Diseases and access to treatment by the Peruvian prison population: an analysis according to gender

Health in Persons Deprived of Their Liberty in South America: A Painful Reflection of Our Public Health

Objectives

To describe sociodemographic characteristics and health-related data in persons deprived of liberty (PDL) from South America in the last five years.

Methods

Documentary descriptive study.

Results

There are 1.5 million PDL in Latin America and the Caribbean; the average overcrowding is 64%; 58% do not sleep in beds, 20% do not have access to clean water and 29% do not receive medical care. In Peru, during 2021, there were 87,245 PDL and 69 penal institutions. The national average overcrowding is 120%, the second-highest in South America. In South America, the prevalence of tuberculosis is 2.0% SD = 0.64 and the median of illegal substances prevalence is 34.6 (IQR = 7.5-41.4). In Peru, the prevalence of tuberculosis has decreased since 2016 (4.3%), 2018(3.5%), and 2021(2.5%). Among the health problems by country, there were more data on substance use: 8/10, and tuberculosis, 7/10 countries. Cardiovascular diseases had the least available data. Regarding COVID-19, during the first wave in Peru, 54% of the total PPL were infected, and by the end of the wave, 446 PDL and 46 members of the prison staff had died. In Colombia, between April and October 2020, there were 16,804 cases (80 in ICU) and 136 deaths. In Brazil, up to March 2021, 340 people had died, and there were over 67,000 infections.

Conclusions

Overcrowding is an unresolved problem; tuberculosis and substance use are the most frequent issues. Data are limited in quality, homogeneity and availability. Greater effort is needed from health authorities to improve health management and information systematization.

Source

MesH.

Associated factors to depression diagnosed during incarceration in Peruvian male prisoners: a sub-analysis of the national census of prison population

PURPOSE

Depression has become a major health concern, particularly in developing countries. This disorder is highly prevalent among certain vulnerable populations, such as prisoners. In Peru, prisons are overcrowded, and the health of prisoners is neglected. Thus, this study aims to estimate the prevalence of depression diagnosed during incarceration in male inmates from all Peruvian prisons and assess its associated factors.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study was conducted based on the secondary data analysis of the National Census of Prison Population 2016 in Peru. This study included records of prisoners who reported whether they were diagnosed with depression by a health-care professional after admission into the prisons. Descriptive, bivariate and multivariable analyses were performed.

FINDINGS

Of the 63,312 prisoners included in this study, 1,007 reported an in-prison diagnosis of depression by a health-care professional, which represents a prevalence of 1.59%. Substance use disorder (adjusted prevalence ratio [aPR] 3.10; 95% confidence interval [CI]: 1.91-5.03), hypertension (aPR 7.20; 95% CI: 6.28-8.24) and previous discrimination (aPR 1.97; 95% CI: 1.62-2.40) were strongly associated with depression, even when adjusting for multiple confounders. Other directly associated variables were, for example, violence during childhood, infrequent visits in prison and diabetes.

ORIGINALITY/VALUE

The right of prisoners to adequate health care is being neglected in Peru. Mental health is a cornerstone of health quality. Acknowledging which factors are associated with depression in prison is important to implement strategies to improve the mental health of prisoners.

Psychological distress of inmates at a women's prison in Lima after the first wave of COVID-19 in November 2020

OBTECTIVES

A descriptive study was carried out to establish the levels of psychological distress amongst female inmates at a high-security prison in Lima in November 2020, after the first wave of COVID-19.

MATERIAL AND METHOD

The Brief Symptoms Inventory-18 (BSI-18) was applied to a representative sample of 314 female inmates who agreed to participate in the study.

RESULTS

Results showed that 34.6% of the inmates could be considered as cases of psychological distress. Moreover, the depression subscale had the highest score, followed by the anxiety and the somatisation subscales. The most prevalent symptom was "feeling blue".

