1

PT. B. D. SHARMA UNIVERSITY OF HEALTH SCIENCES, ROHTAK

Proforma for application for the approval of the subject of thesis for M.D. (Psychiatry)
Examination
1. Name of Candidate
2. Fathers Name
3. Address of Candidate

:
:
:

Dr. Savita Chahal

Sh. Raj Singh Chahal
Department of Psychiatry
Pt. B.D.Sharma PGIMS,
Rohtak

4. Name of the University from

which graduated
5. Year & Month of passing
MBBS Examination
6. Date of joining M.D. Course
7. Proposed subject of thesis

:
:

Maharishi Dayanand University,

Rohtak
Dec. 2007

:
:

10th May 2010

A STUDY OF QUALITY OF LIFE
PERSONALITY, COPING AND
PSYCHIATRIC MORBIDITY
AMONG CONVICTED PRISONERS

8. Detailed Scheme according to

:
which candidate proposes to work
9. Facilities for work on the subject :

Plan Attached

10. Name & Address of Supervisor

Dr. Priti Singh

All facilities exist at PT. B.D. Sharma

PGIMS, Rohtak
Professor
Department of psychiatry,
Pt. B.D.Sharma Post Graduate
Institute of Medical Sciences, Rohtak

Signature of the Candidate

CERTIFICATE OF SUPERVISOR

I certify that facilities for the work on the subject of thesis exist in the department and
will be provided to the candidate. I shall guide the candidate in this work and shall see that
the data being included in the thesis are genuine and the work is done by the candidate
himself. I also certify that no work has been done on this topic in this institute earlier.

Dr. Priti Singh

Professor
Department of Psychiatry,
Pt. B.D. Sharma Post Graduate
Institute of Medical Sciences, Rohtak.
(SUPERVISOR)

ETHICAL JUSTIFICATION

Psychiatric morbidity is quite common among prisoners. There are limited studies on
psychiatric morbidity , quality of life , coping and personality of prisoners in India. In all the
subjects informed written consent will be taken . Strict confidentiality will be maintained.
Subjects are free to withdraw at any time without assigning any reason. No invasive
procedure will be carried out on subjects as a part of the study. Thus the present study is well
within the ethical norms and is ethically justified.

Dr. Rajiv Gupta

Senior Professor and Head
Department of Psychiatry
Pt. B.D. Sharma Post Graduate
Institute of Medical Sciences, Rohtak.

Chairman, PG Board of studies in Medicine

And Head of Deptt.
Dr.P.S Ghalaut
Senior Professor and Head
Department of Medicine
Pt. B.D. Sharma PGIMS, Rohtak.

Dr. Priti singh

Professor
Department of Psychiatry
Pt. B.D. Sharma Post Graduate
Institute of Medical Sciences, Rohtak.

INTRODUCTION AND REVIEW OF LITERATURE

A Prison is an institution of compulsory detention for confining and punishing
criminals by severely restricting their freedom, i.e., limiting their actions, mobility,
associations and interactions.1 A prisoner is a person held in prison while on remand awaiting
trial, on trial or for punishment following conviction for a criminal offence.2
There is increased prevalence of mental disorders among prisoners compared with
rates observed in the general population with variation according to the type of prisoners:
sentenced, remand, male or female. There are two categories of mentally ill patients within
the prison walls. First, the individuals who were mentally ill, even before coming to the
prison. Many people with mental disorders are arrested and imprisoned causing mental
problems to be imported from the outside world into prisons . Second category is of the
people who become psychiatrically deranged after incarceration i.e people without mental
disorders develop mental problems during their imprisonment due to certain types of
deprivation they encounter.1-3
Although prisoners

represent a very small proportion of the total population ,

approximately 0.1% , they are likely to be extensive consumers of a wide range of services.
The number of people imprisoned worldwide is increasing rapidly .There are more than 9
million people worldwide in prison, according to International Centre Of Prison
Studies(2005). As a consequence prisons have become increasingly crowded. The increase in
prison population is a part of a global trend towards the increasing popularity and use of
imprisonment and a corresponding underuse of constructive alternative, non custodial
sanctions.3
Further, the rate of increase in the number of women in prison is much greater than
that for men .4 For instance, in England and Wales, the number of women in prison has
increased by more than 200% in the past 10 years versus a 50% increase in the number of
men in prison during the same period (Prison Reform Trust, 2006).2
Persons with mental illnesses are likely to be arrested and imprisoned as a result of
their mental illness, particularly for relatively minor crimes.2 On the other hand
,imprisonment negatively impacts the mental health of prisoners. The initial shock of
imprisonment, feelings of guilt or shame about the offences they have commited , separation
from families, disruption of social support network, emotional deprivation, enforced living

