Prevalence of Depression and its

associated factor among inmates

in Kathmandu Prison

Presented by:
Simran Mahato
Symbol no. : 18370159
Pu reg no. : 2017-4-71-0122
BPH 8th sem
National open College, Sanepa Lalitpur
01/15/2023 1
 Outline of the presentation

Statement of the problem

Rationale of the study
Objectives
Conceptual Framework
Methodology
Ethical consideration
Findings
Discussion
Conclusion and Recommendation
References
Annexures
01/15/2023 2
 Statement of the problem : Global Status

• According to the World Prison Population list (thirteen edition) there are more
than 10.77 million of prisoners held in penal institutions. 13
• Many studies reported that prevalence of depression among inmates were 42%,
43%, 81%, 85%, 35.3% and 37% in Iran, New York, India, Pakistan, Nepal, and
Nigeria, respectively. 14
• The magnitude of depression was found to be 43.8% in Northwest of Amhara
Regional State, 41.9% in Jimma town, 45.5% in Bahir Dar prison, and 56.4% in
southern Ethiopia in 2015, 2017, 2015. 5
• Study conducted in 2019 in Wollega zones, Oromia region, Ethiopia shows that
prevalence of depression was found to be 45.1% and Lack of job opportunity in
prison, not attending religious place at all, and Unsentenced for suspected crime
01/15/2023
were associated with depression. 5 3
 Statement of the problem : SEAR Status

• A study conducted in Indian Prisoners (2014) prevalence of depression was found

to be 14.1%.
• A study conducted on convicted jail inmates of district Jail, Rohtak, Haryana from
September 2016 to April 2018 revealed that the prevalence of depression was
found to be 18.5 % among inmates. 2
• According to various study conducted the prevalence of depression was found to
be 59.4% among women inmates in Central Prison of Pehawar, Pakistan and 29%
among sentenced inmates in Iran. 6
• According to study conducted in local male prison of Malaysia (2019) it was
found that prevalence of depression rose up to 40.7% among the inmates mainly
with the communicable and non-communicable diseases. 1

01/15/2023 4
 Statement of the problem : National Status

• This first study conducted in Jhumka Regional Prison, the largest prison in eastern
Nepal (2014-2015) shows higher rate of prevalence of depression among inmates
which was 35.3% and the factor associated with depression was with previous
incarceration, poor self-rated health, frequent appointments when encountering health
problems, suicidal ideation and loss of weight. 9
• According to analytical study conducted in 2018 male prisoners of Dillibazar, the
prevalence of depression among inmates was 45.6%. 7
• It was found that depression was significantly associated with a history of drug use
and mental illness. 7
• Based on the findings of study conducted among female inmates of Central Prison,
40.1% had reported symptoms of depression. 8
01/15/2023 5
 Rationale of the study

• Trend of national data shows that there is increasing rate of depression among
inmates from previous study to new one.
• According to the data of 2079/02/16 the total prison of nakkhu jail is 1367 which is
out of its capacity, central jail is 3249 it clear that overcrowding is also the main
problem.
• Very limited research on this topic and also no any proper policy for prisoner mental
health since prisoner have their rights to basic food and health. (in context to Nepal)
• Since inmates are marginalized and ignored population. Most of them belong to poor
family background, socially deprived community so they have a worse chance of
having their mental health issues acknowledged and treated.

01/15/2023 6
 Rationale of the study

• Prisoner come from community and return back to community so their health
must be given priority as healthcare for detainees can help avoid not only mental
illness but also communicable diseases so prisoner is interlinked with community.
• Also to achieve sustainable goal we must not neglect health of prisoner.
• Still adequate prevalence of depression among inmates of various prison of Nepal
is unknown.
• Hence, it is of great urgency to concentrate on timely detection, proper treatment
and prevention of mental health disorders.

01/15/2023 7
 Objectives

General Objectives :
•To study the prevalence of depression and identify its associated factor among inmates.
Specific Objectives:
1.To measure the prevalence of depression among inmates.
2.To identify the association of socio-demographic with depression among inmates.
3.To identify the association of substance use with depression among inmates.
4.To identify the association of clinical history with depression among inmates.
5.To identify the association of imprisonment characteristics with depression among
inmates.
6.To identify the association of suicidal characteristics with depression among inmates.

