Prison Health Care Research Articles

Prison health services across ten central prisons in Cameroon.

In 2021, Cameroon held approximately 26,300 inmates in 84 prisons. The Ministry of Justice manages health services in prisons. Conclusive data concerning health care in prisons are lacking. Herein, we present the results of an assessment of health care provision and delivery in 10 central prisons. We adopted mixed methods, including document review, observations, interviews with the Ministry of Justice and prison facility officials, and inmate focus group discussions (FGDs). The 6 building blocks of the World Health Organization's health system framework guided the data collection. Moreover, we collected data on imprisonment conditions. Ministerial authorisation and verbal informed consent were obtained for all activities. There were a total of 17,126 inmates, with the prison populations ranging from 353 inmates to 4,576 inmates. The majority of prisons were characterised by huge overcrowding (mean 301%). The 10 central prisons operated infirmaries with insufficient space and equipment. Compared with the civilian health sector, the numeric ratio of paramedical personnel/inmates was favourable (1:3.4 vs. 1:0.5 p. 1,000 pop, respectively). Recent admissions were screened for the coronavirus disease 2019, tuberculosis (TB), and human immunodeficiency virus (HIV). Moreover, the inmates were diagnosed for current pathologies and lesions. For the treatment of chronic diseases and medical emergencies, the prison health services bridged service gaps on a case-by-case basis through informal arrangements with the civilian health sector. The service quality control was limited to those performed by the TB and HIV/acquired immune deficiency syndrome control programmes. Health data was collected and transmitted with a multitude of data collection tools, without standardisation and systematic verification. The primarily reported problems comprised the scarcity of resources and the absence of an effective oversight of resource management and service quality performance entailing governance problems. Participants in FDGs esteemed the quality of treatment as poor unless paid for in cash, and denounced severe difficulties for access to care outside the prisons when required. For meeting the standard minimum rules for the treatment of inmates, prison health care in Cameroon should fill the crucial gaps involving imprisonment conditions, access to health services, and accountability. Regarding chronic underfunding, intensifying collaboration with the civil health sector may partially address the problem.

Prisoners with reduced criminal responsibility stand out based on their rates of hospitalisation during their sentences

PurposeGlobally, health problems are very common among prisoners. A mental state examination aims to help in recognising psychiatric problems among offenders and the possible association of these psychiatric issues with their committed crime. The legal-medical term “reduced criminal responsibility” refers to a weakened sense of reality and the ability to control one’s behaviour because of compromised mental health and without an evaluated need for forensic psychiatric hospitalisation. However, little is known about the actual need for the health care of prisoners with reduced criminal responsibility (PRCR). The purpose of this study was to explore treatment-related visits to prison by PRCR in Finland.Design/methodology/approachThe research data comprise information on PRCR’s treatment-related visits and that of a matched control group (n = 222). Descriptive cross-tabulation with X²- and nonparametric Mann–Whitney U-tests and Cox regression analyses are applied.FindingsThe results show that almost every PRCR had at least one treatment-related visit during their sentences. Visits to a psychiatric hospital for prisoners, to the prison hospital and especially to a civil hospital are more common among PRCR. The need for treatment appears significantly earlier in their sentences.Originality/valueThese findings demonstrate the PRCR’s greater need for access to health services and the need for further development between the Health Care Services for Prisoners, Prison and Probation Service of Finland and public health and social services in Finland. More exploration of the medical reasons and locational distribution of the vast amount of civil hospitalisation is needed.