DISCUSSION

The prevalence of distress symptoms was analyzed, taking into account the effects of the first wave of COVID-19, the suspension of family visits, the restriction of treatment and leisure activities, etc. Gender aspects were also taken into consideration.

The use of benzodiazepines and the mental health of women in prison: a cross-sectional study

In this article we assessed the prevalence of benzodiazepine (BZD) use in women before and during imprisonment, as well as its related factors and association with symptoms of anxiety, depression, and posttraumatic stress disorder in a quantitative, cross-sectional, analytical study of regional scope. Two female prisons in the Brazilian Prison System were included. Seventy-four women participated by completing questionnaires about their sociodemographic data, BZD use and use of other substances. These questionnaires included the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C). Of the 46 women who reported no BZDs use before arrest, 29 (63%) began using BZDs during imprisonment (p < 0.001). Positive scores for PTSD, anxiety, and depression, as well as associations between BZD use during imprisonment and anxiety (p = 0.028), depression (p = 0.001) and comorbid anxiety and depression (p = 0.003) were found when a bivariate Poisson regression was performed. When a multivariate Poisson regression was performed for tobacco use, the PHQ-9 and GAD-7 scales, BZD use was associated with depression (p = p = 0.008), with tobacco use (p = 0.012), but not with anxiety (p = 0.325). Imprisonment increases the psychological suffering of women, consequently increasing BZD use. Nonpharmacological measures need to be considered in the health care of incarcerated women.

Prevalência e fatores associados a sintomas ansiosos e depressivos em mulheres privadas de liberdade em Juiz de Fora-MG, Brasil

Resumo Sofrimento psíquico e desenvolvimento de transtornos mentais nas prisões são questões de saúde pública reconhecidas mundialmente. Objetivou-se identificar a prevalência destes sintomas e os fatores associados em 99 mulheres com mais de 18 anos de idade, nos regimes provisório, fechado e semiaberto de Juiz de Fora-MG. Trata-se de um estudo transversal, do tipo censo, com dados coletados face a face através de questionário semiestruturado e multidimensional. Os desfechos foram avaliados pelo Patient Health Questionannaire-4 (PHQ-4). Para a análise de associação foi construído um modelo teórico de determinação com três blocos hierarquizados. Foram estimadas razões de prevalência brutas por meio do teste Qui-quadrado e ajustadas entre si dentro de cada bloco (p≤0,20). Para o modelo final de regressão de Poisson com variância robusta foi adotado p≤0,05. A prevalência de sintomas ansiosos e depressivos foi, respectivamente, de 75,8% (IC95% 66,1%-83,8%) e 65,7% (IC95% 55,4%-74,9%). No modelo final, sintomas ansiosos associaram-se à presença de sintomas depressivos. Já sintomas depressivos associaram-se à faixa etária de 20 a 29 anos e à presença de sintomas ansiosos. Verificou-se prevalência dos desfechos em mais da metade das participantes, com destaque para interassociação entre eles.

Prevalence and factors associated with anxiety and depressive symptoms in women deprived of liberty in Juiz de Fora-MG, Brazil

Abstract Psychological distress and developing mental disorders in prisons are globally recognized public health issues. This study aimed to identify the prevalence of these symptoms and associated factors in 99 women over 18 years of age in the provisional, closed, and semi-open regimes in Juiz de Fora-MG, Brazil. This cross-sectional census study collected data face-to-face through a semi-structured and multidimensional questionnaire. We assessed outcomes using the Patient Health Questionnaire-4 (PHQ-4). We built a theoretical determination model with three hierarchical blocks for the association analysis. We estimated crude prevalence ratios using the chi-square test and adjusted for each other within each block (p≤0.20). We adopted p≤0.05 for the final Poisson regression model with robust variance. The prevalence of anxiety and depressive symptoms was 75.8% (95%CI 66.1%-83.8%) and 65.7% (95%CI 55.4%-74.9%), respectively. In the final model, anxiety symptoms were associated with depressive symptoms. On the other hand, depressive symptoms were associated with the 20-29 years age group and anxiety symptoms. We identified a prevalence of the outcomes in more than half of the participants, emphasizing the inter-association between them.

