Physical Activity and Associated Factors among Brazilian Adult Inmates: A Cross-Sectional Study.

Previous studies on health in prison facilities have determined that imprisonment has adverse effects on both physical and emotional well-being. Therefore, the introduction of public health measures is encouraged. This study aimed to (a) evaluate the levels of physical activity and the health condition of a sample of Brazilian prisoners and (b) determine the predictors of low physical activity. An observational and cross-sectional study was developed following the STROBE checklist. Data collection took place between June and November 2019 in a maximum-security Brazilian prison institution. This study's final sample included 220 people selected through convenience sampling, of which 115 (53.2%) were aged 18 to 29 years, followed by 79 (36.6%) aged 30 to 44 years and 22 (10.2%) aged 45 to 59 years old. Overall, 64.3% of participants failed to meet the World Health Organization (WHO) recommendation for physical activity [at least 150-300 min of moderate-intensity or 75 min of vigorous-intensity aerobic physical activity per week]. The majority reported unhealthy food consumption (116; 53.7%). Regarding body mass index (BMI), 50.2% of individuals were classified as eutrophic, 38.1% were overweight and 11.6% were obese. Older age (AOR: 0.95; CI95%: 0.92-0.99; p = 0.01) and sitting time (AOR: 0.74; CI95%: 0.65-0.85; p < 0.01) were associated with low adherence to physical activity. Our results highlight the importance of practicing physical activity within the prison context and the need for institutional programs that promote regular physical activity.

The Present State of Housing and Treatment of Transgender Incarcerated Persons.

The care and housing of transgender (TGD) incarcerated persons is a complex concern that is growing because of the increased recognition and diagnosis of gender dysphoria in society. To remain current in this evolving landscape, there have been updates to federal manuals and state guidelines regarding the medical care and housing of the TGD population. Since the publication by Glezer and colleagues in 2013, there has not been a comprehensive overview of current federal and state guidelines, and legal and other considerations on this topic. We provide an update with special consideration given to housing practices, safety, and access to care. A review of the literature shows that the World Professional Association for Transgender Health (WPATH) standards and Prison Rape Elimination Act (PREA) requirements are not uniformly implemented and enforced on a state level. In fact, some states have policies that are in direct conflict with federal requirements. The safety and equitable treatment of both TGD and cisgender populations is an important topic that merits attention. As new challenges emerge, an increase in federal enforcement and consistency is needed to ensure the humane treatment and protection of TGD inmates.

Behavioural activation for people in custody with depression: A protocol for a feasibility randomised controlled study.

People in custody are at high risk of developing depression. Accessing psychological treatments in a prison setting is a particular challenge, in part, due to difficulties accessing specialist mental health workers. Behavioural Activation (BA) may be helpful in improving health outcomes for people in custody experiencing depressive symptoms. The aim of this study is to establish the feasibility and acceptability of custodial health nurses delivering BA to improve depressive symptoms of people in custody. We will conduct a pilot randomised controlled trial with process observation examining the feasibility and acceptability of BA in treating people in custody with depressive symptoms. 60 people in custody presenting with depressive symptoms will be randomised to receive BA plus treatment as usual (TAU) or TAU provided by custodial health nurses. Eight custodial health nurses will be recruited, trained, and deliver BA. BA will be delivered twice a week for six weeks, with sessions lasting up to 30 minutes. Changes in depression and quality of life (QoL) will be assessed at baseline, 6 weeks, and 3 months post-intervention. Participants will be interviewed to understand feasibility and acceptability of BA in prison settings. The findings will inform the design of a randomised controlled trial to test the efficacy of BA for people in custody with depression. Findings will help determine whether BA for depression is suited to prison health care system and services. Improving depressive symptoms in people in custody has benefits beyond prison settings. The Central Adelaide Local Health Network Human Research Ethics Committee and University of South Australia Human Research Ethics Committee have approved the study. The trial results will be disseminated through peer-reviewed journals and scientific conferences and reported to local stakeholders and policy makers. If feasibility and acceptability is demonstrated, we will seek to progress to an effectiveness study. A potential strength of the trial model proposed, is in its scalability, with potential to increase the trial sites and locations. This trial has been prospectively registered with the Australian New Zealand Clinical Trials Registry (reference number: ACTRN12623000346673p). Trial registration ACTRN12623000346673p.

