Temperament, substance use and psychopathology in a prisoner population: implications for treatment

Global Estimates of the Prevalence of Depression among Prisoners: A Systematic Review and Meta-analysis

BACKGROUND

Prison populations tend to be marginalized and disadvantaged of the rights and freedoms that other people in the community benefit from. Their separation from families, a narrow room and lack of privacy in the prison, violence between prisoners, and the uncertainty about the future result in psychological distress, for example, depression. The review has synthesized previous studies conducted on the topic and summarized to formulate recommendations for future prison health care services.

METHODS

We systematically searched the databases: PubMed, Psych Info, and SCOPUS, as well as manual Google Scholar searches, were conducted to retrieve published literature globally. We have included observational studies, written in English language. Estimates were pooled using a random-effects model. The study protocol was registered in PROSPERO with protocol number CRD42020156108. Subgroup and sensitivity analysis was conducted, and heterogeneity across the studies was evaluated using Q and the I ²-test. Publication bias was assessed by inspection of the funnel plot and Egger's regression test.

RESULT

A total of 1313 studies were initially identified through the electronic database; among these, a total of 73 full-text articles were retrieved for further appraisal. Further, 32 full-text articles were included in the final systematic review and meta-analysis. In this meta-analysis, the pooled prevalence of depression among prisoners was 36.9% (95% CI; 27.3-47.6). The pooled prevalence of depression among prisoners in the developing and developed countries was 39.2% and 33.1%, respectively. Moreover, the prevalence of depression was 19.1% and 54% for the studies that used diagnostic and screen tools to diagnose or screen depression, respectively. A leave-one-out analysis revealed that the pooled prevalence of depression among prisoners was not dependent on a single study removal or addition. Thus, the pooled prevalence of depression ranges between 35.3 and 38.0%.

CONCLUSION

The prevalence of depression among prisoners was high. Therefore, regular and continuous screening of depressive symptoms for prisoners along with its appropriate management is highly recommended.

Polydrug use patterns and their impact on relapse among heroin-dependent patients in Shanghai, China

AIMS

To describe the polysubstance use patterns of heroin-dependent patients and to understand the impact of polysubstance use patterns on relapse during the 5 years after completing compulsory rehabilitation programmes.

DESIGN

In this secondary analysis, the baseline data of 503 heroin-dependent patients were linked with their 5-year follow-up data from official records.

SETTING

Four compulsory rehabilitation centres in Shanghai, China.

PARTICIPANTS

A total of 564 heroin-dependent patients who were discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008 were recruited. Among these, 503 patients with available follow-up records were included in this analysis.

MEASUREMENTS

The baseline measurements included the Addiction Severity Index, the Temperament and Character Inventory and the Medical Outcomes Study Social Support Scale. Relapses after discharge from the compulsory rehabilitation centres were extracted monthly from the official electronic record system. Latent class analysis was used to identify different polysubstance use patterns. Associations between the identified latent classes and heroin use and the factors related to relapse during the 5-year follow-up were analysed with the Cox regression model.

FINDINGS

Three latent classes were identified in this cohort: (1) alcohol polydrug users (APU; 13.7%), (2) low polydrug users (LPU; 76.5%) and (3) amphetamine-type stimulant polydrug users (ASPU; 9.7%). During the 5-year follow-up, 298 heroin patients relapsed, and the three groups showed different relapse rates (ASPU 69.4 versus LPU 60.5 versus APU 44.9%, P = 0.02). The average durations of abstinence for the three groups differed (ASPU 31.27 ± 3.41 months versus LPU 36.77 ± 1.19 months versus APU 42.46 ± 2.81 months, P = 0.02). Multivariate Cox regression analyses found that the LPU [hazard ratio (HR) = 1.63, 1.06-2.51] and ASPU (HR = 2.10, 1.24-3.56) classes were positively associated with the risk of heroin relapse.

CONCLUSION

Polydrug use patterns differ among heroin-dependent patients in compulsory rehabilitation programmes in China. A history of polydrug use may predict heroin relapse risk among patients in those compulsory rehabilitation programmes.

Temperament and character traits associated with the use of alcohol, cannabis, cocaine, benzodiazepines, and hallucinogens: evidence from a large Brazilian web survey

OBJECTIVES

To evaluate how personality traits are associated with occasional use, abuse, and dependence of alcohol, cannabis, cocaine, benzodiazepines, and hallucinogens in a large availability sample of adults via online questionnaires.

METHODS

The sample consisted of 8,646 individuals (24.7% men and 75.3% women) who completed an anonymous web survey. Involvement with drugs and temperament/character traits were assessed through the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the Temperament and Character Inventory - Revised (TCI-R), respectively. Interactions among variables were analyzed using MANOVA with Bonferroni adjustment.

