PROFILE OF FEMALE USERS OF PRESCRIBED PSYCHOTROPICS IN A PRISON UNIT IN MINAS GERAIS

PERFIL DE LAS MUJERES USUARIAS DE PSICOTRÓPICOS RECETADOS EN UNA UNIDAD PENITENCIARIA DE MINAS GERAIS

ABSTRACT

Objective:

to analyze the profile of women who use prescribed psychotropic drugs in a female prison unit.

Method:

this is a quantitative, exploratory, descriptive cross-sectional study developed with the population of a female penitentiary complex in the state of Minas Gerais. The total population admitted to the institution during the collection period was 363 people deprived of liberty and all were included in the analysis. Data were collected between August and December 2022 from the institutional database and were analyzed according to statistical tests (descriptive statistics and dispersion measures, Mann-Whitney test and Chi-squared test).

Results:

the sample was composed of young women of African descent, with a low education level, mothers and who did not receive visitors. Approximately 70% (n=250) used some prescribed psychotropic drug. The most frequent psychiatric diagnoses were anxiety disorders, followed by mood disorders. Women who used prescribed psychotropic drugs had a higher median length of incarceration. There was a significant association between the use of psychotropic drugs and chronic diseases.

Conclusion:

the identified profile reaffirms the effects of existing differences regarding gender. Even with the increase in public policies aimed at women, their specificities are often disregarded. Regarding the use of psychotropic drugs, it is suggested that the high rate corresponds to the conditions generated by incarceration.

DESCRIPTORS:
Women; Gender role; Prison; Mental health; Psychotropics

RESUMEN

Objetivo:

analizar el perfil de las mujeres consumidoras de psicofármacos prescritos en una unidad penitenciaria femenina.

Método:

se trata de un estudio cuantitativo, exploratorio y descriptivo, de carácter transversal, desarrollado con la población de un complejo penitenciario femenino del estado de Minas Gerais. La población total ingresada en la institución durante el período de recolección fue de 363 personas privadas de libertad y todas fueron incluidas en el análisis. Los datos fueron recolectados entre agosto y diciembre de 2022, de la base de datos institucional y analizados según pruebas estadísticas (estadística descriptiva y medidas de dispersión, prueba de Mann-Whitney y prueba de Chi-cuadrado).

Resultados:

La muestra estuvo conformada por mujeres jóvenes, afrodescendientes, con bajo nivel educativo, madres y que no recibieron visitas. Aproximadamente el 70% (n=250) consumía algún psicofármaco prescrito. Los diagnósticos psiquiátricos más frecuentes fueron los trastornos de ansiedad, seguidos de los trastornos del estado de ánimo. Las mujeres que consumían psicofármacos recetados tenían una mediana de duración de encarcelamiento mayor. Hubo una asociación significativa entre el uso de psicofármacos y enfermedades crónicas.

Conclusión:

el perfil identificado reafirma los efectos de las diferencias existentes en cuanto al género. Incluso con el aumento de las políticas públicas dirigidas a las mujeres, a menudo se ignoran sus especificidades. En cuanto al uso de psicofármacos, se sugiere que la alta tasa corresponde a las condiciones generadas por el encarcelamiento.

DESCRIPTORES:
Mujer; Rol de género; Prisión; Salud mental; Psicotrópicos

RESUMO

Objetivo:

analisar o perfil das mulheres usuárias de psicotrópicos prescritos em uma unidade prisional feminina.

Método:

trata-se de um estudo quantitativo, exploratório e descritivo, de caráter transversal, desenvolvido com a população de um complexo penitenciário feminino do estado de Minas Gerais. A população total admitida na instituição no período de coleta era de 363 privadas de liberdade e todas foram incluídas na análise. Os dados foram coletados entre agosto e dezembro de 2022, a partir do banco de dados institucional e foram analisados de acordo com testes estatísticos (estatística descritiva e medidas de dispersão, teste de Mann-Whitney e teste Qui-quadrado).

Resultados:

a amostra foi composta por mulheres jovens, afrodescendentes, com baixo nível de escolaridade, mães e que não recebiam visitas. Aproximadamente, 70% (n=250) usavam algum psicotrópico prescrito. Os diagnósticos psiquiátricos mais frequentes foram os transtornos ansiosos, seguidos pelos de humor. As mulheres que utilizavam psicotrópicos prescritos apresentaram uma mediana maior em relação ao tempo de reclusão. Houve associação significativa entre o uso de psicotrópicos e doenças crônicas.