Worldwide incidence of suicides in prison: a systematic review with meta-regression analyses.

BACKGROUND: Suicide is a leading cause of death during imprisonment. This systematic review aimed to synthesise available evidence of prison suicide incidence worldwide. METHODS: We systematically searched the scientific literature, data repositories, and prison system reports, supplemented by correspondence with prison administrations. We included reports on people living in prison but excluded studies in preselected groups (by age or offence type). Absolute numbers and incidence rates of suicide mortality per 100 000 person-years by sex and country were extracted from 2000 to 2021. IQRs were used to describe the suicide incidence in different world regions. Incidence rate ratios comparing suicides of people living in prison with age-standardised general populations were calculated. We conducted meta-regression analyses on national-level and prison-level factors to examine heterogeneity. The study protocol was pre-registered with PROSPERO, CRD42021296819. FINDINGS: We included three scientific studies, 124 official reports, and 11 datasets from email correspondence. Between 2000 and 2021, there were 29 711 reported suicides during 91·2 million person-years of imprisonment in 82 jurisdictions worldwide (sex-specific data available for 13 289 individuals: 12 544 [94·4%] male and 745 [5·6%] female individuals). There were large variations between countries, with most studies reporting suicide rates in the range of 24-89 per 100 000 person-years in both sexes (22-86 in male individuals and 25-107 in female individuals). In meta-regression analyses, Europe (vs other regions), high-income countries (vs low-income and middle-income countries), and countries with lower incarceration rates (vs those with higher incarceration rates) had higher suicide rates. Incidence rate ratios between people who are incarcerated and age-standardised general populations in the same jurisdictions were typically in the range of 1·9-6·0 in male and 10·4-32·4 in female individuals. INTERPRETATION: Prison services worldwide, and particularly in Europe, should prioritise suicide prevention. Assessment and management of suicide risk in female individuals living in prison need particular attention due to excess mortality relative to community-based populations. Interpretation of synthesised data needs to be done with caution due to high heterogeneity between jurisdictions. FUNDING: Agencia Nacional de Investigación y Desarrollo, Economic and Social Research Council, and Wellcome Trust.

Examining the Past Injustices Suffered by Those in Corrections and the General Public: A New Therapeutic Approach May Be Necessary.

One under-researched area within corrections is the connection among (a) past adverse events, particularly in the form of injustices against those who now are incarcerated, (b) crimes committed and then (c) healing from the effects of that past adversity of injustice. Might those who have experienced severe injustices against them develop an anger or a hatred that then is displaced onto others, leading to arrest, conviction and imprisonment? This is not to imply that societies condone illegal behaviour but instead to assist in the healing from the adversity so that future crime is reduced. As a first step in this sequence, the study here examined in detail the kinds of injustices suffered by men in a maximum-security correctional institution (N = 103) compared with men in a medium-security environment (N = 37) and in the general public (N = 96). Findings indicated differences between those in the general public and those in the two correctional contexts. The latter two groups had (a) a higher severity of injustices against them (rated by a panel of researchers), (b) a more negative current impact that past injustices are having on them (also rated by a panel of researchers), (c) more reports that the injustices contributed to their choices to harm others, (d) more serious types of hurt (such as sexual abuse), (e) a stronger degree of self-reported hurt and (f) more injustices from family members. Implications for correctional rehabilitation to reduce the negative psychological effects caused by the injustices of others are discussed.

Navigating pregnancy in detention: lived experiences in a Philippine women's prison.

