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

Laurindo, Cosme Rezende; Leite, Isabel Cristina Gonçalves; Cruz, Danielle Teles da

doi:10.1590/1413-812320222712.08952022EN

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ARTICLE • Ciênc. saúde coletiva 27 (12) • Dec 2022 • https://doi.org/10.1590/1413-812320222712.08952022EN copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Key words:
Prisons; Women; Health surveys; Mental Disorders

Variable		Anxiety symptoms				Depressive symptoms
		Identified		Not identified		Identified		Not identified
		n	%	n	%	n	%	n	%
Block 1 - Sociodemographic variables
Age group
	20-29 years	29	38.7	7	29.2	30	46.2	6	17.6
	30-59 years	46	61.3	17	66.7	35	53.8	28	82.4
Self-declared skin color
	Black	58	77.3	16	33.3	50	23.1	24	70.6
	Non-black	17	22.7	8	66.7	15	76.9	10	29.4
Gender
	Cisgender	70	93.3	21	87.5	62	95.4	29	85.3
	Transgender	1	1.3	2	8.3	1	1.5	2	5.9
	Non-binary	4	5.3	1	4.2	2	3.1	3	8.8
Marital status
	Companion/married	40	53.3	11	45.8	35	53.8	16	47.1
	Single/separated/widow/other	35	46.7	13	54.4	30	46.2	18	52.9
Children
	Yes	66	88.0	19	79.2	55	84.6	30	88.2
	No	9	12.0	5	20.8	10	15.4	4	11.8
Level of education
	Up to incomplete elementary school	47	62.7	14	58.3	43	66.2	18	52.9
	Elementary school to incomplete High School	18	24.0	3	12.5	13	20.0	8	23.5
	High School and over	10	13.3	7	29.2	9	13.8	8	23.5
Monthly income before incarceration
	0-1 minimum wage	50	66.7	16	66.7	43	66.2	23	67.6
	>1 to ≤2 minimum wages	22	29.3	4	16.7	17	26.2	9	26.5
	>2 minimum wages	3	4.0	4	16.7	5	7.7	2	5.9
Subjective Social Status
	Best SSS	12	16.0	6	25.0	14	21.5	4	11.8
	Worse SSS	63	84.0	18	75.0	51	78.5	30	88.2
Block 2.1 - Variables related to the health of women deprived of liberty: referred
Self-perceived health
	Good	45	40.0	23	95.8	38	58.5	30	11.8
	Poor	30	60.0	1	4.1	27	41.5	4	88.2
Referred morbidity
	Yes	39	52.0	13	54.0	34	52.3	18	52.9
	No	36	48.0	11	45.8	31	47.7	16	47.1
Active smoker
	Yes	57	76.0	15	62.5	51	78.5	21	61.8
	No	18	24.0	9	37.5	14	21.5	13	38.2
Anxiety symptoms
	Yes	75	75.8	24	24.2	59	90.8	16	47.1
	No	-	-	-	-	6	9.2	18	52.9
Depressive symptoms
	Yes	59	78.7	6	25.0	65	65.7	34	34.3
	No	16	21.3	18	75.0	-	-	-	-
Hansen’s Disease
	Yes	0	0.0	0	0.0	0	0.0	0	0.0
	No	75	100.0	24	100.0	65	100.0	34	100.0
Variable		Anxiety symptoms				Depressive symptoms
		Identified		Not identified		Identified		Not identified
		n	%	n	%	n	%	n	%
Leishmaniasis
	Yes	0	0.0	0	0.0	0	0.0	0	0.0
	No	75	100.0	24	100.0	65	100.0	34	100.0
Dengue
	Yes	8	10.7	0	0.0	6	9.2	2	5.9
	No	67	89.3	24	100.0	59	90.8	32	94.1
Tuberculosis
	Yes	0	0.0	0	0.0	0	0.0	0	0.0
	No	75	100.0	24	100.0	65	100.0	34	100.0
Syphilis
	Yes	5	6.7	1	4.2	5	7.7	1	2.9
	No	70	93.3	23	95.8	60	92.3	33	97.1
Gonorrhea
	Yes	0	0.0	0	0.0	0	0.0	0	0.0
	No	75	100.0	24	100.0	65	100.0	34	100.0
HIV/AIDS
	Yes	1	1.3	1	4.2	1	1.5	1	2.9
	No	74	98.7	23	95.8	64	98.5	33	97.1
Alcohol use in the last 30 days of deprivation of liberty
	Yes	3	4.0	0	0.0	2	3.1	1	2.9
	No	72	96.0	24	100.0	63	96.9	33	97.1
Tobacco use in the last 30 days of deprivation of liberty
	Yes	54	72.0	16	66.7	50	76.9	20	58.8
	No	21	28.0	8	33.3	15	23.1	14	41.2
Marijuana use in the last 30 days of deprivation of liberty
	Yes	4	5.3	0	0.0	3	4.6	1	2.9
	No	71	94.7	24	100.0	62	95.4	33	97.1
Use of weight loss medication or medication for staying awake (on) without a prescription in the last 30 days of deprivation of liberty
	Yes	1	1.3	0	0.0	1	1.5	0	0.0
	No	74	98.7	24	100.0	64	98.5	34	100.0
Use of tranquilizer, anxiolytic, tranquilizer, or anti-dystonic without a prescription in the last 30 days of deprivation of liberty
	Yes	8	10.7	1	4.2	6	9.2	3	8.8
	No	67	89.3	23	95.8	59	90.8	31	91.2
Block 2.2 - Variables related to the health of women deprived of liberty: health care
Health care report
	Yes	67	89.3	23	95.8	59	90.8	31	91.2
	No	8	10.7	1	4.2	6	9.2	3	8.8
Doctor visit in the last year
	Yes	70	93.3	23	95.8	60	92.3	33	87.1
	No	5	6.7	1	4.2	5	7.7	1	2.9
Psychologist visit in the last year
	Yes	59	78.7	16	66.7	48	73.8	27	79.4
	No	16	21.3	8	33.3	17	26.2	7	20.6
Social worker visit in the last year
	Yes	72	91.7	22	91.7	61	93.8	33	97.1
	No	3	8.3	2	8.3	4	6.2	1	2.9
Number of doctor visits in the last year
	None to two	42	56.9	7	29.1	34	52.3	15	44.1
	More than two	33	44.0	17	70.8	31	47.7	19	55.9
Number of psychologist visits in the last year
	None to two	54	72.0	20	83.3	48	73.8	26	76.5
	More than two	21	28.0	4	16.7	17	26.2	8	23.5
Number of social worker visits in the last year
	None to two	29	38.7	9	37.5	27	41.5	11	32.4
	More than two	46	61.3	15	62.5	38	58.5	23	67.6
Level of satisfaction with doctor visits
	Good	35	48.6	15	34.8	30	48.3	20	60.6
	Fair/Poor	37	51.4	8	65.2	32	51.6	13	39.4
Level of satisfaction with psychologist visits
	Good	43	72.9	17	89.5	36	73.5	24	82.8
	Fair/Poor	16	27.1	2	10.5	13	26.5	5	17.2
Level of satisfaction with social worker visits
	Good	57	78.1	20	87.0	50	79.4	27	81.8
	Fair/Poor	16	21.9	3	13.0	13	20.6	6	18.2

