|Year : 2016 | Volume
| Issue : 2 | Page : 105-107
Prevalence of mental illness among inmates at Mukobeko maximum security prison in Zambia: A cross-sectional study
Mweene T Mweene, Seter Siziya
Department of Clinical Sciences, School of Medicine, Copperbelt University, Ndola, Zambia
|Date of Web Publication||4-Nov-2016|
Mweene T Mweene
Department of Clinical Sciences, School of Medicine, Copperbelt University, P. O. Box 71191, Ndola
Source of Support: None, Conflict of Interest: None
Objectives: The objective of this study is to determine the prevalence and sociodemographic correlates for mental illness among inmates at Mukobeko Maximum Security Prison, Zambia. Materials and Methods: A cross sectional study was conducted to assess psychiatric disturbance using a Self-Reported Questionnaire (SRQ20). A cut off point of 7/8 was used. The Chi-square test and Fishers' exact test were used to determine associations at the 5% significance level, and magnitude of association was estimated using the odds ratio and its 95% confidence interval. Results: Of the 394 inmates in prison, 29.2% had a current mental illness. Gender status was significantly associated with mental illness. Male participants were 35% (odds ratio = 0.65, 95% confidence interval [0.51, 0.82]) less likely to have mental illness compared to female participants. Conclusions: The prevalence of mental illness is high in Mukobeko Maximum Security Prison in Zambia. Gender-specific interventions should be designed to reduce the level of mental illness in this prison.
Keywords: Inmates, maximum prison, mental illness, prevalence, risk factors, Zambia
|How to cite this article:|
Mweene MT, Siziya S. Prevalence of mental illness among inmates at Mukobeko maximum security prison in Zambia: A cross-sectional study. J Mental Health Hum Behav 2016;21:105-7
|How to cite this URL:|
Mweene MT, Siziya S. Prevalence of mental illness among inmates at Mukobeko maximum security prison in Zambia: A cross-sectional study. J Mental Health Hum Behav [serial online] 2016 [cited 2017 Jun 26];21:105-7. Available from: http://www.jmhhb.org/text.asp?2016/21/2/105/193428
| Introduction|| |
Mental illness is a global problem among inmates. Sirdifield et al.  reported that 15% of all British prisoners had four or five co-existing mental health disorders. In England and Wales, over 90% of prisoners had a mental disorder.  A more recent study also reported that the burden of mental illness in the Zambian medium security prisons could be as high as 63%. 
Prevalence rates for mental illness may be higher among inmate than the general populations. Meltzer et al.  found that 10% of men on remand and 14% of female prisoners had shown signs of psychotic illness compared to 0.4% in the general population. Singleton et al.  also reported that psychiatric morbidity was more common among prisoners than among general population.
Although a number of studies have not been able to establish factors associated with mental illness in inmate populations, there is a number of contributing factors which could be identified to help explain the high rates of people with mental illnesses in the criminal justice system. These factors could include deinstitutionalization of mentally ill people, an increase in the use of drugs and alcohol by people with mental illnesses and the limited capacity or none functionality of community-based mental health services to address the needs of mentally ill offenders.  The general prison environment and regimes governing daily life inside prison can also be detrimental to the mental health of inmates.  There is little information on the prevalence and correlates for mental illnesses in Zambian prisons. Hence, a study was conducted in a maximum security prison to determine the prevalence and socio-demographic correlates for mental illness among inmates.
| Methods|| |
A cross-sectional study was conducted at Mukobeko Maximum Security Prison in Kabwe, Zambia. The population included remanded, sentenced, and condemned inmates. Those serving their sentences outside the prison premises and also those below 18 years of age were not included in the study population. Sample size of 394 was derived after using the formula:
Sample size = z2 × p (1 − p)/m2
Whereby " m" was margin of error that was set at 5%, " z" was confidence level at 95% (1.96) and " p" was postulated prevalence of mental illness in the project area (63.1%).
A sampling frame was constructed by enumerating all the names of the inmates with their corresponding numbers on the register. A Windows excel function was used to generate a list of random numbers which was used to select inmates from the sampling frame.