Behind Walls: Mass Incarceration as an Oppressor of Reproductive Justice in the United States

The purpose of this study is to determine if and how mass incarceration denies women of color their right to reproductive justice in the United States. By analyzing the prison system’s legal framework as well as its practices, the study aims to analyze both known and unknown barriers to reproductive justice in the correctional setting. Data on such policies and practices was collected through personal interviews as well as through podcast interviews with formerly incarcerated women and a lawyer knowledgeable in prison healthcare laws within the United States. The findings from this data indicate that incarcerated women are not just denied necessary reproductive healthcare, but are essentially punished by the prison system for existing as reproductive individuals. Furthermore, this oppression disproportionately harms women of color due to the disproportionate mass incarceration of black and brown people in the United States, which stems from the criminalization of poverty and the “war on drugs” that began in the 1970s. These findings imply that there is a large group of women who have and continue to be dehumanized and threatened behind walls. Reproductive healthcare is necessary healthcare; thus, it must be prioritized in prison reform and legislature.

Motivation and training needs of prison healthcare professionals: findings from a qualitative study

Health care in prison is a challenging task. The conditions of imprisonment create distinct difficulties for those providing health care in this setting. These particular circumstances have led to a shortage of quality professionals, working for the health of imprisoned people. The aim of this study is to elaborate reasons for healthcare professionals to work in a prison environment. The main research question is: why do healthcare workers choose to work in prisons? Furthermore, our study identifies training needs in various fields. Interview data that comes from a national project carried out in Switzerland and three other relatively wealthy countries were analyzed using content analysis. One-on-one, semi structured interviews were designed and conducted with professionals working in prison context. A total of 105 interviews were carried out and for this work 83 of them were analyzed and coded into themes responding to the study aim. Most participants chose to work in prison either because of practical reasons, as many reported various forms of contact with the studied prison environment at a younger age, or because of intrinsic reasons, including among others, having the wish to change the system of healthcare in prisons. Even though the education of the participants varied greatly, a lack of specialist training was expressed by many health care professions as an important factor. This study points out the need for more specific training programs for healthcare workers in prison and provides suggestions to ameliorate the recruitment and education for future prison health care workers.

Sexual and reproductive history of female prisoners in Iran: a health care needs analysis

PurposeAccording to estimates, there are approximately 714,000 female prisoners in the world. A considerable proportion are pregnant, of childbearing age at the time of incarceration and may experience numerous reproductive health concerns. The purpose of this study is to examine the demographics and sexual and reproductive history of female prisoners in Iran.Design/methodology/approachFour hundred and thirty-four female prisoners (mean age: 39.0 ± 9.9) serving sentences at Qarchak prison, Iran, completed a questionnaire. The participants were recruited between October 2017 and September 2018 using a convenient sampling method. The questionnaire captured sociodemographic characteristics and sexual and reproductive history.FindingsMost respondents had 7–12 years of formal education, were housewives (69.9%), were either married (41.6%) or divorced (41.8%) and were literate (91.3%). History of drug use among the respondents was 34.7%. Most respondents had regular menstruation (63.5%) and were pre-menopausal (86.1%). Natural birth control was preferred (39.7%) compared to other methods, such as condoms (18%) and oral contraceptive pills (8.4%). Spontaneous and induced abortions were reported by 17.8% and 16.4% of respondents, respectively. There was 5.9% of respondents that reported having a history of sexually transmitted infections (STIs) before incarceration, with HPV the most common (12.7%).Research limitations/implicationsThis study has limitations, including the problem of following up with prisoners to shorten the average length of their imprisonment, which can leave many issues in the field of women’s health and their follow-up incomplete. Prison health care workers should also follow up on women’s health and pregnancy hygiene after their release because there is usually a high prevalence of STIs in prisoners.Practical implicationsThe findings highlight the importance of improving the quality of women’s health care and pregnancy-related care in prisons. Additionally, the importance of having a health protocol for incarcerated women in Iran. Other programs should also be implemented for women prisoners to eliminate the discrimination they may face in prison.Originality/valueThe international community has attempted to develop care guidelines for pregnant prisoners, particularly for prenatal and mental health services. However, currently in Iran no such guidelines have been developed. To date no research has explored the sexual health among female prisoners of this country. The aim of the present study was to examine the demographics and sexual and reproductive history of female prisoners in Iran. A secondary aim was to identify the health care needs of female prisoners in Iran.

California's Public Safety Realignment Act and prisoner mortality.