Variable		Anxiety symptoms				Depressive symptoms
		Identified		Not identified		Identified		Not identified
		n	%	n	%	n	%	n	%
Block 3.1 - Variables related to incarceration: sociability and leisure
Family ties
	With family ties	59	78.7	21	87.5	52	80.0	28	82.4
	No family ties	16	21.3	3	12.5	13	20.0	6	17.6
Receives social visit
	Yes	44	58.7	16	66.7	42	64.6	18	52.9
	No	31	41.3	8	33.3	23	35.4	16	47.1
Receives scheduled visit
	Yes	18	24.0	7	29.2	18	27.7	7	20.6
	No	57	76.0	17	70.8	47	72.3	27	79.4
Level of satisfaction with the relationship with other inmates
	Good	57	76.0	22	91.7	49	75.4	30	88.2
	Fair/poor	18	24.0	2	8.3	16	24.6	4	11.8
Level of satisfaction with the relationship with criminal police officers
	Good	55	73.3	6	25.0	48	73.8	25	73.5
	Fair/poor	20	26.7	18	75.0	17	26.2	9	26.5
Studying
	Yes	9	12.0	3	12.5	8	12.3	4	11.8
	No	66	88.0	21	87.5	57	87.7	30	88.2
Working
	Yes	26	34.7	14	58.3	22	66.2	18	52.9
	No	49	65.3	10	41.7	43	33.8	16	47.1
Attending religious celebrations
	Yes	60	80.0	9	37.5	50	76.9	25	73.5
	No	15	20.0	15	62.5	15	23.1	9	26.5
Reading
	Yes	53	70.7	19	79.2	49	75.4	27	79.4
	No	22	29.3	5	20.8	16	24.6	7	20.6
Watching TV
	Yes	66	88.0	21	87.5	59	90.8	28	82.4
	No	9	12.0	3	12.5	6	9.2	6	17.6
Engaging in sports
	Yes	12	16.0	6	25.0	10	15.4	8	23.5
	No	63	84.0	18	75.0	55	84.6	26	76.5
Having a conversation
	Yes	65	86.7	23	95.8	57	87.7	31	91.2
	No	10	13.3	1	4.2	8	12.3	3	8.8
Staying alone
	Yes	56	74.7	14	58.3	50	76.9	20	58.8
	No	19	25.3	10	41.7	15	23.1	14	41.2
Sleeping
	Yes	71	94.7	22	91.7	62	95.4	31	91.2
	No	4	5.3	2	8.3	3	4.6	3	8.8
Writing
	Yes	53	70.7	19	79.2	45	69.2	27	79.4
	No	22	29.3	5	20.8	20	30.8	7	20.6
Block 3.2 - Variables related to incarceration: penal characteristics
Type of crime committed
	Drug trafficking	40	53.3	12	50.0	30	46.2	22	64.7
	Other	35	46.7	12	50.0	35	53.8	12	35.3
Incarceration time
	≤15 months	42	56.0	11	45.8	36	55.4	17	50.0
	>15 months	33	44.0	13	54.2	29	44.6	17	50.0
Sentence
	Yes	54	72.0	16	66.7	45	69.2	25	73.5
	No	21	28.0	8	33.3	20	30.8	9	26.5
Sentence time
	≤7 years	30	60.0	6	37.5	24	57.1	12	50.0
	>7 years	20	40.0	10	62.5	18	42.9	12	50.0
Penal regime
	Provisional	21	28.0	8	33.3	20	30.8	9	26.5
	Closed	35	46.7	11	45.8	31	47.7	15	44.1
	Semi-open	19	25.3	5	20.8	14	21.5	10	29.4
Level of satisfaction with the cell conditions and size
	Good	39	52.0	17	70.8	33	50.8	23	32.4
	Fair/Poor	36	48.0	7	29.2	32	49.2	11	67.6
Level of satisfaction with prison activities
	Good	43	37.7	18	78.3	36	59.0	25	80.6
	Fair/Poor	26	62.3	5	21.7	25	41.0	6	19.4
Level of satisfaction with prison food
	Good	7	9.3	4	16.7	8	12.3	3	8.8
	Fair/Poor	68	90.7	20	83.3	57	87.7	31	91.2
Level of satisfaction with escort/transport
	Good	36	56.3	17	81.0	33	58.9	20	69.0
	Fair/Poor	28	43.8	4	19.0	23	41.1	9	31.0