A Self-Reported Questionnaire (SRQ20) was used to collect data. The SRQ, consisting of 20 questions, is an instrument developed by the World Health Organization  to screen for psychiatric disturbance especially in developing countries. The following disorders can be screened using SRQ20: depression (depressive episodes, recurrent depressive disorders, and dysthymia), anxiety-related disorders (phobic anxiety disorder, panic disorder, generalized anxiety disorder, mixed anxiety-depressive disorder, obsessive-compulsive disorder, and adjustment disorder), somatoform disorders (somatization disorder and undifferentiated somatoform disorder), and other neurotic disorders (Neurasthenia).  The questionnaire was self-administered to consenting participants and took 15-20 min to be administered. Sociodemographic information (age, sex, religion, education, occupation, marital state, and admission status) were added to the SRQ20. The tool (SRQ20) with a cut off point of 7/8 has been validated and used in a variety of settings including Zimbabwe, Swaziland, Kenya, Sudan, South Africa, Zambia, and Malawi. In SRQ 20 validation studies, test sensitivity ranged from 63% to 90% and specificity from 44% to 95%. 
Data entry and analysis
Data entry and analysis were conducted using a Statistical Package for Social Sciences version 16.0 (SPSS) Release 16.0.0 (Sep 13, 2007) (SPSS Inc., 1989-2007). Data were edited using range checks. Associations were established using the uncorrected Chi-square test at the 5% significance level. The Fisher's exact test for association was used to test for the association when a cell in a two by two contingency table had an expected frequency of <5. The magnitude of association was estimated using Odds ratio (OR) and its 95% confidence interval (CI) to determine associations between socio-demographic factors and mental illness.
The research proposal was approved by the Copperbelt University School of Medicine, Department of Clinical Sciences, Public Health Unit. Permission to conduct the study was granted by the Permanent Secretary, Ministry of Home Affairs and Mukobeko Maximum Security Prison administration. A clinical officer (MTN), an environmental health technologist and one social worker administered the questionnaire. Both verbal and written consent were obtained from the participants before taking part in the study. Participants were informed that their participation was entirely voluntary and that they were free to decide whether or not to participate and were also at liberty to withdraw at any time from the study without giving reasons for doing so. Participants who had mental health problems were referred to Kabwe General Hospital, Psychiatric Unit for assessment and management. Confidentiality was upheld by use of codes on the questionnaires. Interviews were carried out in privacy. Consent forms and questionnaires were only accessible to the investigator.
| Results|| |
The sample consisted of 394 participants with a mean age of 36 (standard deviation 11.0) years. [Table 1] shows the distribution of participants by sociodemographic factors. Most of the participants were males (73.6%) and were Christians (97.0%). About half of the participants had attained the secondary level of education (50.5%). Altogether, 87.8% of the participants were sentenced.
|Table 1: Description of the sample of participants in Mukobeko Maximum Security Prison |
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Out of 394 participants, 115 (29.2%) had a mental illness. [Table 2] shows factors associated with mental illness. Only gender was significantly associated with mental illness. Respondents who were male were 35% (OR = 0.65, 95% CI [0.51, 0.82]) less likely to suffer from mental illness compared to female participants.
|Table 2: Factors associated with mental illness in bivariate analyses among inmates in the Mukobeko Maximum Security Prison |
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| Discussion|| |
The prevalence rate of mental illness in this study was 29.2%. Male participants were less likely to have mental illness compared to females. This prevalence rate of 29.9% was lower than 63.1% obtained in the medium security prison in Zambia.  These findings are synonymous to those by James and Glaze  that show a pattern of lower prevalence rate in maximum security prisons than in the medium security prisons: 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates.
James and Glaze  found no gender difference in the prevalence rates of mental illness, contradicting the finding from the current study that reported male participants were less likely to have mental illness compared to females. Male inmates in this study had a number of social amenities like sports, religious activities as well as education facilities which were contributing positively to their mental well-being.
There are a few limitations to the study. First, as a cross-sectional study, we are unable to make causal inference on whether being imprisoned causes mental illness since there was no psychiatric screening before imprisonment to rule out who may already have had mental health problems. Second, the SRQ20 does not measure specific mental disorders but symptoms of psychiatric morbidity; hence, the prevalence herein does not specify the prevalence of a specific mental disorder. Third, the SRQ does not elicit other causes of mental health problems since it is highly structured. Fourth, we used an SRQ20 that is a screening questionnaire, and no confirmatory diagnostic was made. However, it was used since it is the only validated and convenient tool for estimating mental health problems in Zambia for both the prison and general populations.
| Conclusion|| |
This is the first large-scale prevalence study of mental illness in the maximum security prison in Zambia. The observed prevalence in the current study is high, and gender should be considered in designing interventions to reduce the prevalence of mental illness among inmates in a maximum security prison in Zambia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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World Health Organization. A User's Guide to the Self Reporting Questionnaire (SRQ). Geneva: World Health Organization; 1994.
James DJ, Glaze LE. Mental health problems of prison and jail inmates. Bureau of Justice Statistics. Washington: US Department of Justice; 2006.
[Table 1], [Table 2]