01/15/2023 8
 Research question

1. What is the prevalence of depression among inmates?

2. What is the factor associated with depression among inmates?

01/15/2023 9
 Conceptual framework
(Independent variable)
(Independent variable)
Imprisonment characteristics
Socio-demographic
 Previous incarceration
 Age
 Duration of incarceration
 Gender
 Types of criminality
 Marital status
 No of prisoners per cell
 Ethnicity
 Bullying
 Occupation
 Stress after life
 Education status
 Work in prison
 Previous income
 Social support
 
Depression  Family support
 
(Dependent variable)
 

Clinical history Substance use

 Family history of mental illness  Drug
 Previous mental illness history Suicidal Characteristics  Alcohol
 History of clinical illness  Suicidal ideation  Smoking
 Frequent follow-up with health during imprisonment  Tobacco
care provider  Suicidal attempt chewing
 Loss of weight during imprisonment  
 Current health problems  
  (Independent variable)
01/15/2023 (Independent
  variable) (Independent variable) 10
 Methodology

Study site Nakkhu and Sundhara, Kathmandu

Study duration July 15 to August 15 2022

Study design Cross-sectional descriptive

Study population Inmates of Nakkhu and Central Jail

01/15/2023 11
 Methodology

•Sample size :
The sample size was determined by using following statistical
formula:

Where,
n = initial sample size
Z = Z score at level of significance 5% and confidence interval
95% which is 1.96
01/15/2023 12
P= 45.6% i.e. Prevalence of depression among inmates ((Prevalence is
taken from the cross sectional study, “Prevalence of Depression and its
Associated Factors among Male Prisoners at Dillibazar Prison, Kathmandu,
Nepal”)7
Thus, the required sample size is calculated as:
= 381 .
The tota1 number of prisoners in Nakkhu Jail was 1367 and Central Jail
was 3249 which is less than 10,000. Using finite population correction
formula the final sample size was

nf =

= = 352
01/15/2023 13
 Sampling frame
Purposively
Kathmandu and Lalitpur District selected

Total list of Prisons was taken from Sampling

concerned authority Frame

Nakkhu Jail and Central Jail was

selected purposively

Using stratified sampling for

Using Probability proportional to size sampling
Central Jail
Nakkhu = Central jail =
= (104) = ( 248) Stratum 1 Stratum 2
Male = Female =
= 218 = 30

Study unit (Prisoners ) was selected by

systematic random sampling
01/15/2023 14
• Finally each individual prisoner was chosen by systematic random sampling. For
this sampling interval of Nakkhu Jail (i) =
= = 13
• So, a starting point was chosen randomly i.e. “r” was taken as 2. Hence, the
elements of sample were 2, 2+i = 15, 2+2i = 28, 2+3i = 41 and so on
• Sample prisoner was taken from Prisoner ID number list for the study.

01/15/2023 15
 Methodology

Unit of analysis Inmates

Inclusion criteria Inmates of age 18-75yrs.

Inmates stayed in prison for at least 3 months.
Inmates whose release is not expected within 6
months.

Exclusion criteria Inmates with severe somatic pathologies

Sampling method Systematic random sampling

01/15/2023 16
 Methodology

Data collection tools and techniques :

Data sources Techniques Tools
Primary Data
1. Interview (Prisoner) Face to face interview Semi structured questionnaire

2. Interview (Prisoner) Face to face interview Standard Tool

Center for Epidemiological
Studies- Depression Scale
(CESD)

01/15/2023 17
 Methodology

Data Management analysis :

Data Processing
Editing Coding Classification Tabulation
Data entry Epidata version 3.1
Data analysis • SPSS (Statistical Package for Social Science)
Version 17
• Descriptive analysis
• Chi-square, logistic regression and
multivariate regression.
• CES-D was calculated based on the criteria

01/15/2023 18
 Methodology

Data Management analysis :

Data analysis

Data analysis: Logistic regression was used as
dependent variables have binary value; yes or
no.
Test assumption of regression was done:
Met assumption of linearity.
Met assumption of normality.
Met assumption of collinearity.
Met assumption of homoscedasticity.
Now eligible to perform regression.