In 2011, a historic Supreme Court decision mandated that the state of California substantially reduce its prison population to alleviate overcrowding, which was deemed so severe as to preclude the provision of adequate healthcare. To comply, California passed the Public Safety Realignment Act (Assembly Bill [AB] 109), representing the largest ever court-ordered reduction of a prison population in U.S. history. AB109 was successful in reducing the state prison population; however, although the policy was precipitated by inadequate healthcare in state prisons, no studies have examined its effects on prisoner health. As other states grapple with overcrowded prisons and look to California's experience with this landmark policy, understanding how it may have impacted prisoner health is critical. We sought to evaluate the effects of AB109 on prison mortality and assess the extent to which policy-induced changes in the age distribution of prisoners may have contributed to these effects. To do so, we used prison mortality data from the Bureau of Justice Statistics and the California Deaths in Custody reporting program and prison population data from the National Corrections Reporting Program to examine changes in overall prison mortality, the age distribution of prisoners, and age-adjusted prison mortality in California relative to other states before and after the implementation of AB109. Following AB109, California prisons experienced an increase in overall mortality relative to other states that attenuated within three years. Over the same period, California experienced a greater upward shift in the age distribution of its prisoners relative to other states, suggesting that the state's increase in overall mortality may have been driven by this change in age distribution. Indeed, when accounting for this differential change in age distribution, mortality among California prisoners exhibited a greater reduction relative to other states in the third year after implementation. As other states seek to reduce their prison populations to address overcrowding, assessments of California's experience with AB109 should consider this potential improvement in age-adjusted mortality.

A cross-sectional study on health status of convicted prisoners in a central jail of central India

: Health care in prisons is one of the neglected health areas in our country, looking in to the health problem of prisons will show us a way for the approach in providing a healthcare for prisoners.The planning and implementing prevention strategies and interventions can bring about long-term reductions in expenditure on criminal justice, health and other services. There is clear evidence that well planned crime prevention strategies not only prevent crime and victimization, but also promote community safety and contribute to the sustainable development of countries. This study aims to assess the health status of convicted prisoners along with study socio-demographic profile of prisoners and to give suitable recommendation based on study findings. A cross-sectional study was conducted among convicted prisoners of central jail in central India for the period of one year (July 2021 to July 2022). This study was conducted among 225 convicted prisoners by using Pre-designed and pretested proforma.participant was selected by systemic random sampling. Face to face interview was carried out for obtaining data.: Data was checked for consistency and completeness and entered in SPSS 20. Descriptive statistics like mean, standard deviation and percentages was will be used to describe the findings. : It is observe that 153 (68%) were anaemic followed by 111(49%) participants were depressed, 59 (26%) had hypertension, 16(7.1%) had type II DM, 11(4.8%) had mental illness, 20(8.8%) had ringworm infestation, 11(4.8%) had Asthma, 7(3.1%) had haemorrhoids, 27 (12%) complained of low back pain, 3(1.3%) had epilepsy.

Morbilidad metabólica en la población penitenciaria de Cataluña

ObjectiveTo investigate the prevalence of metabolic morbidity (MM) amongst prison inmates. DesignMulticentric, cross-sectional observational study. SettingAll (nine) prisons in Catalonia. ParticipantsConvicted inmates that are not in an «open regime», whose healthcare relies on the Prison Primary Care Teams. InterventionsMM was defined as the presence of at least one component of the metabolic syndrome, i.e., obesity, arterial hypertension, type2 diabetes, and/or dyslipidemia. The variables collected included anthropometric measurements, medical history and laboratory values related to MM. The source of information was the Catalan Primary Healthcare Services Information System (SISAP). Main measurementsThe prevalence of MM, overall and by several participant subcategories, was calculated. To investigate the risk factors associated to a higher prevalence of MM, a multivariable logistic regression analysis was carried out and expressed as adjusted odds ratios and 95% confidence intervals. Results4338 inmates were studied, of whom 93.9% were male. Mean age was 38.4years, 51.7% were born in European Union countries, and 6.7% were infected by HIV. The variables associated with a significantly increased risk of presenting MM were older age and HIV infection, whereas certain geographical origins (i.e., non-UE European countries, Maghreb and Sub-Saharan Africa) were associated with lower risk of MM. ConclusionsIn spite of being an overall young population, prison inmates present high rates of MM. Older age, HIV infection and geographic origin appear as the most strongly associated factors with MM in the prison population. MM should be detected early in order to prevent complications. Prevention, screening and treatment of MM ought to be considered a priority in the clinical routine of prison healthcare professionals.