with other prisoners, deprivation of liberty ,lack of purposeful activity , lack of privacy and
time for quiet relaxation , anxiety about how much of their former lives will remain intact
after release negatively affects their mental health.4
Though men have outnumbered women as prisoners but female prisoners have higher
level of mental disorders than their male counterparts. Women commit much less crime than
men. This has contributed to a tendency to see female offenders as having medical and social
problems rather than as being hardened criminals . This has also led to the idea that female
prisoners are more likely to be psychiatrically disordered.5 Moreover women in prison
frequently come from deprived backgrounds, and many have experienced physical and sexual
abuse, domestic violence and inadequate health care before imprisonment. Therefore, they
are more likely than male prisoners to have poor mental health. 2
Lindquist & Lindquist analysed gender differences in psychological distress in prison
and proposed two possible interpretations . Female prisoners may experience a greater
additive effect of the combined dimensions of environmental stress and secondly the impact
of incarceration on coping mechanisms may account for gender differences.6
Prisoners have alarmingly high rates of mental health problems such as post traumatic
stress disorder, depression, anxiety, phobias, neurosis, self mutilation and suicide. This is
frequently a result of lifetime abuse and victimization .7
Gibbens (1971) carried out a survey of a total of 638 women prisoners. Mental illness
was found in 15% of sentenced women whereas recent in-patient treatment (within the last
three years) was reported by 17% of sentenced women .The conclusion from this study that
women prisoners have high rates of psychiatric disorder was partially refuted by another
study by Gunn et al;1978 where mental health was a major problem in 15% of sentenced
women compared to 34% of sentenced men who were identified as current psychiatric cases.5
Maden et al studied a cross sectional sample comprising 25% of all women serving
a prison sentence in England and Wales. A 5% of the male sentenced prison population was
used for comparison. The prevalence of psychosis ,around 2% was similar in the two groups
but women had higher rates of mental handicap (6% vs 2%), personality disorder (18% vs
10%), neurosis (18% vs 10%) and substance abuse (26% vs 12%).5
Singleton et al study found that women prisoners were significantly more likely than
men to suffer from a neurotic disorder, matching the trend in the general house population
survey (Meltzer et al, 1995) Whereas 59 % of remand and 40% of sentenced male prisoners
in England and Wales had a neurotic disorder, the corresponding figures for women were 76
% and 63% respectively.7

Wing et al; 1990 found the rates for any functional psychosis assessed by SCAN
Schedules for clinical assessment in Neuropsychiatry ,to be 7% for male and 14 % for female
prisoners

These rates of functional psychotic disorder were considerably higher than the

overall prevalence of 0.4% reported in the general household survey of adults . Schizophrenia
and delusional disorders were found more frequently than affective disorders.8
Herrman et al ;1991 estimated the prevalence of hidden psychiatric morbidity in a
representative sample of sentenced prisoners including 158 men and 31 women. Six prisoners
(3%) received current diagnoses of psychotic disorders, and 23 (12%) were diagnosed as
having current mood disorders, mainly major depression. A lifetime diagnosis of at least one
mental disorder each was made for 82% of the respondents, and in 26% more than one
lifetime disorder was diagnosed. Sixty-nine percent received lifetime diagnoses of
dependence on or abuse of alcohol, other psychoactive substances, or a combination of these.9
Agbahowe et al ;1998 assessed the psychiatric morbidity in 100 inmates in Nigerian
prison. The 34 subjects who scored upto GHQ-30 cut-off, four, had specific axis I DSM III-R
diagnoses, including, schizophrenia in two, major depression in two in recurrent mild
depression in twenty one, generalised anxiety disorder in eight and somatisation disorder in
one. On axis II, six subjects had antisocial personality disorder while another subject had
probable mild mental retardation. 10
Study on psychiatric morbidity among sentenced prisoners in Iran by Assadi et al
2006; found that majority of the Iranian prisoners had psychiatric disorder. Current mental
disorders were diagnosed in 57.2% of participants,with mood disorders having the highest
prevalence. 29.1% met the diagnostic criteria for major depressive disorder making it the
most common current diagnosis, whereas the most prevalent lifetime diagnosis was opioid
dependence. Those incarcerated for financial crimes appeared to have lower rates of
psychiatric morbidity than other offenders.11
Meltzer et al. found that while 28% of the women in the general population reported
sleep problems, 62% of sentenced women and up to 81% of those on remand reported sleep
problems. 11% of women in the general population reported depression compared to 54% in
women prisoner. The prevalence rate for any neurotic disorder was 66% of the sample group
as a whole. These rates are much higher than that found in the general household population,
where the rate was 16% 12-13
In England and Wales, 90 % of women in prison have a diagnosable mental disorder,
substance use or both, and 9 of 10 women in prison have at least one of the following :
neurosis ,psychosis , personality disorder , alcohol abuse or drug dependence. Existing