Conclusão:

O perfil identificado reafirma os efeitos das diferenças existentes no que tange ao assunto gênero. Mesmo com o aumento de políticas públicas destinadas às mulheres, as suas especificidades, muitas vezes, são desconsideradas. Quanto ao uso de psicotrópicos, sugere-se que a alta taxa corresponde às condições geradas pelo encarceramento.

DESCRITORES:
Mulheres; Papel de gênero; Prisão; Saúde mental; Psicotrópicos

INTRODUCTION

Several recent studies have been developed on the general health, quality of life or mental health of the population deprived of liberty1. Some of these studies were developed with the prison population in general1^-11, however several researchers have specifically dedicated themselves to the female public12^-25, highlighting issues inherent to this subgroup which must be prioritized13^-14^,16^,25.

Even though the number of women in Brazil is numerically greater than that of men, public policies reflect the historical and social circumstance of female invisibility, both in free society and in prison15^-16. The lack of consideration of the particularities of this genre reaffirms a stigmatized and deficient view that does not guarantee those deprived of liberty to fulfill their sentences with their fundamental rights guaranteed14^,24.

Furthermore, women deprived of liberty are often emotionally abandoned, especially due to factors that reinforce the implications of sexism established by patriarchal society, reproduced in the family and institutional environment23^,25. Thus, due to their gender and the different roles attributed to them (mother, daughter, wife, worker, caregiver), women carry with them several specificities and face different forms of prejudice and discrimination, which also intensifies when they are incarcerated, becoming more likely to develop illnesses related to mental health2^,23. Furthermore, considering intersectionality, incarcerated women also face inequities related to race/ethnicity, which results in reduced access to basic rights, such as health, education and work opportunities3^,13.

Taking into account the importance of the topic, one of the Sustainable Development Goals (SDGs) established by the 2030 Agenda seeks to achieve gender equality and the empowerment of all women. Furthermore, the UN System in Brazil proposes an alignment between the 2030 Agenda and the SDGs with the International Decade for People of African Descent, as well as activities aimed at promoting comprehensive care for women’s health, education, political and economic empowerment, combating violence and racism, considering that they affect women in their diversity26.

In this sense, it is understood that with the increase in the number of women deprived of liberty in Brazil and around the world, it is necessary to prioritize this population by the health teams of the prison unit. This includes considering pre- and post-admission factors that may pose a risk for developing mental disorders, such as a lifetime history of trauma, abuse and neglect. When combined with the hostile prison environment and difficulties in accessing care and treatment, these factors contribute to intensify emotional suffering, and in some cases result in self-destructive attitudes21^,24.

The use of psychotropic drugs stands out among such attitudes, which has a high prevalence among women, and is therefore an important issue to be investigated in relation to the mental health of women deprived of their liberty. Specifically in reference to this topic, some studies have discussed the issue in a tangential way to others which compose the mental health of this population2^,5^,11^-12^,16^,18^,20^,22, while other studies have specifically focused on this phenomenon per se4^,6^-7^,10. The results of these studies have elucidated the need for more research on the use of psychotropic drugs and mental health, particularly in the female prison population.

In view of the above, and considering the heightened risk that these women present as a result of being in the prison system, it is emphasized that studies which support nursing in developing interventions focused on promoting mental health that are more sensitive to the specificities of this population are extremely important. Therefore, the objective of the present study was to analyze the profile of women users of prescribed psychotropic drugs in a female prison unit in Minas Gerais, Brazil.

METHOD

This is a quantitative, exploratory, descriptive cross-sectional study based on secondary data from the population of a female penitentiary complex in the state of Minas Gerais, Brazil. This complex is a prison unit with capacity for 426 women. A total of 363 inmates were deprived of their liberty until December 2022, predominantly convicted and divided into open, semi-open and closed regimes. Data collection took place between August and December 2022 from the institutional database on healthcare, and information from 363 inmates was considered for analysis, without using exclusion criteria.

The information obtained from the institutional database was age, gender identity, number of children, visitor registration, date of admission to the prison unit, marital status, use of psychotropic drugs, presence of chronic illness and psychiatric diagnosis in order to outline the sample profile.

Descriptive statistics and dispersion measures (percentage, mean and standard deviation) were used to analyze clinical and sociodemographic data and detail the characteristics of the use of psychotropic drugs. The Mann-Whitney Test was used to analyze the difference in the median time spent in prison between women who used and those who did not use psychotropic drugs. Therefore, the Chi-squared test was used to analyze the association between clinical characteristics and the use of psychotropic drugs.