What can coronial cases tell us about the quality of emergency healthcare for prisoners in Australia?

This research aimed to examine the legal and regulatory obligations of authorities and healthcare professionals in the provision of prison emergency health services and to identify problems in the provision of emergency care to prisoners by using case examples from coronial findings. Review of legal and regulatory obligations and a search of coronial cases for deaths related to the provision of emergency healthcare in prisons in the past 10 years in Victoria, New South Wales and Queensland. The case review identified several themes - issues with prison authority policies and procedures that delay access to timely healthcare or compromise the quality of care, operational and logistical factors, clinical issues and stigmatic issues including prison staff attitudes to prisoners requesting urgent healthcare assistance. Coronial findings and royal commissions have repeatedly identified deficiencies in the emergency healthcare provided to prisoners in Australia. These deficiencies are operational, clinical and stigmatic and not limited to a single prison or jurisdiction. Applying a health quality of care framework focussed on prevention and chronic health management, appropriate assessment and escalation when urgent medical assistance is requested, and a structured audit framework could avoid future preventable deaths in prisons.

High Failure Rates in Prisoners Undergoing Spine Fusion Surgery.

The medical literature on prisoner health care is limited, despite data showing that prisoners experience high rates of physical and mental health challenges. We compared clinical outcomes for prisoners undergoing spine fusion with comparable nonincarcerated patients and determined what factors were implicated in differences in outcomes. Prisoners who underwent spinal fusion in 2011-2021 were retrospectively compared with an age-, sex-, and procedure-matched 3:1 control group of nonincarcerated spinal fusion patients. Fusion failure was confirmed by lack of bridging bone between vertebrae on CT or radiographic images >1year postoperatively or evidence of instrumentation failure with resultant >2mm of translation on flexion/extension radiographs. Twenty-seven identified prisoners were compared with 81 nonincarcerated controls. Ten prisoners and 6 controls experienced nonunion (37% vs. 7%, P < 0.01). Rates of risk factors for nonunion, such as smoking history, elevated body mass index, chronic steroid use, diabetes mellitus, previous spine surgery, and levels fused, were not significantly different between prisoners and controls. Among prisoners, those with nonunion were younger (45 vs. 53years, P= 0.03), had greater body mass index (34 vs. 29, P= 0.02), and were more likely to undergo reoperation (30% vs. 0%, P= 0.02). Multivariate analysis revealed that prisoners carry a 9.62 increased odds of nonunion compared with controls. This is one of few studies investigating health care outcomes in prisoners. We found they had a significantly higher rate of nonunion than matched control patients from the general population treated at the same hospital, suggesting additional measures may be necessary postoperatively to support fusion in prisoners.

Defining avoidable healthcare-associated harm in prisons: A mixed-method development study.