Variable		Anxiety symptoms				Depressive symptoms
		Identified		Not identified		Identified		Not identified
		n	%	n	%	n	%	n	%
Block 3.3 - Variables related to incarceration: prejudice and violence
Prejudiced treatment by employees due to detainee status
	Yes	35	46.7	5	20.8	32	49.2	8	23.5
	No	40	53.3	19	79.2	33	50.8	26	76.5
Prejudiced treatment by employees due to ethnicity/skin color
	Yes	2	2.7	1	4.2	3	4.6	0	0.0
	No	73	97.3	23	95.8	62	95.4	34	100.0
Prejudiced treatment by employees due to social condition
	Yes	13	17.3	1	4.2	9	13.8	5	14.7
	No	62	82.7	23	95.8	56	86.2	29	85.3
Prejudiced treatment by employees due to sexual orientation
	Yes	7	9.3	1	4.2	6	9.2	2	5.9
	No	68	90.7	23	95.8	59	90.8	32	94.1
Prejudiced treatment by employees due to crime committed
	Yes	16	21.3	3	12.5	16	24.6	3	8.8
	No	59	78.7	21	87.5	49	75.4	31	91.2
Prejudiced treatment by employees due to looks
	Yes	9	12.0	5	20.8	9	13.8	5	14.7
	No	66	88.0	19	79.2	56	86.2	29	85.3
Prejudiced treatment by other detainees due to detainee status
	Yes	27	36.0	4	16.7	25	38.5	6	17.6
	No	48	64.0	20	83.3	40	61.5	28	82.4
Prejudiced treatment by other detainees due to ethnicity/skin color
	Yes	5	6.7	0	0.0	5	7.7	0	0.0
	No	70	93.3	24	100.0	60	92.3	34	100.0
Prejudiced treatment by other detainees due to social condition
	Yes	24	32.0	2	8.3	22	33.8	4	11.8
	No	51	68.0	22	91.7	43	66.2	30	88.2
Prejudiced treatment by other detainees due to sexual orientation
	Yes	13	17.3	3	12.5	14	21.5	2	5.9
	No	62	82.7	21	87.5	51	78.5	32	94.1
Prejudiced treatment by other detainees due to crime committed
	Yes	14	18.7	4	16.7	16	24.6	2	5.9
	No	61	81.3	20	83.3	49	75.4	32	94.1
Prejudiced treatment by other detainees due to looks
	Yes	21	28.0	3	12.5	19	29.2	5	14.7
	No	54	72.0	21	87.5	46	70.8	29	85.3
Physical abuse risk
	Yes	38	50.7	11	45.8	36	55.4	13	38.2
	No	37	49.3	13	54.2	29	44.6	21	61.8
Sexual violence risk
	Yes	0	0.0	1	4.2	1	1.5	0	0.0
	No	75	100.0	23	95.8	64	98.5	34	100.0
Psychological violence risk
	Yes	50	66.7	13	54.2	44	67.7	19	55.9
	No	25	33.3	11	45.8	21	32.3	15	44.1
Stab wound risk
	Yes	18	24.0	7	29.2	17	26.2	8	23.5
	No	57	76.0	17	70.8	48	73.8	26	76.5
Risk of firearm injury
	Yes	14	18.7	6	25.0	13	20.0	7	20.6
	No	61	81.3	18	75.0	52	80.0	27	79.4
Burning risk
	Yes	16	21.3	6	25.0	16	24.6	6	17.6
	No	59	78.7	18	75.0	49	75.4	28	82.4
Explosion risk
	Yes	24	32.0	9	37.5	22	33.8	11	32.4
	No	51	68.0	15	62.5	43	66.2	23	67.6
Victim of physical abuse in the last year
	Yes	14	18.7	2	8.3	12	18.5	4	11.8
	No	61	81.3	22	91.7	53	81.5	30	88.2
Victim of verbal abuse in the last year
	Yes	41	54.7	5	20.8	37	56.9	9	26.5
	No	34	45.3	19	79.2	28	43.1	25	73.5
Victim of sexual harassment or abuse in the last year
	Yes	0	0.0	1	4.2	1	1.5	0	0.0
	No	75	100.0	23	95.8	64	98.5	34	100.0
Victim of fall in the last year
	Yes	13	17.3	2	8.3	12	18.5	3	8.8
	No	62	82.7	22	91.7	53	81.5	31	91.2
Victim of attempted murder in the last year
	Yes	1	1.3	0	0.0	1	1.5	0	0.0
	No	74	98.7	24	100.0	64	98.5	34	100.0
Attempted suicide in the last year
	Yes	7	9.3	0	0.0	7	10.8	0	0.0
	No	68	90.7	24	100.0	58	89.2	34	100.0