Data Presentation Graphic, Tabular, Diagrammatic, Description

01/15/2023 19
 Methodology

Pre-testing • Internal consistency = 0.842

• Pre testing was done 10% of sample size i.e.
35 in Dillibazar prison.
Ethical Consideration • Approval letter from Central Department of
Prison Management, Kalikasthan.
• The formal approval letter from Institute
Review Board Committee (IRC).

Confidentiality • Participant’s personal information was not

disclosed
• Participants were not force to participate in
research study.
Limitation • It was cross sectional study so, the study does
not allow inferring the causation.
• Do not follow up.

01/15/2023 20
 Findings : Socio-demographic variables

Age of the respondents (n = 352) Mean±SD =

50.0 32.76±10.17
45.0 43.2 Minimum = 18
40.0 36.4 Maximum = 77
Percentage %

35.0
30.0
25.0
20.0
15.0 12.5
10.0 6.3
5.0 1.7
0.0
18-28 29-39 40-50 51-61 61 and older
Age in years

01/15/2023 21
 Socio-demographic variables

Sex of the respondents (n = Marital status of respondents

352) (n = 352)

0%
9% Male 2% Married
Female Unmarried
Others 39% Widowed
58%

91%

01/15/2023 22
 Socio-demographic variables

Ethnicity of respondents (n = 352)

35
30 28.98
25.00
25
Percent %

20
15.06
15 12.78
10 8.81
5.40
5 3.13
0.85
0
Janjati Chhetri Brahmin Newar Dalit Madhesi Others Foreigners
Fig: Bar diagram showing ethnicity of inmates

01/15/2023 23
 Socio-demographic variables

Religion of respondents (n = 352)

90
80 77.56
70
60
Percent %

50
40
30
20 14.20
10 4.26 2.56 1.42
0
Hindu Buddhist Christian Others Mulsim
Fig: Bar diagram showing religion of inmates

01/15/2023 24
 Socio-demographic variables

Previous occupation of respondents ( n = 352)

30 25.28
25
20 17.33 15.34
15 13.07 12.78
9.66
Percent %

10
5 3.69 2.84
0
e ss nts e rs re o b e s ob or
n e t h tl u e j ag t j a b
usi u d O cu a t w en L
B St gr
i i v il y nm
A Pr Da e r
ov
G
Fig : Bar diagram of Previous occupation of inmates

01/15/2023 25
 Socio-demographic variables

Educational status (n = 352)

45 41.48
27.84
30
10.51 13.07
15 7.10
0
Percent %

ac
y -8) 12
)
ar
y
o ve
r 1 - d b
it e
o n( n(
9 o n A
Ill ti tio ec
u ca c a e r s
ed e du i gh
ic ry H
as
B n da
c o
Se
Fig : Bar chart showing Educational status of inmates

01/15/2023 26
 Substance related variables

Ever consumed drug in a life- Ever consumed alcohol in a

time (n = 352) lifetime (n = 352)

33% Yes Yes

No No
50% 50%
67%

01/15/2023 27
 Substance related variables

Ever consumed tobacco Ever smoked cigarette in a

products in a lifetime (n=352) lifetime (n=352)

Yes Yes
40% No No
48% 52%
60%

01/15/2023 28
 Clinical history variables

Family history of mental Types of history of mental

illness (n=352) illness (n=16)

5% Depression
Yes 13%
Anxiety
No 19% Others
69%
95%

01/15/2023 29
 Clinical history variables

History of mental illness Types of history of mental

(n=352) illness (n=15)

4% Depression
Yes 31% Anxiety
No
50% Others

19%
96%

01/15/2023 30
 Clinical history variables

History of clinical illness Types of history of clinical illness

(n=352) (n=59)
31.3%
30.0% 25.0%
20.0% 14.1%
17% Yes 9.4%
10.0% 6.3% 6.3% 7.8%

Percentage %
No
0.0%
a se sis e se
i o n n s
t e s
em
83% e l o a s t i o e l
di
s
r cu dis
rt en f e c i ab r ob
in be rt e i n D p
k a p l e
S Tu He Hy t o ry u sc
i ra M
sp
R e