PURPOSE: Imprisonment impacts women's childbearing and mothering experiences. Using sociological concepts of total institutions, pains of imprisonment and gendered pains of imprisonment, this study aims to explore the childbearing experiences of 18 Filipino incarcerated women. DESIGN/METHODOLOGY/APPROACH: A qualitative, inductive approach was undertaken to explore imprisoned women's pregnancy experiences. This research project used reflexive thematic analysis to examine the data from semi-structured interviews with 18 Filipino pregnant prisoners. FINDINGS: The participants' experiences of childbearing in prison were reflected in three overarching themes: lack of autonomy over pregnancy; reduced capacity to manage discomforts and needs; and coping with prison deprivations. These themes embody women's experiences of how imprisonment disrupts Filipino women's childbearing and mothering experiences. Furthermore, the results illustrated how the women navigated the prison regime to address their needs and cope with the pains of imprisonment. ORIGINALITY/VALUE: Although there is a small but growing body of research specifically focusing on mothering and imprisonment, little consideration has been given to analyzing Filipino women's pregnancy experiences in custody. This paper highlights an urgent need to reform correctional policies and practices to address incarcerated women's distinct needs.

Mental Health, Drug Use, and Programming: Applying a Needs Assessment Framework in Arkansas' Largest Jail.

Jail programming is rarely informed by site-specific health needs, diagnostic-specific screening tools that are validated, or the input of incarcerated individuals. Using the community needs assessment (CNA) framework, we aimed to fill these gaps among people incarcerated in the Pulaski County Regional Detention Facility (PCRDF), Arkansas' largest jail. Participants were 179 adults at the PCRDF who completed surveys and open-ended questions focused on (a) their mental and behavioral health and (b) programming needs at the facility. Using a concurrent transformative mixed-methods design, we descriptively analyzed surveys and conducted content analysis of the open-ended questions. Over half of participants reported clinically significant anxiety (62.6%), post-traumatic stress disorder (53.1%), and/or depression (50.3%) symptoms; positive substance use disorder screening was especially common (91.7%). Nearly all (97%) individuals queried desired more programming, with the most desired being mental health and substance use programs. Other desired programs included physical health, education, community reintegration, family support, recreation, nutrition, religious/spiritual services, and meditation. Our CNA ensured the input of those directly impacted during program-focused decision making and identified strategies to effectively implement and sustain jail-based programs. Such assessments can be a potential mechanism for addressing the burden of mental and behavioral health problems in jail populations.

Depression among inmates of Gandaki Province, Nepal: a cross-sectional study.

INTRODUCTION: Depression is a pervasive mental health condition that affects individuals across various demographic categories, including imprisoned adults. The prevalence of mental health problems among inmates worldwide is considerably higher than in the general population, and it is estimated that 11% of inmates have significant mental disorders, such as anxiety and depression. This study aimed to find out the prevalence of depression and factors associated with it among the prisoners of Gandaki Province, Nepal. METHODS: A descriptive cross-sectional study was conducted among the inmates in Gandaki Province, Nepal. Data were collected from 223 inmates, who were recruited through systematic random sampling from eight district-level prisons. The Beck Depression Inventory-II was used to measure depression, with the cumulated score dichotomized into depressed and not-depressed categories. Additionally, a structured questionnaire was employed to capture socio-demographic and imprisonment-related variables. Bivariate and multivariable logistic regressions were performed to examine the factors associated with depression. RESULTS: Findings revealed that 18.8% of the inmates exhibited symptoms of depression. Inmates with health problems [(adjusted odds ratio (aOR) = 2.39], suicide ideation during imprisonment (aOR = 4.37), and attempted suicide before imprisonment (aOR = 7.97) had a statistically significant relationship with depression. This study revealed a notable prevalence of depression among incarcerated individuals in the Gandaki Province of Nepal. CONCLUSION: The findings imply a crucial need for psychosocial and rehabilitative interventions to enhance inmates' mental health and overall well-being.

Predictors of substance use disorder treatment and mutual support group participation among Black women across the criminal legal spectrum: A latent class approach.