Knowledge, attitudes and practices related to sexually transmitted infections of men in prison

OBJECTIVES

to analyze the knowledge, attitudes, and practices related to sexually transmitted infections of men in prison.

METHODS

qualitative study, based on the methodology Knowledge, Attitude and Practice, conducted with 30 men in prison. The study applied individual interviews submitted to the analyze of the discourse.

RESULTS

the incipient knowledge of men was associated with: self-illness and the others', diagnosis, and perception of risk behavior, pervaded by distrust or lack of understanding of the rapid test for detection. The attitudes involved culpability of partnerships, non-adherence to prevention inputs, and resistance to look for health services. The practices are linked to health care after the identification of the disease, use of penile condoms, and attention to the partnership.

CONCLUSIONS

the reduced knowledge about Sexually Transmitted Infections makes attitudes stereotyped, stigmatized, compromised by the level of education. The level of health care and the limits of deprivation of liberty weaken the practices.

Clinical and epidemiological characteristics of prisoners infected and deceased by COVID-19, National Penitentiary Institute of Peru, 2020

Objectives

To describe the clinical and epidemiological characteristics of inmates who were infected and died from COVID-19 in Peruvian prisons from April to October 2020.

Material and method

Descriptive, cross-sectional, retrospective study with a secondary data source. All the inmates who were infected and died from COVID-19 in Peruvian prisons during the study period were considered. The information was collected through the validated data collection sheet and was analyzed with descriptive statistics applying the SPSS v26 software.

Results

37,103 (42.3%) inmates were analyzed out of a prison population of 87,754. All of them reactive to the rapid test, with a mean age of 39.9 ± 12.6 years; 95.5% were male. 60.1% were IgG reactive; 36.1% were IgM/IgG reactive and 3.8% were IgM reactive. 20.1% of reactive inmates had COVID-19 symptoms at the time of testing. The most frequent symptoms were headache (55.6%), general malaise (49.7%), fever (49.0%) and cough (48.0%). Among the risk factors for COVID-19 were: age over 60 years (8.4%), high blood pressure (2.8%) and diabetes mellitus (2.4%). 445 deaths were registered. Total fatality reached 1.2% of the number of infected. The highest number of deaths was recorded in April and May (89 and 162, respectively).

Discussion

The study findings imply different approaches to managing epidemics in the prison context compared to the general population. The short and long term scenarios are uncertain, but the need to reorganize the prison health system, and to prioritise and modernise it are evident. The long-delayed reform of the prison system and the measures that set out to contain the spread of the COVID-19 disease in prisons are related processes in this regard.

Experiences of incarcerated mothers living with their children in a prison in Lima, Peru, 2020: a qualitative study

OBJECTIVES

This study explores the experiences of incarcerated women living with their children in the Women Chorrillos Penitentiary, Lima, Peru, 2020.

MATERIAL AND METHOD

Qualitative, exploratory study with a phenomenological design, through semi-structured interviews with inmates who lived with their minor in the prison. In total there were 13 interviews considering the theoretical saturation of categories.

RESULTS

The experiences consisted of mostly negative intrapersonal experiences, related to different individual aspects and the conditions of confinement and prison treatment. Serious deficiencies perceived in the health care of inmates and children stand out, with emphasis on mistreatment and indifference on the part of the staff. Other factors involved in the construction of these experiences were identified.

DISCUSSION

The results provide evidence of serious structural and organizational deficiencies that violate the fundamental rights of the population group studied. Government efforts to date are partial and insufficient. Sustainable policies and programs are urgently needed that prioritize quality health care and adequate prison treatment for these people with an emphasis on preventive promotional actions. There is a need for evidence-based interventions to reduce the harmful effects of childhood incarceration.