 85 11.4 108 10.7
Occupation Employed 67 25.4 147 19.6 214 21.1
Unemployed 77 29.2 209 27.9 286 28.2 0.079
Free Work 120 45.4 393 52.5 513 50.7
Illiterate 25 9.5 130 17.4 155 15.3
Education Primary School 81 30.7 178 23.7 259 25.6
Intermediate 89 33.7 272 36.3 361 35.6 0.004
Secondary 47 17.8 130 17.4 177 17.5
University 22 8.3 39 5.2 61 6.
Duration of Prison Below 5 yrs 35 13.3 158 21.1 193 19
5 yrs -10 yrs 137 51.9 369 49.3 506 50 0.016
More than 10 yrs 92 34.8 222 29.6 314 31
Living Live with family Live Alone 259 5 98.1 1.9 738 11 98.5 1.5 997 16 98.4 1.6 0.408
Non Smoker 46 17.4 147 19.6 193 19
Smoking In Prison Smoker 218 82.6 602 80.4 820 81 0.433
Substance Abuse Non abusers Abusers 264 0 100 0 374 375 49.9 50.1 638 375 63 37 0.000
Total 264 100% 749 100% 1013 100%
Figure 3. Table 4 :
4
Frequency and percentages of psychiatric morbidity among the total sample with statistical relation with duration of imprisonment <5 yrs Durations of Prison 5-10yrs >10 yrs Total (1013) No. % P Value
SRQ -20 Responses Negative Positive 35 158 137 369 92 222 264 26.1% 0.016 749 73.9%
No mental illness 35 137 92 264 26.1%
GAD 13 22 19 54 5.3%
PANIC 7 18 11 36 3.6%
PTSD 0 12 0 12 1.2%
OCD 2 9 0 11 1.1%
Clinical Diagnosis SUBSTANCE ABUSE 87 184 104 375 37% 0.000
DEPRESSION 29 35 25 89 8.7%
PSYCHOSIS 9 25 35 69 6.8%
SCHIZOPHRENIA 9 14 1 24 2.4%
PERSONALITY DISORDER 2 50 27 79 7.8%
Total 193 (19%) 506 (50%) 314 (31%) 1013 100%
Figure 4. Table 5
5
Total (749)
Psychiatric Morbidity
No. %
GAD 54 7.2 %
PANIC 36 4.8%
PTSD 12 1.6%
OCD 11 1.5%
SUBSTANCE ABUSE 375 50.1%
Year 2019 DEPRESSION PSYCHOSIS SCHIZOPHRENIA 89 69 24 11.9% 9.2% 3.2%
16 PERSONALITY DISORDER 79 10.5%
Volume XIX Issue I Version I
D D D D ) A
(
Medical Research
Global Journal of shows the statistical significances of
each clinical diagnosis, resulted from the DSM-IV
Structured Interview for (SCID), with the
sociodemographic characteristics of the Iraqi prisoners
included in this study.
© 2019 Global Journals 1
Figure 5. Table 5 :
5

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Date: 2019 2019-01-15