RESULTS

Novelty seeking was the trait most associated with increased involvement with alcohol, cannabis, and cocaine. There was a significant association between harm avoidance and benzodiazepine use. Persistence was lower in cannabis-, benzodiazepine-, and cocaine-dependent subjects, as well as in hallucinogen abusers. Self-directedness was reduced in dependents of all drug classes. No strong relationships were found between other temperament or character dimensions and the severity of drug use.

CONCLUSIONS

Novelty seeking was associated with increased involvement with all drugs studied in this sample, although to a lesser extent with benzodiazepines and hallucinogens. The temperament and character profile for benzodiazepine use was different from that of other drugs due to the relationship with higher harm avoidance and self-transcendence and lower self-directedness.

Personality differences between drug injectors and non-injectors among substance-dependent patients in substitution treatment

BACKGROUND

Understanding personality differences between injectors and non-injectors in substitution treatment may provide new insights to help improve treatment programs.

OBJECTIVE

The aim of this study was to compare drug injectors and non-injectors in terms of personality disorders and dimensions.

METHODS

Forty participants recruited from substance abuse treatment centers (23 injectors and 17 non-injectors) completed the self-report Personality Diagnostic Questionnaire 4th version and Temperament and Character Inventory. Mann-Whitney U tests were used to compare means of personality disorder traits, temperament, and character differences between injectors and non-injectors.

RESULTS

The mean (SD) age of the sample (72.5% male) was 36.5 (8.7) years. Injectors reported more borderline personality disorders and increased global personality disturbance (p < .05). Similarly, Anticipatory worry, Shyness, and Fatigability facet scores were higher among injectors (p < .01). Attachment, Purposeful, and Congruent second nature facet scores were higher among non-injectors (p < .01).

CONCLUSION

According to the route of drug administration, drug dependents differed in terms of personality disorders and dimensions.

SCIENTIFIC SIGNIFICANCE

These results may have implications for the implementation of treatment programs. New research in this area may contribute to the understanding and prevention of intravenous drug use.

Depression, anxiety, and history of substance abuse among Norwegian inmates in preventive detention: reasons to worry?

BACKGROUND

Inmates on preventive detention are a small and select group sentenced to an indefinite term of imprisonment. Mood disorders and substance abuse are risk factors for inmate violence and recidivism, so the prevalence of depression, anxiety, and substance abuse was examined in this cohort using psychometric tests.

METHODS

Completion of self-report questionnaires was followed by face-to-face clinical interviews with 26 of the 56 male inmates on preventive detention in Norway's Ila Prison. Substance abuse histories and information about the type of psychiatric treatment received were compiled. To assess anxiety and depression, the Hospital Anxiety and Depression Scale (HADS), the Clinical Anxiety Scale (CAS), and the Montgomery Asberg Depression Rating Scale (MADRS) were used.

RESULTS

Scores on the MADRS revealed that 46.1% of inmates had symptoms of mild depression. The HADS depression subscale showed that 19.2% scored above the cut-off for depression (κ = 0.57). The CAS anxiety score was above the cut-off for 30.7% of the subjects, while 34.6% also scored above the cut-off on the HADS anxiety subscale (κ = 0.61). Almost 70% of all these inmates, and more than 80% of those convicted of sex crimes, had a history of alcohol and/or drug abuse.

CONCLUSIONS

Mild anxiety and depression was found frequently among inmates on preventive detention. Likewise, the majority of the inmates had a history of alcohol and drug abuse. Mood disorders and substance abuse may enhance recidivism, so rehabilitation programs should be tailored to address these problems.

Traumatic brain injury rates and sequelae: a comparison of prisoners with a matched community sample in Australia

AIM

To compare rates of past reported traumatic brain injury (TBI) in a prisoner sample with those in a control group drawn from the same location of usual residence.

METHOD

The prisoner group comprised a consecutive sample of men (n = 200) received into custody and screened by face-to-face interview. The control group comprised men (n = 200) matched for location of usual residence screened by telephone interview. Participants were asked about past TBIs and screened for drug and alcohol abuse, impulsivity and dissocial personality disorder.

RESULTS

Eighty-two per cent of prisoners and 71.5% of community participants reported at least one past TBI of any severity (i.e. with or without a loss of consciousness (LOC)) and 64.5% of prisoners and 32.2% of community participants reported at least one TBI associated with a LOC. Prisoners were more likely to report persisting side-effects of TBI and were much more likely to screen positive for impulsivity and dissocial personality disorder. Multivariate analyses found no significant association between TBI frequency or severity and custody/community group membership.

CONCLUSIONS

High reported rates of TBI in prisoner populations may reflect the excess of socio-demographic risk factors for TBI. Results of the current study do not support a role for TBI as causally related to criminal conduct.