Gabrysch Caroline, Sepúlveda Carolina, Bienzobas Carolina, Mundt Adrian P
Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Psychiatry and Mental Health, Hospital Clínico Universidad de Chile, Santiago, Chile.
Front Psychol. 2020 Jun 8;11:1208. doi: 10.3389/fpsyg.2020.01208. eCollection 2020.
Severe mental illness (SMI) among imprisoned individuals is a global health concern. Quantitative research indicates on average mental health symptom improvements during imprisonment, however, it cannot reflect multifaceted factors influencing the course of SMI. This study aimed to explore the subjective course of SMI during imprisonment and to identify influencing factors.
The study has a 3-year-follow-up design of imprisoned individuals in Chile. We conducted semi-structured interviews with 10 men and 9 women at follow-up who had either major depression or psychosis (severe mental illnesses) at baseline. We included individuals who deteriorated, remained stable or improved their mental health according to quantitative assessments. We explored the subjective course of their mental health condition during the follow-up period. Qualitative data was transcribed and coded using NVivo Software for quantitative content analysis. Qualitative data was also manually coded and was subsequently analyzed using the thematic analysis method with an inductive approach. We developed the final themes using the results of this analysis in combination with the inclusion criteria.
The mental health of 10 individuals subjectively improved, 6 experienced deteriorations, and 3 did not perceive any change. Good infrastructure, structure/occupation, intrapersonal resources (will to change, spirituality) and supportive relationships were identified as factors improving mental health. Factors deteriorating mental health were identified as bad infrastructure (e.g., no running water and bad housing conditions) and crowding, lack of psychological treatment, exposure to violence, interpersonal stress (conflictive relationships and separation from family), perceived injustice through sentencing, intrapersonal stressors and previous medical conditions.
SMI in prison can improve in a supportive environment under certain conditions. These conditions include the improvement of infrastructure (housing and healthcare), the opportunity to work or study, protection from violence during imprisonment, and to develop intrapersonal resources and family relationships. To reduce SMI in prisons the improvement of these conditions should become a priority.
被监禁者中的严重精神疾病是一个全球健康问题。定量研究表明，监禁期间心理健康症状平均有所改善，然而，它无法反映影响严重精神疾病病程的多方面因素。本研究旨在探讨监禁期间严重精神疾病的主观病程并确定影响因素。
该研究对智利的被监禁者进行了为期3年的随访设计。我们在随访时对10名男性和9名女性进行了半结构化访谈，这些人在基线时患有重度抑郁症或精神病（严重精神疾病）。我们纳入了根据定量评估心理健康状况恶化、保持稳定或改善的个体。我们探讨了随访期间他们心理健康状况的主观病程。定性数据使用NVivo软件进行转录和编码，以进行定量内容分析。定性数据也进行了手动编码，随后使用归纳法的主题分析方法进行分析。我们结合该分析结果和纳入标准制定了最终主题。
10个人的心理健康主观上有所改善，6人病情恶化，3人未察觉到任何变化。良好的基础设施、结构/职业、个人资源（改变的意愿、精神性）和支持性的人际关系被确定为改善心理健康的因素。导致心理健康恶化的因素被确定为基础设施差（如没有自来水和恶劣的住房条件）、拥挤、缺乏心理治疗、遭受暴力、人际压力（冲突性的关系和与家人分离）、因判刑而感到的不公正、个人压力源和既往病史。
在某些条件下，监狱中的严重精神疾病在支持性环境中可以得到改善。这些条件包括基础设施（住房和医疗保健）的改善、工作或学习的机会、监禁期间免受暴力侵害，以及发展个人资源和家庭关系。为了减少监狱中的严重精神疾病，改善这些条件应成为优先事项。