BACKGROUND: The purpose of this study includes: 1) identifying classes of substance-related needs among Black women, and 2) examining the effect of substance-related need classes and culturally-relevant factors on Black women's use of substance use disorder (SUD) treatment and mutual support groups. METHODS: As part of a longitudinal cohort study, Black women were recruited in prison nearing release, on probation, and in the community without involvement in the criminal legal system (CLS, n=565) and followed-up at 18-months. We conducted a baseline latent class analysis of substance-related needs among Black women. Logistic regression models adjusted for culturally-relevant factors to predict the use of treatment and frequency of mutual support group participation over 18-months among Black women who use drugs. RESULTS: Four classes by level of needs were found: low, daily marijuana use, high mental health, and high comorbidity. During the 18-month follow-up, women characterized by the high comorbidity need class and with higher scores of religious well-being were more likely to frequently participate in mutual support groups. Non-CLS-involved women were less likely to engage with both treatment and mutual support groups than women from the prison sample at 18-months. CONCLUSIONS: This study highlights four distinct classes of substance-related needs among Black women, highlighting the complex patterns of behavior and within-racial group differences among Black women. Black women with high comorbidity needs were more likely to participate in mutual support groups, but the latent classes did not predict SUD treatment indicating other non-medical and social contextual need factors may be at play.

The prison-based Therapeutic Community: Resident recommendations for program improvement.

INTRODUCTION: The prison-based Therapeutic Community (TC) is widely used within correctional institutions to address substance use disorders (SUDs). While most evaluations of the prison-based TC find the program to be effective, recent mixed evidence and the continued surge of the opioid crisis call for deeper investigation into program operations, barriers to engagement, and sources of treatment effect heterogeneity. Notably lacking from prior evaluations, and critical to our understanding of variable program engagement, is first-hand experiences and perceptions from program participants. METHODS: To assess prison-based TC resident perceptions of the program and their recommendations for improvement, we utilize data from the Therapeutic Community Prison Inmate Network Study (TC-PINS), a longitudinal data collection effort conducted in one prison-based TC unit within a Pennsylvania state prison. Specifically, we assess resident responses to the open-ended item "What can the TC do better?" Analyzing 470 responses to this question by 177 residents, two independent coders identified seven substantive categories of recommended changes or improvements to their TC program. RESULTS: Residents provided tangible recommendations for improvement of their prison-based TC program based on their experiences and perceptions. Importantly, a number of their recommendations directly counter the intended model of the TC, which highlights imperative issues underlying the translation of the TC model within the prison environment. Resident suggestions include enhanced structure, increased individualization, expanded curriculum, stricter enforcement of rules, and improved or more experienced staff. Additionally, many question the coercive nature of TC program participation within this prison system. CONCLUSIONS: Resident recommendations for program improvement unveil important sources of treatment effect heterogeneity and highlight tangible program changes that can be implemented to reduce barriers to treatment engagement. We provide suggested changes to this prison-based TC based on resident perceptions and discuss both the importance and relative ease of eliciting this critical participant feedback.

Parental Legal System Involvement, Positive Childhood Experiences, and Suicide Risk.

OBJECTIVES: To examine whether adverse parental legal system involvement (incarceration, arrest) was associated with suicide risk, accounting for other adverse childhood experiences, and whether there was a moderating relationship between positive childhood experiences (PCEs) and parental legal system involvement in suicide risk. METHODS: This cross-sectional study used 2-year follow-up data from the Adolescent Brain Cognitive Development Study when children were age 11 to 12 years. Outcomes were lifetime suicidal ideation, attempts, and nonsuicidal self-injury (NSSI). Exposures were parent incarceration or arrest. We used generalized linear models to estimate the relative risk of suicide outcomes from adverse parent legal involvement and whether there was an interaction between parent legal system involvement and PCE count, controlling for adverse childhood experiences and demographic factors. RESULTS: Among our sample (n = 10 532;), 687 children (6.5%) reported parent incarceration and 1265 (12.0%) reported parent arrest. Suicidal ideation was the most frequent risk outcome (n = 490; 4.7%). Children whose parents had been incarcerated had a relative risk of suicidal ideation of 1.74 (95% CI: 1.32-2.31). Children whose parents had been arrested had a relative risk of suicidal ideation of 1.89 (95% CI: 1.53-2.37) and a relative risk of suicide attempt of 2.69 (95% CI: 1.7-4.25). Parental incarceration/arrest were not associated with NSSI. PCEs were associated with reduced relative risk of suicidal ideation and NSSI, though there was no significant interaction between PCEs and adverse parent legal system involvement exposures. CONCLUSIONS: Parental legal system involvement may negatively affect child mental health. Strengthening PCEs in childhood may mitigate suicide-related risks.