01/15/2023 31
 Clinical history variables

Frequent follow-up with Weight loss experienced after

health care provider (n=352) entering jail (n=352)

21.6%
26.4% Yes Yes
No No

73.6% 78.4%

01/15/2023 32
 Clinical history variables

Current health problem Types of current health problem

faced by respondents (n=58)
(n=352)
40 35.29 32.35
20 13.24 8.82 5.88
2.94 1.47

Percentage %
Yes 0
16.5% No m
s
i on t es a se e se s is
o ns
ble ns be i se i sa u lo c ti
o e i a d d rc fe
pr e rt D n r t e n
l e y p
S ki e a u b
r y
i
c H H T
83.5% us r a to
M pi
s
Fig : Bar diagram showing types of current Re health
problem faced by inmates

01/15/2023 33
 Imprisonment variables

Previous incarceration (n=352) Duration of previous in-

carceration (n=26)
70
7.4% 60 57.69
50 42.31
Yes

Percent %
No 40
30
92.6% 20
10
0
<1 year 1-10 years
long

01/15/2023 34
 Imprisonment variables

Duration of incarceration(years) (n=352)

60
50 48.86

40
Percent %

30 28.41

20 17.90

10 4.83
0
1-5 years 6-10 years >10 years <1 year
Fig : Bar diagram showing Duration of incarceration(years) of inmates

01/15/2023 35
 Imprisonment variables

Types of crime that led to incarceration (n=352)

30
24.43
25 22.73
20.74
20 17.05
Percent %

15
10 7.10 5.68
5 2.27
0
Drugs Rape Bank issue Murder Robbery Theft Corruption
Fig: Bar chart showing Types of crime that led to incarceration

01/15/2023 36
 Imprisonment variables

Number of prisoners per cell (n=352)

45
40 38.35
35
30 25.28
Percent %

25 21.59
20
14.77
15
10
5
0
>39 26-38 13-25 1-12
Fig : Bar diagram showing Number of prisoners per cell

01/15/2023 37
 Imprisonment variables

Thought that life will be dif- Experienced bullying inside

ficult after release from jail prison (n=352)
(n=352)

1%
Yes Yes
No No
45.5%
54.5%
99%

01/15/2023 38
 Imprisonment variables

Experienced violence inside Involved in work inside

prison (n=352) prison (n=352)

1.7%
Yes Yes
No 48.3% No
51.7%

98.3%

01/15/2023 39
 Imprisonment variables

Prison meal (n=352) Family support (n=352)

29.5% Good 30.7%

Yes
Bad
No
Satisfactory
64.5% 6% 69.3%

01/15/2023 40
 Imprisonment variables

Social support (n=352) Thought of committing suicide

during imprisonment by in-
mates (n=352)

34.1% Yes 4.3% Yes

No No
65.9%

95.7%

01/15/2023 41
 Dependent variable: Prevalence of depression

Prevalence of depression among

inmates

Yes Based on CESD score

45.7% No Cut off value 16
54.3%

01/15/2023 42
 Association between variables and depression
Multivariate regression analysis table
Socio- Depression   AOR 95% CI P value
demographic
characteristics
  Present Absent      
Previous          
occupation
Agriculture 17(37%) 29(63%) - - 0.017*
Business 53(59.6%) 36(40.4%) 0.081 0.023-0.288 0.001*
Private job 25(55.6%) 20(44.4%) 0.139 0.036-0.539 0.004*
Government job 5(38.5%) 8(61.5%) 0.244 0.028-2.122 0.201
Students 29(47.5%) 32(52.5%) 0.298 0.078-1.136 0.076
Daily wages 27(79.4%) 7(20.6%) 0.133 0.027-0.647 0.012*
Labor 3(30%) 7(70%) 0.216 0.021-2.192 0.195
Others 32(59.3%) 22(40.7%) 0.167 0.038-0.736 0.018*

01/15/2023 43
Variables Depression   AOR 95% CI P value
  Present Absent      
Drug use          
Yes 75(64.7%) 41(35.3%) ref - -
No 116(49.2%) 120(50.8%) 2.539 0.995-6.478 0.050

History of clinical          
illness
Yes 40(67.8%) 19(32.2%) ref - -
No 151(51.5%) 142(48.5%) 4.040 1.290-12.658 0.017*