The present study was approved by the institution’s Research Ethics Committee. Considering that the secondary data were analyzed anonymously and the results do not enable identifying the participants, the Research Ethics Committee was asked to waive the Informed Consent Form (ICF). Even though it was granted, all ethical aspects provided for by Resolution No. 466/12 of the National Health Council were considered.

RESULTS

Participants’ profile

As seen in Table 1, the majority of participants identified themselves as cisgender women (CIS); heterosexuals; black, brown or indigenous, and with incomplete primary education. There was a predominance of single women, with two or more children, and they did not have registered visitors. The average time spent in prison was 13.96 months (SD=9.01).

The participants’ ages ranged between 19 and 69 years old, with an average of 35.43 years old (SD=10.24), with the majority in this range considered young adults. For clinical aspects, the majority did not have a formal diagnosis of chronic or psychiatric illnesses, but were users of prescribed psychotropic drugs (Table 1).

Table 1 -
Clinical and sociodemographic characteristics of the participants, Belo Horizonte, MG, Brazil, 2022. (n=363).

Characteristics	n	%
Gender identity
Cis Woman	320	88.20
Non-binary person	3	0.8
Transvestite	6	1.7
Trans Man	2	0.6
Missing	32	8.8
Age range
Young adult (19 to 30 years old)	216	59.5
Adult (31 to 59 years old)	134	36.9
Older adult (60 years and over)	13	3.6
Sexual orientation
Homosexual	69	19.0
Heterosexual	227	62.5
Others	56	15.40
Missing	11	3.0
Ethnicity
Black, brown and indigenous people	281	77.5
Whites	58	16
Missing	24	6.6
Education level
Illiterate	5	1.4
Incomplete elementary education	181	49.9
Complete primary education	92	25.3
Complete high school	73	20.1
Complete higher education	11	3.1
Missing	1	0.3
Civil status
Single	271	74.7
Married	57	15.7
Divorced/Separated	21	5.8
Widow	12	3.3
Missing	2	0.6
Number of children
None	97	26.7
1 child	64	17.6
2 or more children	202	55.6
Imprisonment period
Up to 5 months	155	42.7
From 6 to 15 months	98	27
More than 15 months	110	30.3
Registered visitors
Yes	169	46.6
No	191	52.6
Missing	3	0.8
Prescribed psychotropic drug
Yes	250	68.9
No	113	31.1
Chronic disease
Yes	105	28.9
No	258	71.1
Psychiatric diagnosis
Yes	125	34.4
No	238	65.6

Each woman took an average of three types of psychotropic drugs (mean=2.76; SD=1.32), and some up to seven of them (minimum=1; maximum=7). As can be seen in Table 2, the most prevalent types among them were benzodiazepines/hypnotics or anxiolytics.

Table 2 -
Psychotropic drugs prescribed with greater prevalence during prison, Belo Horizonte, MG, Brazil, 2022. (n=250).

Psychotropic drug	n	%
Antidepressants	226	62.2
Amitriptyline	110	48.7
Fluoxetine	89	39.3
Nortriptyline	16	7.0
Sertraline	4	1.7
Escitalopram	2	0.8
Clomipramine	2	0.8
Imipramine	1	0.4
Venlafaxine	1	0.4
Trazodone	1	0.4
Benzodiazepine/hypnotic or anxiolytic	240	66.6
Clonazepam	182	76.0
Diazepam	28	11.7
Levozine	27	11.2
Alprazolam	2	0.8
Zolpidem	1	0.4
Antipsychotics	86	23.6
Haldol	31	36.0
Risperidone	20	23.2
Chlorpromazine	27	31.4
Trifluoperazine	3	3.5
Olanzapine	3	3.5
Quetiapine	1	0.2
Amisulpride	1	0.2
Mood stabilizers	78	21.5
Carbamazepine	32	41.0
Valproic acid	28	35.9
Lithium carbonate	15	19.2
Sodium valproate	2	2.5
Aripiprazole	1	1.3
Anticholinergics/Antiepileptics	30	8.2
Biperiden	19	63.3
Phenobarbital	9	30.0
Phenytoin	1	3.3
Naltrexone	1	3.3

Regarding diagnoses, 34.4% of participants had some psychiatric diagnosis (n=125), with 23.2% of them (n=29) having two or more diagnoses. The most prevalent were related to mood and anxiety disorders (Table 3).

Table 3 -
Most frequent psychiatric diagnoses according to ICD-10, Belo Horizonte, MG, Brazil, 2022. (n=125).

