Mental disorder prevalence and associated risk factors in three prisons of Spain

Psychosocial stressors perceived in the process of social reintegration and compliance time remaining in prison sentence

M García-Jarillo, F Caravaca-Sánchez, C Sánchez-Alcaraz, A Luna

Department of Legal Medicine and Social and Health Sciences, University of Murcia



Introduction: This study shows the results obtained from evaluating the main psychosocial stressors perceived in the process of social reintegration and their relation to a remaining sentence time in prison.

Material and methods: A questionnaire based on an ad hoc design was administered, using a Likert scale, with a total of 383 inmates serving sentences in southeast Spain.

Results: Findings show that inmates with a remaining sentence period of more than one year, like those who had served more than a year of their sentence, showed greater concern about possible economic difficulties.

Conclusions: The psychosocial stressors studied might provide relevant information to facilitate the process of social reintegration after the completion of a prison sentence.

Keywords: Prisons; Prisoners; Stress Psychological; Social Adjustment; Quality of Life; Cross-Sectional Studies; Psychology; Spain.



Imprisonment is usually conceived as a traumatic event in someone’s life1, since it involves most of the attributes of traumatic events such as a threat to someone’s usual lifestyle, distance from someone’s social network and the admission to an environment where deprivation is the rule2. On the other hand, imprisonment could be placed at the beginning of a stress chain reaction which will entail relationship problems, reduction of family income, difficulties communicating the situation to children, etc3. For Zamble and Porporino4 preparing for release is also difficult for many since it involves recovering someone’s place in society, reconnecting with people and situations which have changed during imprisonment. Therefore, it is not uncommon to hear about people who re-offended to come back to prison2, in what is known as prisonization5.

Several studies have been conducted on the issues implicit in social reintegration and have allowed the identification of several risk factors both personal and contextual6-15: a) difficulties getting a job, sometimes because of prior criminal record; b) financial problems, specially immediately after release, which jeopardizes the coverage of basic needs; c) housing issues, since a considerably high proportion of inmates has not a house of their own, therefore depending on family support or penitentiary aid services.; d) psychosocial issues, such as disorientation, difficulties in forging new relationships and interacting with others, family conflicts, fear of re-offending and problems adjusting to the environment’s new demands; e) drug and/or alcohol abuse; and f) factors associated to the situation of deprivation of liberty such as prejudice and social stigma, break of bonds with relevant persons, detachment and physical and/or mental health problems16.

The importance of the link between psychosocial stress and health is mostly due to the negative effects of psychosocial stress on the latter and its potential impact on several elements of social structure such as crime. The effects of psychosocial stress depend on the perception of stressors that each individual has, his/her capacity to address stressors, his/her individual training provided by society and the use of socially accepted coping strategies17. This is therefore why this study has addressed the evaluation of the perception of psychosocial stressors which can be encountered once imprisonment ends.

Thus our primary endpoints are: a) to assess the degree of concern on several psychosocial stressors by inmates once the sentence has been served and b) to assess the remaining time of imprisonment with reference to several psychosocial stressors perceived by inmates.



TA cross-sectional analytical study was conducted throughout January-March 2014 in three correctional facilities in Spain: Murcia I and Murcia II (The Region of Murcia) and Villena (Alicante), with an overall imprisoned population of approximately 1800. Almost 10 days before field research in each of the prisons, the lead researcher contacted the facility and requested information on the legal situation of inmates at the time and their location within the correctional, as to verify what inmates fulfilled inclusion criteria to take part in the study. Inclusion criteria in the present research were: a) to be serving a sentence, b) to be able to read and to write in Spanish, and c) to provide informed consent with each of the questionnaires. Exclusion criteria were: a) preventive detention and b) inability to understand Spanish.

The final sample (n= 383) was obtained by means of simple randomized sampling techniques with a ± 5% margin of error and a 95% confidence intervals (CI), randomly selecting 410 inmates serving sentence in prison. 18 inmates (4.3%) were unable to read and to write in Spanish and 27 (6.5%) refused to participate, mainly alleging that "they were not going to gain anything" and "that they had little time left in prison".

Data was gathered by means of a self-assessment questionnaire provided to participants in common areas within each of the modules. At all times, interviewers were available to solve potential doubts among participants. Inmates were divided into groups of about ten people, with an approximate duration of 30 minutes per group. In 35 cases (9.1% of the sample) and due to different reasons (reading and/or understanding issues) interviews were carried out individually in other locations within the prison.

Prior authorization from the Support Unit of the General Secretariat of Penitentiary Institutions (SGIP) was sought in accordance with Articles 4.2b and 211 of the Prisons Regulations and with Act 15/1999 on data protection and the standards required by the Research Ethics Committee of the University of Murcia. In order to ensure the participants’ anonymity, researchers had no access to the inmates’ records or protocols during the research period.

The necessary data to satisfy the main endpoints of this study were collected by a purposefully designed questionnaire based on previous research. The questionnaire gathers information on the following variables: socio-demographic, criminal and psychosocial stressors perceived throughout social reintegration processes.

Socio-demographic and criminal variables included: age, country of birth, employment status prior to imprisonment, education, re-offence and crime or main crimes committed in connection with imprisonment. Items used at the time had been adapted from previous research18.