No. of prisoner          
per cell
1-12 31(59.6%) 21(40.4%) ref - 0.001*
13-25 34(44.7%) 42(55.3%) 0.500 0.146-1.708 0.269
26-38 32(36%) 57(64%) 1.060 0.296-3.795 0.928
>39 94(69.6%) 41(30.4%) 0.152 0.046-0.504 0.002*

Family support          

Yes     Ref - -
No
01/15/2023     0.182 0.073-0.454 0.001*
44
Suicidal thought Depression   AOR 95% CI P value
during
imprisonment
  Present Absent      
Yes     ref - -
No     136.822 1.467-12762.213 0.034*

Social support          
Yes     ref - -
No     0.384 0.176-0.837 0.016*

01/15/2023 45
 Discussion

This study Previous study

• Prevalence of depression = 54.3%. • Similar to study conducted in Tigray, Ethiopia,
•May be due to by the use of different prevalence was 55.9%. Oromia region,
depression assessment tools, study Ethiopia revealed prevalence of depression
environments, study year, inclusion criteria of was 45.1%.5,14
the study. • Dillibazar Prison prevalence = 45.6% .7

•Only significant association between previous
occupation of inmates and depression.
•No association between drug use and
depression
• Similar to the findings of study in Tigray,
Ethiopia.9,14
• Study done in Ethiopia, and Pakistan was in
contrastingly with the current result but
similar to study of Jimma prison.14,39,43

01/15/2023 46
 Discussion
This study
•Significant association between clinical
illness history and depression.
•Worse physical health is related to
perceived bad mental health and vice versa.
•Types of offense and duration of stay inside
prison was not associated.
•Number of prisoner per cell was found to be
statistically significant.
01/15/2023
Previous study
•Similar to the findings of study conducted in
Jimma Prison and Malaysia.1,39
•Similar to the findings of study of Central
female prison Nepal, Eastern Nepal and
Jimma prison.8,39,9
•Association between duration of stay in
Tigray prison.14
•Different than that of Eastern Nepal may be
due to the different settings of prison.
47
 Discussion

This study Previous study

• Family support and social support were • This result was consistent with research from
associated with depression. Jimma, Northwest Amhara, Tigray.6,14,39
• isolated from family and society, lack of
family support can worsen the conditions and
lead inmates to be sad, depressed.
• Suicidal thought during imprisonment was • Result was consistent with research from
significantly associated with depression Northwest Amhara and Eastern Nepal. 6,9
having p-value 0.034
• Possible cause The absence of family,
criminal guilt, jail violence, and an inability to
adapt to prison life. 6,9

01/15/2023 48
 Conclusion

• The current study showed that inmates of Nakkhu Prison and Central Prison have
high prevalence of depression i.e. more than half of the inmates.
• This study has also demonstrated a high rate of smoking cigarette among the
inmates which is almost half of the population.
• The factors like previous occupation of inmates,
• history of clinical illness,
• number of prisoner per cell,
• family support, social support and
• thought of suicide during imprisonment was found to be associated p-value less
than 0.05 with depression from the multiple regression analysis table.

01/15/2023 49
 Recommendation

• Inmates' mental health issues need to be addressed right away through accurate
diagnosis and treatment, as well as the utilization of rehabilitation programs.
• To take action to reduce social isolation.
• Guarantee that mental care continues after release, and reintegrate inmates into
society.
• Prison authorities should enhance income generating activities within jail without
violating laws and rules.
• Mental health professionals should periodically evaluate depression in prisoners.
• Further research should be done including all the prison of Kathmandu valley for more
generalized result.
01/15/2023 50
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 Acknowledgement

•Mr. Nishchal Devkota (Supervisor and HOD of Research Department)

•Mrs. Purnalaxmi Maharjan and Mr. Shailesh Regmi (Public Health Department) NOC.
•Mr. Basudev Ghimire, Director General of Prison Management and all the prison staffs.
•Police of prison for providing me security.
•Library of NOC.
•Participants of this study.
•Family .
•Everyone directly or indirectly involved.

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Annexes: Acceptance letter from institution and IRC

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 Annexes: Test assumption of regression

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 THANK YOU

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