research indicates that women in prison are more likely to engage in self harm than male
prisoners (Quaker Council For European Affairs , 2007). In England and Wales , women were
14 times more likely than men to harm themselves. Outside prison men are more likely to
commit suicide than women, but this is reversed inside prison .Being a mother appears to
protect women in the community against suicide but this protection does not apply in prison
if mothers are separated from their children.8
The study on prevalence of serious mental illnesses among jail inmates by Steadman
et. al estimated the rates of current serious mental illness for male inmates to be 14.5% and
31.0% for female inmates. 14
Marzano et al; studied psychiatric disorders in women prisoners who have engaged in
near lethal self harm and found the strongest associations of current depression with near
lethal self harm, followed by presence of two or more diagnoses, a history of psychiatric inpatient treatment and previous attempted suicide ,especially in prison.15
Rivlin et al ; investigated the association of psychiatric disorders with near lethal
suicide attempts in male prisoners. Most current psychiatric disorders were associated with
near-lethal suicide attempts, including major depression, psychosis, anxiety disorders and
drug misuse whereas lifetime psychiatric disorders associated included recurrent depression
and psychoses.16
Goel et al estimated the prevalence of mental morbidity to be 70% among convicts and
93% among non convicts.20% of convicts and 80% of non-convicts had AXIS I disorders
while 24.6% of convicts and 75.4% of non convicts had AXIS- II disorders. 17
Taylor et al ; found that overall two-thirds of the life sentenced prisoners had a
psychiatric diagnosis. Nearly 10 per cent of them had schizophrenia, a slightly higher
proportion had a depressive illness and one-third had received a definite diagnosis of
personality disorder. 18
Quality of life is an important aspect of mental health. Quality of life is
conceptualized as the individuals perception of their position in life, in the context of their
culture and value systems and in relation to their goals, expectations and standards and
modified by their physical and psychological state, social relationships and environmental
factors.
Mooney et al; 2002 found that women in Irish prisons have a poor quality of life and
their mental health profile is significantly poorer than their male prisoner counterparts and
than women in the general population, while their quality of life profile was closer to that of
their drug using male counterparts. Significant differences remained on the physical and

psychological domains of the WHOQOL BREF between female prisoners and drug using
male prisoners. Adverse social circumstances, unhealthy lifestyles and negative life
experiences undoubtedly contribute to high level of distress and poor quality of life .19
Zwemstra et al ; 2009 studied the quality of life in a population of Dutch prisoners
with mental disorders using WHO-bref and found that the QOL of the study population was
worse compared with the QOL of the General Dutch population and prisoners without
psychopathology but better than the QOL of the psychiatric outpatients.20
Research suggests that for many inmates, the prison setting itself magnifies the
negative impact of earlier life experiences. In prison, vulnerable inmates are readily targeted
and their coping skills and options are limited. When

they enter a stressful prison

environment, psychological symptoms from earlier traumas, such as intrusive memories,

denial, and emotional numbing, return. This emotional response is thought to increase
vulnerability to further violence, repeating a cycle of traumatic experience and response .
Fortunately, all people are not passive, and people do make active efforts to address
and cope with problem situations and the emotions around them. Unfortunately, inmates have
generally been found to lack adequate coping skills in addressing their personal problems.
Coping strategies typically identified among criminal populations include avoidance,
momentary relief of problems with little thought to consequences, and aggressive behaviour.
Such approaches, likely selected out of familiarity and past experience, tend to worsen
problem situations. As unhealthy coping is continued, problems again worsen, and the pattern
continues. The coping strategies and the resources available to each person differ, sometimes
dramatically. The effect of incarceration will therefore vary and there is no simple formula to
predicting outcomes. 21
Reed et al ;2009 studied the coping strategies used by prisoners and the relationship
between prison sentence length and the coping strategies employed. Coping strategies that
focused on emotions, rather than on the source problem, were found to be most often
employed. Shorter-term prisoners adopted problem-focused strategies more than longer-term
prisoners, while longer-term prisoners adopted emotion-focused strategies more than shorterterm prisoners.22
Cuomo et al ;2008 analysed the personality traits of prisoners with substance abuse
to those without and found higher scores for psychoticism and neuroticism.23
Ireland & Ireland found less extraversion and high neuroticism within the prisoners.
Cale et al

found Extraversion considerably elevated

because of inherent cortical

underarousal and a consequent need for stimulation and Neuroticism is elevated because of

heightened emotional drive. Eyesenck reported that those scoring highly on psychoticism
would present with particularly elevated psychopathy scores. Eyesenck and Gudjonsson
argued that Extraversion is more closely related to antisocial behaviour in younger ages and
Neuroticism

in older age groups and the experience of imprisonment decreases

Extraversion.24
There are limited studies on psychiatric morbidity , quality of life , personality and
coping skills among prisoners in India. The current study aims at estimating the psychiatric
morbidity among convicted prisoners as the studies mixing

undertrial and convicted

prisoners do not yield an accurate account owing to higher rates of psychiatric morbidity
among undertrial prisoners.

