Mental health and spirituality of female prisoners in a women’s prison in Chile
Item statusRestricted Access
Embargo end date30/06/2019
Aboaja, Anne Marie
Background The mental health of prisoners is of growing global health importance as prison populations increase exponentially. Though additional risks of mental disorder and poor mental wellbeing of prisoners are now better understood, women, especially those in low and middle income countries, and in regions outside North America and Europe are underrepresented in prison mental health studies. There is strong evidence of associations between religion and spirituality (RS) and mental health in the general population in North America and Europe. This thesis aims to measure and explain any associations between RS and depression and mental wellbeing among female prisoners in Chile. Methods An explanatory sequential mixed methods approach comprised an initial quantitative study linked to a subsequent qualitative study. In the quantitative phase, 94 randomly sampled female prisoners in Chile participated in a pooled two-stage cross-sectional survey which collected data on background, mental health and RS variables. Mental wellbeing was measured using the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Self-report depression data were collected and 40 prisoners were also administered the Mini International Neuropsychiatric Interview (MINI). RS variables included: affiliation, personal importance, involvement (frequency of attending services), benefits and beliefs. The design of the qualitative phase was informed by quantitative study findings. Six prisoners who had participated in the cross-sectional survey attended one of two focus groups. Individual in-depth interviews were conducted with 3 prison chaplains and 2 health professionals from the prison health centre. Topic guides for focus groups and interviews were used to facilitate discussions on the mental health and RS of female prisoners and to elicit views on selected findings from the quantitative study. Logistical regression techniques were used to statistically test the hypothesis of no association between RS and depression and mental wellbeing. Audio-recorded qualitative data were transcribed in Spanish and analysed thematically in English. Results Of the 94 women, 11 (11.7%) reported a current professional diagnosis of depression, while major depression was confirmed in 13 (32.5%) of the 40 women assessed using the MINI. The women had a median WEMWBS score of 55 (IQR 43- 61) out of 70. Religiosity was high among the sample with 86 (91.5%) women affiliated to mainstream Christianity and 69 (73.4%) who considered RS to be personally very important. In a sample of 40 women, frequency of attendance at RS services was significantly higher in prison than during the year prior to incarceration (Wilcoxon Sign Ranks Test Z=3.1; p<0.002). No significant associations were found between depression and mental wellbeing, and the key RS variables. However, 61 (89.7%) women believed there was a connection between their mental health and spirituality. The qualitative data revealed differences within and between participant groups in understandings of mental health and RS terminology and concepts. Themes emerged around the prison determinants of mental health and the mental health effects of the female gender. Prisoners identified RS variables that influenced mental health which had not been measured in the survey. Explanations were found for the divergent survey results of the association between RS and mental health. The data showed how RS shapes prisoners’ help-seeking behaviour and attitudes to mental health care. Conclusion The association between RS and mental health among prisoners in Chile remains unclear but may differ from established patterns reported in non-prisoner populations. This a challenging area of study with an additional layer of complexity present in prison populations where there are high levels of religiosity and spirituality. Larger studies are needed to confirm the quantitative findings, while qualitative findings should lead to raised awareness of RS in the development of prison mental health strategies in accordance with the needs of a given population.