Analysis of implementation processes in a hybrid effectiveness-implementation trial of interpersonal psychotherapy (IPT) for major depressive disorder in prisons: Training, supervision, and recommendations.

BACKGROUND: There are 10 million admissions to U.S. prisons and jails each year. More than half of those admitted have mental health problems. The goal of this article is to inform: (1) implementation of evidence-based mental health treatments in prisons and jails, an important effort that needs more evidence to guide it; (2) psychotherapy and interpersonal psychotherapy (IPT) training efforts, especially in low-resource settings. METHODS: A randomized hybrid effectiveness-implementation trial of group IPT for major depressive disorder (MDD) in state prisons found that IPT increased rates of MDD remission and lowered posttraumatic stress disorder symptoms relative to prison treatment as usual. The trial used prison counselors, only some of whom had prior psychotherapy training/experience, to deliver IPT. IPT treatment adherence was high (96%), but trial training and supervision were too costly to be scalable outside the trial. The current article reports results from a planned qualitative analysis of 460 structured implementation and supervision documents in that trial to describe training and supervision processes and lessons learned, inform training recommendations, and facilitate future work to optimize training and supervision for under-resourced settings. RESULTS: Themes identified in implementation and supervision process notes reflected: work on psychotherapy basics (reflective listening, focusing on emotions, open-ended questions, specific experiences), IPT case conceptualization (forming a conceptualization, what is and is not therapeutic work, structure and limit setting, structure vs. flexibility), IPT techniques (enhancing social support, role plays, communication analysis), psychotherapy processes (alliance repair, managing group processes), and managing difficult situations (avoidance, specific clients, challenging work settings). Counselors were receptive to feedback; some relied on study supervisors for support in managing stressful prison working conditions. CONCLUSIONS: Findings can be used to make future training and supervision more efficient. Based on our results, we recommend that initial and refresher training focus on IPT case conceptualization, steps for addressing each IPT problem area, and reflective listening. We also recommend supervision through at least counselors' first two rounds of groups. More low-cost, scalable training methods are needed to get mental health treatment to individuals who need it most, who are often served in challenging, low-resource settings such as prisons. This is a mental health access and equity issue. TRIAL REGISTRATION: The trial was registered at clinicaltrials.gov (NCT01685294).

Share of Adult Suicides After Recent Jail Release.

Importance: Although people released from jail have an elevated suicide risk, the potentially large proportion of this population in all adult suicides is unknown. Objective: To estimate what percentage of adults who died by suicide within 1 year or 2 years after jail release could be reached if the jail release triggered community suicide risk screening and prevention efforts. Design, Setting, and Participants: This cohort modeling study used estimates from meta-analyses and jail census counts instead of unit record data. The cohort included all adults who were released from US jails in 2019. Data analysis and calculations were performed between June 2021 and February 2024. Main Outcomes and Measures: The outcomes were percentage of total adult suicides within years 1 and 2 after jail release and associated crude mortality rates (CMRs), standardized mortality ratios (SMRs), and relative risks (RRs) of suicide in incarcerated vs not recently incarcerated adults. Taylor expansion formulas were used to calculate the variances of CMRs, SMRs, and other ratios. Random-effects restricted maximum likelihood meta-analyses were used to estimate suicide SMRs in postrelease years 1 and 2 from 10 jurisdictions. Alternate estimate was computed using the ratio of suicides after release to suicides while incarcerated. Results: Included in the analysis were 2019 estimates for 7 091 897 adults (2.8% of US adult population; 76.7% males and 23.3% females) who were released from incarceration at least once, typically after brief pretrial stays. The RR of suicide was 8.95 (95% CI, 7.21-10.69) within 1 year after jail release and 6.98 (95% CI, 4.21-9.76) across 2 years after release. A total of 27.2% (95% CI, 18.0%-41.7%) of all adult suicide deaths occurred in formerly incarcerated individuals within 2 years of jail release, and 19.9% (95% CI, 16.2%-24.1%) of all adult suicides occurred within 1 year of release (males: 23.3% [95% CI, 20.8%-25.6%]; females: 24.0% [95% CI, 19.7%-36.8%]). The alternate method yielded slightly larger estimates. Another 0.8% of adult suicide deaths occurred during jail stays. Conclusions and Relevance: This cohort modeling study found that adults who were released from incarceration at least once make up a large, concentrated population at greatly elevated risk for death by suicide; therefore, suicide prevention efforts focused on return to the community after jail release could reach many adults within 1 to 2 years of jail release, when suicide is likely to occur. Health systems could develop infrastructure to identify these high-risk adults and provide community-based suicide screening and prevention.