AIMS AND OBJECTIVE

To study the prevalence of psychiatric morbidity among convicted prisoners.

To study the correlation of sociodemographic and criminological variables

psychiatric morbidity in prisoners.

To study the quality of life, personality and coping skills among convicts.

to

10

11

MATERIALS AND METHODS

STUDY SAMPLE
The study will be conducted in the district jail situated at a distance of 3.7 km from Pt.
B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana. All the convicts,
male and female ,will constitute the study sample.
TOOLS
The following tools will be used :
1) PROFORMA FOR SOCIO DEMOGRAPHIC, CRIMINOLOGICAL VARIABLES
AND PSYCHIATRIC HISTORY (Appendix-II): A special Profoma will be used to
gather socio demographic, criminological and psychiatric variables of prisoners.
2) BRIEF PSYCHIATRIC RATING SCALE(BPRS)(APPENDIX III):It is a relatively
brief scale appropriate for evaluating baseline psychopathology including major
psychotic and non psychotic symptoms. It consists of 24 items rated on a scale of 1-7.
Items 1-14 are on the basis of self report. Items 15-24 are rated on the basis of
observed behaviour and speech . Items 7,12 and 13 are also rated on the basis of
observed behaviour. It will be used for the initial screening of psychiatric morbidity in
prisoners.
3) SCHEDULES FOR CLINICAL ASSESSMENT IN NEUROPSYCHIATRY (SCAN)
(APPENDIX- IV): It is a diagnostic scale developed by WHO and NIMH joint
project

aimed at diagnosing and measuring psychiatric morbidity in adults. The

entire SCAN interview is spread over 28 sections. It is demonstrated to have moderate

to good validity , reliability (inter rater ant test-retest), and sensitivity and specificity
indices.
4) WHOQOL-BREF (HINDI VERSION) (APPENDIX V): It is an abbreviated version
of the WHOQOL-BREF are representative of four domains related to the quality of
life: physical health, psychological, social and environmental. Domains scores were
found to correlate highly with the whoqol-100 domains scores. A total quality of life

12

is obtained by summing up the individual scores on each item. Higher scores denotes
a higher quality of life with the highest possible score in each domains being 100.
5) HINDI P.E.N INVENTORY(APPENDIX VI): The Hindi PEN inventory measures
four dimensions of personality, viz. psychoticism (P) tendency or propensity to
develop psychotic symptoms under stress; extraversion (E) (Eysenckenian model of
introversionextraversion dimension, defining extroversive as social, mixing,
outgoing); neuroticism (N) or emotional instability defined as the propensity to
develop and sustain neurotic symptoms under stress, and Lie scale (L) or tendency to
give socially desirable responses in place of real responses. Higher the score greater
the strength of that particular dimension of personality.
6) BRIEF COPE SCALE (Carver, 1997) (APPENDIX VII): The Brief COPE scale is a
28-item self-report measure of both adaptive and maladaptive coping skills.
METHODOLOGY
Prior permission from the concerned authorities regarding the study will be taken. All
the convicts, male and female, in district jail , Rohtak fulfilling the will constitute the study
sample. An informed written consent from the prisoners included in the study will be taken.
The interview will take place in the prison. A special proforma designed for
sociodemographic, criminological variables and psychiatric history will be filled for all the
prisoners included in the study . The subjects will be screened initially by Brief Psychiatric
Rating Scale, and those who screened positive will be administered Schedules for clinical
assessment in neuropsychiatry (SCAN) for diagnostic purpose. Quality of life will be
assessed using WHOQOL-BREF (HINDI VERSION). Coping skills will be measured using
Brief Cope Scale translated in Hindi. HINDI P.E.N.Inventory will be used to assess
personality of the prisoners
STATISTICAL ANALYSIS TO BE USED
The data collected will be subjected to appropriate statistical analysis further.

13

APPENDIX I
CONSENT FORM FOR THE STUDY
I, exercising my free power of choice, hereby give my
consent to be included as a subject in thesis work entitled A STUDY OF QUALITY OF
LIFE, PERSONALITY,COPING SKILLS AND PSYCHIATRIC MORBIDITY AMONG
CONVICTED PRISONERS..I have been informed to my satisfaction by attending doctor
the purpose of the study. I am also aware of my right to opt out of the study at any time
during the course of the study without having to give the reason for doing so.