Psychosocial stressors perceived throughout the social reintegration process: by means of a 5 point Likert scale (5 being the highest punctuation and 1 the lowest) participants indicated their degree of concern with regard to several stressing life events after serving their sentence. The 16 items which are included have been developed on the basis of Holmes and Rahe Social Readjustment Rating Scale (SRSS)1.

Information was processed by means of IBM Statistical Package for the Social Sciences (SPSS v.20) software, with a 95% level of significance (p≤ 0.05). The process included three phases: firstly, frequencies and percentages of the overall sample were analyzed and according to the remaining time of sentence (a year or less, and over a year), as well as statistically significant relations by means of 2x2 contingency tables. Secondly, an analysis was carried out as to determine psychosocial stressors perceived throughout the social reintegration process by the sample. Moreover, these were expressed as averages with 95% confidence intervals. Finally, psychosocial stressors were measured again on the basis of the remaining time of sentence with 95% CI.



Table 1 depicts sociodemographic and penitentiary variables of all survey respondents and according to remaining time for the completion of the sentence. Mean age of the sable is 36.5 years, ranged between 18 and 69 years old, the majority being males of Spanish nationality with a low education level. No statistically significant association according to the remaining time for the completion of the sentence was found for any of the sociodemographic variables studied. However, a statistically significant association was found between inmates serving a sentence due to crimes against individuals (p=0.009) and against public health (p=0.001) according to the remaining time of sentence.

The scores according to the relevance given to each of the psychosocial stressors are depicted in Table 2. As shown, the overall degree of concern is not very high, yet the stressors associated with financial problems have higher punctuations and thus are of special concern. Specific stressors which reported a higher degree of concern were the possibility of not finding a job upon release (2.89; 95% CI: 2.72-3.07), and not having a house of their own (2.74; 95% CI: 2.56-2.90). On the other hand, psychosocial stressors causing far less concern for inmates were sexual concerns or difficulties (1.62; 95% CI: 1.5-1.74) and relationship issues (1.93; 95%CI: 1.79-2.07).

Tables 3 and 4 show the punctuations of each of the psychosocial stressors according to the remaining time of sentence (one year or less, or over a year respectively). As shown, both for inmates with a remaining period of a year or less or over a year, the psycho-social stressor with a higher score is the possibility of future unemployment (2.95; 95%CI:2.71-3.19 vs. 2.85; 95%CI:2.60-3.09 respectively). The stressor with a lower score was potential sexual difficulties upon release for both groups (1.52; 95%CI: 1.37-1.68 vs. 1.71; 95%CI: 1.53-1.89 respectively).

Figure 1 shows concern scores for each of the psychosocial stressors by comparing them between the two groups (remaining time of sentence). As shown, the degree of concern is similar in both groups, except for sexual difficulties, which is slightly lower among inmates with a remaining time of sentence of a year or less, with a statistically significant relation (p=0.039).




As already reported by Crespi16, the data collected in this research suggests that the main psychosocial stressors identified by inmates are financial problems. This category includes a change of the economic situation, not having a home of their own and not finding a job upon release, as reported by previous studies19-20. Other main stressor reported in this paper was spare time and lack of occupation. The relationship between quality of life, the maintenance and improvement of health and using spare time in enjoyable activities. A productive management of spare time so that it generates bilateral profit, at an individual and relational level, would be in the interest of an improved adaptive social behavior.

Both inmates with a remaining time of sentence of a year or less and those with a remaining time over a year showed concern for potential financial problems. There are several stressors derived from a lack of economic resources which cause increased unease among inmates16. We believe that it is important to underline that 47.3% of inmates were unemployed prior to imprisonment, since this can strongly contribute to an increased concern for financial problems once the sentence is completed.

On the other hand, stressors referred to a relational level are perceived with a lower degree of concern in both groups, such as relationship problems as a couple, relationship problems with their children and sexual problems or difficulties. This fact could be explained by the so called "frozen time situation" where inmates expect to continue in their relationship, or act as a parent without considering the changes which may have happened during their imprisonment16.

To conclude the present study, after an analysis of the perception of inmates on different kinds of psychosocial stressors (financial, relational, employment, psychosocial, substance-abuse related and associated to the deprivation of liberty) and according to the remaining time of sentence, we have observed how financial psychosocial stressors are the main cause of concern in the sample under study.

With regard to the limitations of this study, we first want to report the lack of studies thoroughly addressing psychosocial stressors in the social reintegration process and moreover, in connection with the remaining time of sentence (we have not found studies addressing this relation). Furthermore, we had no access to inmates housed in maximum security modules (approximately 2.5% of the total population), who could have provided perceptions on psychosocial stress enriching the information collected. Finally, it is worth considering that all variables were based on self-reports of inmates.

Although no statistically significant differences were found in both groups according to the remaining time of sentence, we believe that it is interesting to address this variable in future research, since it is an issue to consider in addressing other correctional variables, as previous authors have concluded 221. Moreover, it is worth developing longitudinal studies undergoing monitoring of inmates beyond imprisonment. This could improve the situation of those serving a sentence and thus have a positive impact on their health and that of their social environment upon release.



M. García-Jarillo
Departamento de Medicina Legal y Ciencias Sociosanitarias.
Universidad de Murcia



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