Comparing Experiences of Community Reintegration Following Hospitalization Versus Jail Detention During a Mental Health Crisis.

BACKGROUND: This comparative qualitative study explores the experiences of individuals transitioning back to the community after institutionalization following an episode of acute suicidality. METHODS: Semi-structured interviews were conducted with eight individuals who had either been hospitalized (n=4) or incarcerated (n=4) during a mental health crisis that involved acute suicidality. Thematic analysis was conducted first within groups and then between groups. RESULTS: The findings reveal possible disparities in social determinants of mental health, family dynamics, treatment seeking, and coping mechanisms between groups. Social isolation, barriers to socioeconomic stability, and lack of treatment access were all found to be risk factors for poor outcomes during the vulnerable transition period and were experienced by participants in this limited sample. CONCLUSIONS: Individuals transitioning from the hospital after a suicide crisis may benefit from increased family involvement, follow-up, and social support at discharge. After a suicide crisis and incarceration, there is a significant need for housing and employment support to allow for mental health treatment seeking. Future research should build on the proof of concept for comparing the experiences of individuals across institutional settings.

Psychiatric Comorbidities of Incarceration in a Patient With Gender Dysphoria: A Case Report and Literature Review.

ABSTRACT: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines gender identity disorder (GID) as a strong and persistent identification with the opposite sex and the distress that may accompany the incongruence between one's experienced or expressed gender and one's assigned gender. The onset of GID commonly begins early in childhood. Gender dysphoria has a higher prevalence of other comorbid psychiatric illnesses, such as mood, anxiety, and adjustment disorders, with increased suicide incidence and self-harming behaviors than the general population. Studies show that some temperamental, environmental, genetic, and psychological factors play a role in developing GID. Approximately 16% of transgender people and 21% of transgender women get incarcerated compared with the general US population. During incarceration, they face many issues, such as victimization, severe verbal harassment, purposeful humiliation, unwanted sexual advances, physical assault, forcible sex, and unwanted strip searches. There is a need for a better understanding of the issues and needs of this population to promote positive outcomes.

Generalized Resistance Deficits in inmates with hypertension: missing resources that limit health.

OBJECTIVE: to understand the Generalized Resistance Deficits of people deprived of liberty with hypertension in a Brazilian prison unit. METHOD: qualitative research, anchored in Salutogenesis, carried out with 38 people with hypertension from a Brazilian prison unit, from February to July 2022, with a semi-structured interview with open-ended questions, whose analysis was thematic, explaining the limitations to health in prison. RESULTS: 13 Generalized Resistance Deficits were reported, mostly related to the prison environment and, to a lesser extent, to the social group and the individual, respectively. Living in prison for people with hypertension implies living with a high number of Generalized Resistance Deficits, accentuating the movement towards the disease pole. FINAL CONSIDERATIONS: knowing Generalized Resistance Deficits allows directing health promotion to support the use of available Generalized Resistance Resources and contributes to the expansion of intersectoral policies.

Prisoner, Sailor, Soldier, Spy: Hobbes on Coercion and Consent.

This article examines Thomas Hobbes's notorious claim that "fear and liberty are consistent" and therefore that agreements coerced by threat of violence are binding. This view is to a surprising extent inherited from Aristotle, but its political implications became especially striking in the wake of the English Civil War, and Hobbes recast his theory in far-reaching ways between his early works and Leviathan to accommodate it. I argue that Hobbes's account of coercion is both philosophically safe from the most common objections to it and politically superior to the seemingly commonsensical alternatives that we have inherited from Hobbes's critics.