Patient: .
Signature

Attending physician
Name:

14

APPENDIX -II
PROFORMA FOR SOCIODEMOGRAPHIC, CRIMINOLOGICAL AND
PSYCHIATRIC HISTORY CHARACTERISTICS
S.NO:
DATE:
NAME:
GENDER
MALE
FEMALE
AGE (YEARS):
18 21
22 29
30 39
40 49
50+
EDUCATIONAL LEVEL
Illiterate
Primary
Matriculation
Higher secondary
Graduation
Post graduation

15

PRIOR EMPLOYMENT STATUS

Employed
Unemployed
Housewife
BACKGROUND
Rural
Urban
MARITAL STATUS
Single
Married
Separated
Divorce
Widow/widower
TYPE OF FAMILY
Nuclear
Joint
Extend
NATURE OF INDEX OFFENCE & SECTION UNDER
PAST PSYCHIATRIC HISTORY
Previous psychiatric in patient treatment
Previous psychiatric out patient treatment

16

FAMILY HISTORY OF PSYCHIATRIC ILLNESS

Yes
No
PREVIOUS PRISON SPELLS
Yes
No
DURATION OF STAY IN PRISON

17

APPENDIX -III
BRIEF PSYCHIATRIC RATING SCALE

APPENDIX-IV
SCHEDULE FOR CLINICAL ASSESSMENT IN NEUROPSYCHIATRY (SCAN)

APPENDIX- V
WHOQOL-BREF (HINDI VERSION)

APPENDIX-VI
HINDI P.E.N INVENTORY

APPENDIX VI
BRIEF COPE SCALE

18

REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

17.

Gupta RK, Singh GPI, Bhonde AS, Sankhayadar P. Mental Stress Amongst Inmates of
a Prison. J Ment Health Hum Behav 1998;3(1):25-8.
United Nations Office on Drugs and Crime. Womens health in prison: Correcting
gender inequity in prison health. Vienna, United Nations Office on Drugs and
Crime.2009
Fazel S, Lubbe S. Prevalence and characteristics of mental disorders in jails and
prisons. Current Opinion in Psychiatry 2005;18:68-73.
Douglas N, Plugge E, Fitzpatrick R. The impact of imprisonment on health: what do
women prisoners say? J Epidemiol Community Health 2009;63(9):749-54.
Maden T, Swinton M, Gunn J. Psychiatric Disorder in Women Serving a Prison
Sentence. Br J Psychiatry 1994;164:44-54.
Lindquist CH, Lindquist CA. Gender differences in distress: mental health
consequences of environmental stress among jail inmates. Beh Sc Law 1997;15:50323.
Singleton N, Meltzer H, Gatward R, Coid J,Desy D. Psychiatric Morbidity Among
Prisoners :Summary Report. London: Office for National Statistics, 1997.
Cooper CL, Goswami U, Sahakian B. Mental Capital and Wellbeing. 2009 .Section
3 :41 mental ill health of prisoners.
Herrman H, McGorry P, Mills J, Singh B. Hidden severe psychiatric morbidity in
sentenced prisoners : An Australian study. Am J Psychiatry 1991;148:236-9.
Agbahowe SA, Ohaeri JV, Ogunlesi AO, Osahon R. Prevalence of psychiatric
morbidity among convicted inmates in a Nigerian prison community. East Afr Med J
1998;75(1):19-26.
Assadi SM, Noroozian M, Pakravannejad M, Yahyazadeh O, Aghayan S. Psychiatric
morbidity among sentenced prisoners: prevalence study in Iran. Br J Psychiatry
2006;188:159-64.
Meltzer H, Gill B, Petticecrew M, Hinds K. OPCS Survey of psychiatric morbidity in
Great Britain, Report 1: The Prevalence Of Psychiatric Morbidity among adults living
in private households. HMSO: London
Meltzer H, Gill B, Petticecrew M, Hinds K. OPCS Survey of psychiatric morbidity in
Great Britain, Report 3: Economic activity and social functioning in adults with
psychiatric disorders , HMSO: London
Steadman HJ, Osher FC, Robbins PC, Case B, Samuels S. Prevalence of serious
mental illness among jail inmates. Ps.psychiatryonline.org 2009;60:761-5.
Marzano L, Fazel S, Rivlin A, Hawton K. Psychiatric disorders in women prisoners
who have engaged in near- lethal self harm : case control study. Br J Psychiatry
2010;197:219-26.
Rivlin A, Hawton K, Marzano L, Fazel S. Psychiatric disorders in male prisoners who
made near-lethal suicide attempts:case control study. Br J Psychiatry 2010;197:3139.
Goel N, Khanna P, Meena, Vohra AK, Verma R. Prevalence of mental morbidity
amongst prisoners. J Med Genetics Genomics 2010;2(5):63-66.

19

18.