ICD	n	%
F10 to F19 - Mental and behavioral disorders due to substance use	11	6.8
F20 to F29 - Psychotic disorders	33	20.6
F30 to F39 - Mood disorders	53	33.1
F40 to F49 - Anxiety disorders	54	33.7
F60 or F63 - Personality disorders	9	5.6

Association between variables

Women who used psychotropic drugs had a higher median length of incarceration (Table 4).

Table 4 -
Difference in age and length of imprisonment between participants who were or were not prescribed psychotropic drugs, Belo Horizonte, MG, Brazil, 2022. (n=363).

		Age		Imprisonment period
	n(%)	Rank mean	p-value	Rank mean	p-value
Prescribed psychotropic drugs			0.121		0.001
Yes	247(68.0)	187.84		204.20
No	116(32.0)	169.56		134.73

There was also a statistically significant association between the use of psychotropic drugs and the presence of chronic illness or a psychiatric diagnosis (Table 5).

Table 5 -
Relationship between prescribed psychotropic drugs, chronic illness and psychiatric diagnosis among participants, Belo Horizonte, MG, Brazil, 2022. (n=363).

	Prescribed psychotropic drugs
	Yes (%)	No (%)	p-value
Chronic disease			0.001
Yes	87(82.9)	18(17.1)
No	160(62.0)	98(38.0)
Psychiatric diagnosis			0.001
Yes	123(49.4)	2(1.8)
No	126(50.6)	112(98.2)

DISCUSSION

The population profile of the present study was composed of young women of African descent, with a low education level, mothers and who did not receive visitors, corroborating previous research13^,17^,21. The higher incarceration rate of young black people has been highlighted as a important result of the structural racism that underpins Brazilian society, in which the figure of the black/brown person in itself is often stigmatized as dangerous and prone to breaking the laws3^,9^,13. It is important to highlight the need for a decolonial vision of social relations with a view to overcoming the traps of coloniality that reproduce inequalities mainly related to race/ethnicity, but also to gender and class27.

Although women generally present education higher rates than men, young adult women of African descent represented an estimated attendance at higher education of 22.3% in 2019, almost half the frequency among white women (40.9%), and 30% lower than among white men (30.5%)9, constituting data which highlights the structural racism to which this population is subjugated.

The fact that most women are mothers and do not receive visitors is related to the abandonment profile of incarcerated women. The literature points out the double suffering to which these women are subjected: firstly, because they have to leave their children, and secondly, because they often do not receive visitors, either due to the burden of those left with the children and not being available, or due to their own abandonment of their families13^,15^,25. This result highlights the gender discrimination faced by incarcerated women, since even incarcerated men continue to receive visits and support from their family16^,25.

The results demonstrated that almost 70% of the participants used prescribed psychotropic drugs, generally some benzodiazepine, corroborating findings in the literature4^,6^,10^-11. A review study identified that the most prevalent class of psychotropic drugs in the penitentiary system were sedatives, hypnotics and tranquilizers, with benzodiazepines being the most used10. Furthermore, in a study which portrays the health conditions of inmates in a prison in Santa Catarina, it was also mentioned that the class of psychotropic medications most used were benzodiazepines (50% of women and 28.38% of men), followed by antidepressants23. A study carried out in 2022 describing the health situation of people deprived of liberty in Gerona (Spain), identified that 35.5% of those were using anxiolytics or hypnotics, 24.4% antipsychotics and 21% antidepressants, highlighting that there was a higher rate of women than men undergoing antidepressant treatment3. A documentary study carried out in a penitentiary in Rio Grande do Norte identified that the most used medications among people deprived of liberty were amitriptyline hydrochloride (50.9%), clonazepam (47.4%) and diazepam (14.0%) - these rates are similar to those found in this study6.

It is understood that the high prevalence of psychotropic drug use in the studied population may be related to several factors which favor negative mood, such as overcrowding/excess people in cells, structural precariousness, idleness and lack of opportunities for social, psychological and cognitive development2. It is generally clear that managers invest little in strategies that can change this scenario. On the other hand, adherence is also a challenge when health education activities are offered, even in this context of few opportunities2^,14.

According to research carried out with women deprived of liberty in a prison in the Center-West of Brazil, a high prevalence of tobacco use (86.87%), alcohol (67.18%) and marijuana and/or cocaine (57.92%) was identified among participants22. Thus, the use of psychotropic medication is also highlighted as one of the possibilities for dealing with abstinence, which may justify the high prevalence found in the present study. Furthermore, the use of psychotropic drugs has been described as a strategy to face family abandonment, concern for the home, the hostility/aggressiveness with which they are treated and as a way of anesthetizing emotional suffering and the precariousness of the environment, since some of these psychotropic drugs cause drowsiness and sedation6.