Reducing avoidable healthcare-associated harm is a global health priority. Progress in evaluating the burden and aetiology of avoidable harm in prisons is limited compared with other healthcare sectors. To address this gap, this study aimed to develop a definition of avoidable harm to facilitate future epidemiological studies in prisons. Using a sequential mixed methods study design we first characterised and reached consensus on the types and avoidability of patient harm in prison healthcare involving analysis of 151 serious prison incidents reported to the Strategic Executive Information System (StEIS) followed by in-depth nominal group (NG) discussions with four former service users and four prison professionals. Findings of the NG discussions and StEIS analysis were then synthesised and discussed among the research team and study oversight groups to develop an operational definition of avoidable harm in prison healthcare which was subsequently tested and validated using prison patient safety incident report data derived from the National Reporting and Learning System (NRLS). Analysis of StEIS incident reports and NG discussions identified important factors influencing avoidable harm which reflected the unique prison setting, including health care delivery issues and constraints associated with the secure environment which limited access to care. These findings informed the development of a new working two-tier definition of avoidable harm using appropriate and timely intervention, which included an additional assessment of harm avoidability taking into the account the prison regime and environment. The definition was compatible with the NRLS incident report narratives and illustrated how the prison environment may influence identification of avoidable harm and judgements of avoidability. We have developed a working definition of avoidable harm in prison health care that enables consideration of caveats associated with prison environments and systems. Our definition enables future studies of the safety of prison healthcare to standardise outcome measurement.

Incidence and Predictors of COVID-19 Infection in Prison Healthcare Workers.

The aim of the study is to assess the predictors of SARS-CoV-2 infection among correctional healthcare workers (HCWs). We conducted a retrospective chart review to describe the demographic and workplace characteristics of New Jersey correctional HCWs between March 15, 2020, and August 31, 2020, using univariate and multivariable analysis. Among 822 HCWs, patient-facing staff had the highest incidence of infection (7.2%). Associated risk factors include being Black and working in a maximum-security prison. There were few statistically significant findings due to small total numbers ( n = 47) that tested positive. Correctional HCWs' challenging work environment creates unique risk factors for infection with the SARS-CoV-2 virus. Administrative measures taken by the department of corrections may have a significant role in curbing the spread of infection. The findings can help focus preventive measures for reducing the spread of COVID-19 in this unique population.

A qualitative exploration of the older prisoner health and social care assessment and plan (OHSCAP) in a “dangerous” prison system

ABSTRACT Older prisoners are the fasted growing sub group in prisons across developed countries. They have high levels of health and social care needs in relation to their younger counterpart and those of the same age living in the community. There are a lack of interventions to ensure their needs are met. The older prisoner health and social care assessment and plan (OHSCAP) provided a structured process for addressing need and it’s effectiveness was evaluated in a randomised controlled trial (RCT). This paper presents findings from the nested qualitative study relating to this RCT. The aim of this study was to explore the facilitators and barriers to delivering the OHSCAP. Semi-structured interviews were conducted with twelve staff members delivering the OHSCAP and 14 service users who had received the intervention. The framework method was used to analyse the data produced. Participants described a ‘broken’ prison system. They discussed a staffing crisis resulting in individuals’ human rights being violated, which led to dangerous conditions in the prison. These conditions further impeding the staffing crisis, as recruitment was difficult and staff sickness was high. This ‘broken’ prison cycle significantly contributed to a lack of adequate attention being paid to OHSCAP processes. The delivery of health and social care interventions in prison is challenging when basic systems relating to staffing and safety are not adequate. Future research needs to consider how these circumstances can be mitigated.

“It was really poor prior to the pandemic. It got really bad after”: A qualitative study of the impact of COVID-19 on prison healthcare in England