Taylor PJ. Psychiatric disorder in Londons life sentenced offenders. Br J Criminol

1986;26(1):63-78.
19. Mooney M, Hannon F, Michael B, Friel S, Kelleher C. Perceived quality of life and
mental health status of Irish female prisoners. Ir Med J 2002;95:241-3.
20. Zwemstra J, Masthoff E, Trompenaars FJ, Vries JD. Quality of life in a population of
Dutch prisoners with mental disorders. Int J Forensic Ment Health 2009;8(3):186-93.
21. Harreveld FV, Claassen L. Inmate emotional coping and psychological and physical
well being : the use of crying over spilled milk. Crim Justice Behav 2007;34(5):697708.
22 . Reed P, Alenazi Y, Potterton F. Effect of time on prisoners use of coping strategies.
Int J Prisoner Health 2009;5(1):16-29.
23. Cuomo C, Sarchiapone M, Giannantonio MD, Mancini M, Roy A. Aggression
,impulsivity personality traits and childhood trauma of prisoners with substance abuse
and addiction. Am J Drug Alcohol Abuse 2008;34(3):339-45.
24 . Ireland JL, Ireland CA. Personality structure among prisoners:How valid is the fivefactor model model, and can it offer support for Eyesencks theory of criminality?
Crim Behav Ment Health 2011;21:35-50.

20

21

QUALITY OF LIFE
Quality of life is an important aspect of mental health. Quality of life is conceptualized as the
individuals perception of their position in life, in the context of their culture and value
systems and in relation to their goals, expectations and standards and modified by their
physical and psychological state, social relationships and environmental factors.
Women in Irish prisons have a poor quality of life and their mental health profile is
significantly poorer than their male prisoner counterparts and than women in the general
population. while their quality of life profile was closer to that of their drug using male
counterparts. Significant differences remained on the physical and psychological domains of
the WHOQOL BREF between female prisoners and drug using male prisoners. Adverse
social circumstances, unhealthy lifestyles and negative life experiences undoubtedly
contribute to high level of distress and poor quality of life .

Brinded et al ; found that 80.8% of inmates diagnosed with bipolar disorder were receiving
psychiatric treatment in prison however the treatment rate dropped for those suffering from
obsessive compulsive disorder (55.3%), major depression(46.4%), post traumatic stress
disorder (41.4%) , psychosis /schizophrenia (37%) and substance use disorder (35%).A24

22

PSYCHIATRIC MORBIDITY

In general, psychiatric disorders are more prevalent among prisoners than the general
population, with variation according to the type of prisoners: sentenced, remand, male or
female. Personality disorder rates range from 50% to 78%, with antisocial personality
disorders being most prevalent of all categories. Psychotic disorder are far more highly
represented than in the general population, with schizophrenia and delusional states being
more common than affective disorders. Neurotic disorders in prisoners, as in the general
population, are more common among women. Suicidal behaviour and completed suicides are
both serious issues.
The common fault in studies of psychiatrc morbidity among prisoners is mixing of remand
and sentenced prisoners ;offenders may be remanded because of mental disorder and studies
of remand prisoners have shown higher rates of psychosis and suicide.4
Personality disorder: Personality disorder was assessed using the SCID-II-structured clinical
interview for DSM al., 1983).the prevalence of any personality disorder was 78% for male
remand, 64% for male sentenced and 50% for female prisoners. Antisocial personality
disorder had the highest prevalence

Between 1982 and 1999 the proportion of convicts with mental disorders in the USA rose 6%
to 16% and a large proportion of prisoners were abusers of psychoactive substances. 45.about
15% of convicts on their admittance to penitentiary unit were seen as having any mental
disorder and many had the history of previous convictions and incarcerations.45
A recent national study of convicted prisoners using data collected by psychiatrists reported
that 37% of sentenced prisoners have mental disorders. The rates in remand prisoners are
probably higher , partly because mentally disordered people are often remanded in custody
for psychiatric reports. Evidence from North America suggests that mentally disordered
people are more likely to be arrested than those who are not mentally disordered in similar
circumstances. Factors such as homelessness and petty offences that are associated with
mental disorder make remand more likely.17

23

Overall two-thirds of the lifers had a psychiatric diagnosis. Nearly 10 per cent, of them had
schizophrenia, a slightly higher proportion had a depressive illness and one-third had
received a definite diagnosis of personality disorder. In most of the latter cases personality
disorder was not the sole diagnosis.REF NO 19

The Brief COPE scale (Carver, 1997) is a 28-item self-report measure of both
adaptive and maladaptive coping skills. The Brief COPE was developed based on
concepts of coping from Lazarus and Folkman (1984). The scale was designed to
yield fourteen subscales, comprised of two items each. The scales developer
does not advise a particular method for second-order factoring and suggests that
researchers develop their own models for second-order factors based on data
from individual research samples. The purpose of this study was to determine
what factors may exist within the Brief COPE to aid in it usefulness as a
standardized measure of coping and statistical analyses.