Variable		%	Crude PR (95%CI)	p*	Adjusted PR in the block (95%CI)	p**	Adjusted PR - final model (95%CI)	p**
Block 2 - Variables related to the health of women deprived of liberty
Self-perceived health				0.002		0.048		0.071
	Good	66.2	1		1		1
	Poor	96.8	15.33 (1.97-119.67)		8.47 (1.02-70.64)		7.16 (0.84-60.86)
Number of visits with the doctor in the last year				0.046		0.046		0.077
	>2	66.0	1		1		1
	≤2	86.0	3.18 (1.12-9.01)		3.22 (1.02-10.17)		2.88 (0.89-9.34)
Depressive symptoms				<0.001		<0.001		0.002
	No	47.1	1		1		1
	Yes	90.8	11.06 (3.77-32.46)		7.47 (2.34-23.87)		6.42 (1.96-21.06)
Block 3 - Variables related to incarceration
Working				0.069		0.019		0.257
	Yes	65.0	1		1		1
	No	83.1	2.64 (1.03-6.76)		4.28 (1.27-14.43)		1.95 (0.62-6.16)
Satisfaction with escort-transportation				0.077		0.140		-
	Yes	67.9	1		1		-
	No	87.5	3.31 (1.00-10.93)		2.72 (0.72-10.30)		-
Prejudiced treatment by employees due to detainee status				0.045		0.658		-
	No	67.8	1		1		-
	Yes	87.5	3.33 (1.12-9.84)		1.43 (0.30-6.88)		-
Prejudiced treatment by other detainees due to social condition				0.043		0.044		0.288
	No	69.9	1		1		1
	Yes	92.3	5.18 (1.12-23.83)		9.58 (1.06-86.40)		2.51 (0.46-13.71)
Victim of verbal abuse in the last year				0.008		0.177		-
	No	64.2	1		1		-
	Yes	89.1	4.58 (1.55-13.56)		2.91 (0.62-13.76)		-