BackgroundThe impact of COVID-19 has been exceptional, particularly on the National Health Service which has juggled COVID affected patients alongside related staff shortages and the existing (and growing) health needs of the population. In prisons too, healthcare teams have been balancing patient needs against staffing shortfalls, but with additional strains unique to the prison population. Such strains include drastic lockdown regimes and prolonged isolation, the need to consider health alongside security, known health inequalities within prisoner groups, and an ageing and ethnically diverse population (both groups disproportionately affected by COVID). The aim of this paper is to contribute to emerging research on the impact of COVID-19 on prison healthcare.MethodsWe conducted 44 in depth interviews (over phone or video) across three groups: prison leavers, healthcare staff and decision makers, between July and December 2021. Framework analysis was undertaken.ResultsThree themes were found. First, we found that Covid-19 had a significant impact on prison healthcare which involved reduced access and changes to how healthcare was delivered. This affected the health of prisoners by exacerbating existing conditions, new conditions being undiagnosed and mental health needs increasing. Second, the pandemic impacted on healthcare staff through creation of stress, frustration and exhaustion due to minimal staffing levels in an already under-resourced system. Third, an emerging conflict was witnessed. People in prison felt neglected regarding their healthcare needs but staff reported doing the best they could in an unprecedented situation. Healthcare staff and decision makers felt that prison healthcare was seen as a poor relation when compared with healthcare in the community, with no extra resource or staffing for Covid-19 testing or vaccinations.ConclusionThe Covid-19 pandemic has significantly impacted almost all aspects of prison healthcare in the UK. This includes delivery of healthcare by staff, receipt of it by people in prison and the management, planning and commissioning of it by decision makers. These three groups of people were all affected detrimentally but in vastly different ways, with some participants describing a sense of trauma. Health needs that were exacerbated or went unmet during Covid urgently need to be addressed in order to reduce health inequalities. In order for welfare and wellbeing to be maintained, and in some cases repaired, both prisoners and staff need to feel heard and recognised.

Salud en cárceles del Uruguay Reflexiones y propuestas de intervención en gestión y política sanitaria

The Prison Parliamentary Office of Uruguay is the one that, according to the law, supervises and advises the adult penitentiary system. At the end of April 2022, it presented its preliminary report for the year 2021 on the situation of the prison system in our country. Although the report covers multiple thematic areas, ranging from prison administration to the role of external organizations that affect the institute, the purpose of this article is to focus on the health aspects of the report, analyze them, present some reflections, and propose where a policy of prison health care and management should be directed in the country. The report shows a prison system that does not meet the minimum level established by international standards. So far, the Ministry of Health has not yet created a specific area that directs and regulates a prison health strategy in the country. Assistance is fragmented and weak, affecting prisoners, their families and the community. A unified policy led by an area defined in the Ministry of Health, based on primary care, with the participation of all actors involved in the prison system, promoting campaigns that include prisoners as active users, in added a protect and train staff, are some of the aspects that a national health strategy in prisons should consider to guarantee universal and quality access.

Interventions to improve the implementation of evidence-based healthcare in prisons: a scoping review

BackgroundThere are challenges to delivering high quality primary care within prison settings and well-recognised gaps between evidence and practice. There is a growing body of literature evaluating interventions to implement evidence-based practice in the general population, yet the extent and rigour of such evaluations in incarcerated populations are unknown. We therefore conducted a scoping literature review to identify and describe evaluations of implementation interventions in the prison setting.MethodsWe searched EMBASE, MEDLINE, CINAHL Plus, Scopus, and grey literature up to August 2021, supplemented by hand searching. Search terms included prisons, evidence-based practice, and implementation science with relevant synonyms. Two reviewers independently selected studies for inclusion. Data extraction included study populations, study design, outcomes, and author conclusions. We took a narrative approach to data synthesis. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance for scoping reviews.ResultsFifteen studies reported in 17 papers comprised one randomised controlled trial, one controlled interrupted time series analysis and 13 uncontrolled before and after studies. Eight studies took place in the US and four in the UK. Ten studies evaluated combined (multifaceted) interventions, typically including education for staff or patients. Interventions most commonly targeted communicable diseases, mental health and screening uptake. Thirteen studies reported adherence to processes of care, mainly testing, prescribing and referrals. Fourteen studies concluded that interventions had positive impacts.ConclusionsThere is a paucity of high-quality evidence to inform strategies to implement evidence-based health care in prisons, and an over-reliance on weak evaluation designs which may over-estimate effectiveness. Whilst most evaluations have focused on recognised priorities for the incarcerated population, relatively little attention has been paid to long-term conditions core to primary care delivery. Initiatives to close the gaps between evidence and practice in prison primary care need a stronger evidence base.