Psychiatric morbidity among sentenced male prisoners in

Dubai: Transcultural perspectives

Journal of Forensic Psychiatry & Psychology

Volume 8, Issue 2, 1997, Pages 440 44 Rafia Ghubasha; Omer El-Rufaieb6

The aim of this study was to investigate the prevalence and nature of
psychiatric morbidity among sentenced male prisoners in Dubai, United Arab
Emirates (UAE). Sociodemographic data were collected from 142 UAE national
prisoners. All were interviewed by a psychiatrist who administered the CIS and
the CAGE questionnaires, documented self-reported substance misuse, previous
seizures and deliberate self-harm and, finally, made a clinical ICD-10 diagnosis
when appropriate.
A psychiatric diagnosis was made in 25% of the sample, problematic drinking
was identified in 28% and drug and volatile substance misuse in 63%. Evidence
for both problematic drinking and history of drug withdrawal phenomena was
demonstrated in 16% of the sample. Previous seizures were reported by 13% and
self-harm by 32%. These results are suggestive of higher rates of substance
misuse compared to other relevant studies. Among other explanations, this is
most likely related to the strict rules prohibiting such substances: their users are
consequently over-represented among those who are convicted.
Am J Psychiatry 1991; 148:236-239
Copyright 1991 by American Psychiatric Association

24

REGULAR ARTICLES
Hidden severe psychiatric morbidity in sentenced prisoners: an Australian study
H Herrman, P McGorry, J Mills and B Singh
Department of Psychological Medicine, Monash University, Melbourne, Australia.

OBJECTIVE: The aim of this survey was to estimate the prevalence of severe mental
disorders in a representative sample of sentenced prisoners. METHOD: The subjects were
selected as a random sample of sentenced prisoners in Melbourne's three metropolitan
prisons. Interviews were conducted with 158 men and 31 women. Clinicians used the
Structured Clinical Interview for DSM-III-R (SCID) to diagnose psychotic, affective, and
substance use disorders. RESULTS: Six prisoners (3%) received current diagnoses of
psychotic disorders, and 23 (12%) were diagnosed as having current mood disorders, mainly
major depression. A lifetime diagnosis of at least one mental disorder each was made for 82%
of the respondents, and in 26% more than one lifetime disorder was diagnosed. Sixty-nine
percent received lifetime diagnoses of dependence on or abuse of alcohol, other psychoactive
substances, or a combination of these. CONCLUSIONS: These findings do not indicate a
large-scale shift of deinstitutionalized psychotically ill people from mental hospitals to
prisons. They do, however, highlight the diversion into the corrections system of substancedependent people and the apparent pool of prisoners with largely untreated major depression.
East Afr Med J. 1998 Jan;75(1):19-26.

Prevalence of psychiatric morbidity among convicted

inmates in a Nigerian prison community.
Agbahowe SA, Ohaeri JU, Ogunlesi AO, Osahon R.
Psychiatric Hospital, Uselu, Benin City, Edo State, Nigeria.

Abstract
Studies of psychiatric morbidity in Nigerian prisons have not involved
assessment for specific psychiatric disorders. The general aim of this study was
to highlight the prevalence of psychiatric morbidity among convicted inmates at
a medium security prison in Nigeria. In a one month period in 1996, 100 inmates
(93% males, mean age, 31.4 years) of the prison in Benin City, were assessed,
using the General Health Questionnaire (GHQ-30) and the Psychiatric
Assessment Schedule (PAS). The 34 subjects who scored upto GHQ-30 cut-off,
four, had specific axis I DSM III-R diagnoses, including, schizophrenia in two,
major depression in two in recurrent mild depression in twenty one, generalised
anxiety disorder in eight and somatisation disorder in one. On axis II, six subjects
had antisocial personality disorder while another subject had probable mild
mental retardation. On Axis III, 15 subjects had chronic physical illnesses,
including one with epilepsy. Twenty five inmates had past histories of drug abuse
prior to imprisonment, including cannabis (11%) and alcohol (13%). Total PAS
scores were significantly predicted only by GHQ scores and length of stay in
prison. There was no association between offence committed and psychiatric

25
morbidity. Most subjects with psychiatric morbidity developed these illnesses
while in prison. The findings differed from the situation in developed countries
where personality disorders and substance use are much more prevalent. The
fairly high level of psychiatric disorders underscores the need to improve medical
services in the prison.

Psychological Distress and Psychiatric Morbidity in Women Prisoners

1991, Vol. 25, No. 4 , Pages 461-47 australian and new Zealand journal of psychiatry
Psychological distress and psychiatric morbidity among women prisoners.
PDF (828 KB) PDF Plus (365 KB) ReprintsPermissions
William Hurley1 and Michael P. Dunne2
1

Brisbane Correctional Centre

Department of Psychiatry, University of Queensland

Correspondence: William Hurley, 225 Wickham Terrace, Brisbane, Q4000

The population of a women's prison (n=92) was screened for psychological distress and
psychiatric morbidity with the 12-item General Health Questionnaire, the Hamilton
Depression Rating Scale, a Recent Stressful Life Events questionnaire and the Structured
Clinical Interview for DSM-III-R. High levels of symptoms of psychological distress were
recorded. Distress was correlated with recent stressful life events and was more severe in
women awaiting trial. Fifty-three per cent of the prisoners were diagnosed as current cases of
a psychiatric disorder and the most frequent diagnoses were adjustment disorder with
depressed mood and personality disorders. Lifetime prevalence of psychoactive substance use
disorders was 54 per cent. Aboriginal women were over-represented in this prison population.
A follow-up survey after 4 months showed no fall in the prevalence of psychological distress
and psychiatric morbidity.