Variables		%	Crude PR (95%CI	p*	Adjusted PR in the block (95%CI)	p**	Adjusted PR - final model (95%CI)	p**
Block 1 - Sociodemographic variables and Subjective Social Status
Age group				0.010		-		0.009
	30-59 years	55.6	1		-		1
	20-29 years	83.3	4.00 (1.46-10.96)		-		4.85 (1.48-15.87)
Block 2 - Variables related to the health of women deprived of liberty
Self-perceived health				0.005		0.087		-
	Good	55.9	1		1		-
	Poor	87.1	5.33 (1.68 - 16.90)		2.94 (0.86 - 10.06)		-
Depressive symptoms				< 0.001		<0.001		< 0.001
	No	25.0	1		1		1
	Yes	78.7	11.06 (3.78 - 32.46)		8.22 (2.70 - 25.04)		12.67 (3.92 - 40.98)
Block 3 - Variables related to incarceration
Staying alone				0.100		0.138		-
	Yes	51.7	1		1		-
	No	71.4	2.33 (0.95-5.70)		2.15 (0.78-5.91)		-
Satisfaction with prison activities				0.066		0.104		-
	Yes	59.0	1		1		-
	No	80.6	2.89 (1.04-8.08)		2.58 (0.82-8.07)		-
Prejudiced treatment by employees due to detainee status				0.024		0.393		-
	No	55.9	1		1		-
	Yes	80.0	3.15 (1.24-7.99)		1.68 (0.51-5.53)		-
Prejudiced treatment by other detainees due to detainee status				0.058		0.997		-
	No	58.8	1		1		-
	Yes	80.6	2.92 (1.06-8.04)		1.00 (0.24-4.15)		-
Prejudiced treatment by other detainees due to social condition				0.033		0.219		-
	No	58.9	1		1		-
	Yes	84.6	3.84 (1.20-12.28)		2.58 (0.57-11.72)		-
Prejudiced treatment by other detainees due to crime committed				0.043		0.405		-
	No	60.5	1		1		-
	Yes	88.9	5.22 (1.13-24.27)		2.15 (0.35-13.07)		-
Victim of verbal abuse in the last year				0.008		0.176		-
	No	52.8	1		1		-
	Yes	80.4	3.67 (1.48-9.09)		2.23 (0.70-7.10)		-

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