Hereford: Prigionieri italiani non cooperatori in Texas

Hereford: Prigionieri italiani non cooperatori in Texas

ENSURING THE RIGHT TO HEALTH CARE FOR GROUPS VULNERABLE TO HIV IN PENITENTIARY INSTITUTIONS AND PRE-TRIAL DETENTION CENTERS IN UKRAINE.

The aim: To consider the problems of penitentiary health care for groups vulnerable to HIV in penitentiary institutions and pre-trial detention centers in Ukraine, and to determine the state of implementation of the rights of prisoners to health care. Materials and methods: When writing this article, the authors used a number of scientific and special study methods: regulatory method, dialectical method, statistical method. We also conducted an anonymous survey of 150 released persons from penitentiary institutions and 25 medical workers from 7 penitentiary institutions and correctional colonies in different regions of Ukraine to assess the quality and availability of medical care for convicts vulnerable to HIV infection, tuberculosis, and viral hepatitis. Conclusions: The right to health-care of convicted prisoners must be ensured in compliance with the principle of free choice of specialist according to health-care law, health-care standards and clinical protocols (in other words, amount and standards of health-care available for prisoners must be the same as that available for other people). In practice prisoners are thrown out of the national health-care system, and the Ministry of Justice is unable to meet all needs. This can have a disastrous result as the penitentiary system will produce sick people who pose threat for civil society.

Depression in Male Inmates.

Introduction: The prevalence of psychiatric morbidity is high among incarcerated individuals. Severe mental disorder is five to ten times higher among prisoners compared to the general population. Several factors are held to be responsible for the high prevalence of depression in prison: mainly poor living conditions (narrow room, loss of privacy), limited interpersonal relationships, and lack of mental health access. Inmates are at increased risk of all-cause mortality, suicide, self-harm, violence, and victimization while those with mental disorders are involved in conflicts and are more likely to be charged with prison rules. Purpose: To explore depression among male inmates. Methods and material: In the study, 101 male inmates were enrolled. Data were collected by the completion of a “self-rating depression scale (SDS)-Zung” which included participants’ characteristics. The statistical significance level was p < 0.05. Results: Of the 101 participants, 51.4% of inmates were under 40 years old, 54.5% were married, 45.6% had been convicted of homicide and 38.6% had a life sentence. Normal depression levels were experienced by 62.4% of the participants, while 21.8% were mildly depressed, 14.9% were moderately depressed and 1.0% severely depressed. Foreign prisoners had statistically significant higher scores of depression compared to Greeks (median 48 vs. 45, p = 0.012); those suffering from a chronic disease compared to those who did not (median 48 vs. 45, p = 0.038); those who had spent time in solitary confinement compared to those who had not (median 46 vs. 43.5, p = 0.038) as well as those who had not considered harming themselves compared to those who had thought of it (median 46 vs. 44, p = 0.017). Conclusion: Given that prison populations are marginalized and deprived of the rights that people in the community benefit from, establishing the prevalence of depression in male inmates and its associated characteristics may help to formulate recommendations for future prison health care services. Clinical, research, and policy efforts are needed to improve prison mental health.

The contingent effect of incarceration on state health outcomes

IntroductionThis study examines how growth in the population of former prisoners affects rates of communicable diseases such as tuberculosis, syphilis, chlamydia, and HIV. MethodsWe estimate state-level fixed effects count models showing how the former prisoner population affected communicable disease in U.S. states from 1987 to 2010, a period of dramatic growth in incarceration. ResultsWe find contingent effects, based on how specific diseases are recognized, tested, and treated in prisons. The rate of former prisoners increases diseases that are poorly addressed in the prison health care system (e.g., chlamydia), but decreases diseases that are routinely tested and treated (e.g., tuberculosis). For HIV, the relationship has shifted in response to specific treatment mandates and protocols. Data on prison healthcare spending tracks these contingencies. DiscussionImproving the health of prisoners can improve the health of the communities to which they return. We consider these results in light of the relative quality of detection and treatment available to underserved populations within and outside prisons.