Read More: http://informahealthcare.com/doi/abs/10.3109/00048679109064439?

journalCode=anp

26

Prisoners have poorer quality of life compared to the general population, and their
impairment in quality of life may relate to the poor social and demographic factors in
addition to the multiple physical and mental health problems. This may also reflect the
incarceration of individuals with established impairment in quality of life and/or a specific
impact of incarceration on quality of life. Further longitudinal research isrequired to
examine the short- and long-term effects of incarceration on the quality of life of
prisoners. It is also important to examine the effects of treating treatable diseases on
quality of life in prison settings.

Effect of time in prison on prisoners' use of

coping strategies

International Journal of Prisoner

Health
Volume 5, Issue 1, 2009, Pages 16 - 24
Authors: Phil Reeda; Yousef Alenazia; Fenella Pottertona
DOI: 10.1080/17449200802692060

27

Online Sample

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Abstract
Prisoners from two institutions (a low security and a high security prison) were
studied to explore the coping strategies used in stressful situations, and the
relationship between prison sentence length and the coping strategies
employed. Prisoners completed the Eysenck Personality Questionnaire, and the
Ways of Coping Scale. Coping strategies that focused on emotions, rather than
on the source problem, were found to be most often employed. Shorter-term
prisoners adopted problem-focused strategies more than longer-term prisoners,
while longer-term prisoners adopted emotion-focused strategies more than
shorter-term prisoners. These results are discussed with reference to the
influence of the environment on coping strategy.

Coping styles and prison experience as

predictors of psychological well-being in
male prisoners

Psychiatry, Psychology and Law

Volume 7, Issue 2, 2000, Pages 170 - 181
Authors: Eleonora Gullonea; Tessa Jonesb; Robert Cumminsc
DOI: 10.1080/13218710009524983

Online Sample

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Abstract
Research investigating the effects of imprisonment on prisoners' psychological
well-being has suggested that imprisonment does not have an adverse effect on
their well-being. However, given inconsistency across studies, this finding cannot

28
be considered conclusive. The present study sought to investigate this issue
further through a comprehensive assessment of prisoner well-being including
measures of self-esteem, depression, anxiety and subjective quality of life. Given
their documented association with well-being in both community and prisoner
populations, we also included assessment of coping styles. Findings regarding
the association between well-being and prison-related variables such as length of
sentence and time spent in prison have been particulariy inconsistent. Thus, we
also investigated these variables. Data collected from 81 Australian male
prisoners, indicated that prisoners have significantly compromised psychological
well-being and that coping style appears to be more salient for prisoner wellbeing than prison-related variables. However, we argue that it would be overly
simplistic to conclude from these findings that the prison experience is not
playing a part in the compromised well-being of prisoners.

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COPING

Research suggests that for many inmates, the prison setting itself magnifies the negative
impact of earlier life experiences.5 In prison, vulnerable inmates are readily targeted and their
coping skills and options are limited. When they enter a stressful prison environment,
psychological symptoms from earlier traumas, such as intrusive memories, denial, and
emotional numbing, return. This emotional response is thought to increase vulnerability to
further violence, repeating a cycle of traumatic experience and response .
Fortunately, all people are not passive, and people do make active efforts to address and cope
with problem situations and the emotions around them. Unfortunately, inmates and former
inmates have generally been found to lack adequate coping skills in addressing their personal
problems. Coping strategies typically identified among criminal populations include
avoidance, momentary relief of problems with little thought to consequences, and aggressive
behaviour. Such approaches, likely selected out of familiarity and past experience, tend to
worsen problem situations. As unhealthy coping is continued, problems again worsen, and the
pattern continues.
The coping strategies and the resources available to each person differ, sometimes
dramatically. The effect of incarceration will therefore vary and there is no simple formula to
predicting outcomes.

30

PERSONALITY
Ireland & Ireland found less extraversion and high neuroticism within the prisoners.
Cuomo et al analysed the personality traits of prisoners with substance abuse to those
without and found higher scores for psychoticism and neuroticism.D
Cale et al ;found Extraversion considerably elevated because of inherent cortical
underarousal and a consequent need for stimulation and Neuroticism is elevated because of
heightened emotional drive. Eyesenck reported that those scoring highly on psychoticism
would present with particularly elevated psychopathy scores.b
Eyesenck and Gudjonsson argued that E is more closely related to antisocial behaviour in
younger ages and N in older age groups and the experience of imprisonment decreases E.B