Incarceration is a risk condition for developing depression and anxiety6, corroborating the findings of the present study in which more than 30% of women presented at least one diagnosis of mental disorder, with mood disorders (F30 to F39) and anxiety (F40 to F49) the most recurrent. A study carried out in correctional institutions in Canada found that women were more likely than men to have mood and anxiety disorders, in addition to having a high score for somatization28. An investigation that evaluated psychiatric morbidity in Norwegian prisons from 2010 to 2019 identified that the most recurrent diagnoses in women were those related to stress (29%) and mood (27%), followed by phobia and anxiety (23%)29.

The literature emphasizes that women are generally more prone to developing mental disorders due to being intersected by different factors of discrimination and the overload of socially assigned roles2^,25^,28^,30, as previously pointed out. Considering incarcerated women, it is necessary to implement reception and care strategies, as well as actions that promote improvements in quality of life, well-being and self-esteem. Furthermore, when thinking about the inequities faced by black women, it is urgent to prioritize the fight against illiteracy, increasing the supply of professional courses, work, cultural and leisure activities, as well as facilitating access to mental healthcare and preserving human dignity.

In the present study it was detected that the use of psychotropic drugs was more prevalent among women admitted to the prison unit for a longer period of time. The incarceration time can contribute both to physical illness and to an increase in symptoms of stress, anxiety and the use of psychoactive substances in the prison environment9^,20. Therefore, the importance of health professionals working in this scenario is highlighted, thinking about and implementing strategies to promote both physical and mental health for better living and health conditions for women deprived of their liberty.

In relation to women with chronic illnesses, the percentage of those who used psychotropic drugs was higher in the present study than that presented in a study published in 2022, which showed that 46.7% of women incarcerated in Switzerland received medication for health-related physical and mental problems12. In a population-based cross-sectional study that used data from subjects aged between 20 and 59 years (n=23,329) and older adults (n=9,019), it was observed that the greatest use of psychotropic drugs was by women, by those who reported self-perception negative health status and by individuals with a greater number of chronic diseases30. The use of psychotropic drugs by people with a greater number of chronic diseases was identified as a way of coping with the negative consequences of such diseases, such as disabilities, adverse reactions, and losses in work and leisure activities, as these factors generate loss in quality of life and increased emotional suffering, with psychotropic drugs being used to alleviate such conditions. Although the study was not conducted with the incarcerated population, this explanation can be transposed to this reality, since the conditions to which they are exposed, such as the abandonment and overcrowding of cells, as previously mentioned, associated with a chronic health condition, may justify the high rate of use of psychotropic drugs found in the present study.

It is noteworthy that only two women in the studied sample did not use psychotropic drugs, even though they had a diagnosis or diagnostic hypothesis of a mental disorder. It is understood that this result was due to the recent period of diagnosis, which occurred during data collection.

The results found in the present study can substantially contribute to developing interventions aimed at promoting the mental health of women deprived of liberty, being of great use in the development of the nursing process by nurses who work in the prison system.

CONCLUSION

The profile of the women studied was young adults, black, brown and/or indigenous, with a low education level, with children, and mostly without registered visitors. Such characteristics reaffirm the gender and color/race inequalities that demarcate the Brazilian social context. More than half of the participants used some psychotropic drug, especially benzodiazepines, revealing that this high rate reflects, in a certain way, the suffering arising from prison conditions, such as the lack of structure, hostile environment, family abandonment, longing for the family, idleness, difficulty in coexistence and lack of future perspectives.

Furthermore, more than 30% of women had at least one diagnosis and/or diagnostic hypothesis of a mental disorder, with mood and anxiety disorders being the most prevalent. An association was identified between the use of these medications and time spent in prison and previous pathologies.

As a limitation of the study, it can be mentioned that although the information was collected from the institutional database, the reality of the institution may have changed after data collection, since the number of people admitted changes with admissions and dismissals on a daily basis. Furthermore, as the data is filled in by different people, it is possible that some information is underestimated.

Despite this, it is understood that the present study addresses a relevant topic which involves a population that is little reached, especially when it comes to public policies. Thus, it is expected that the results can contribute to develop research that serves as guidance for health professionals who work in this context, in addition to supporting activities to promote the mental health of the population deprived of liberty.

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NOTES

• ORIGIN OF THE ARTICLE

  Extracted from the dissertation - Prevalência de mulheres usuárias de psicotrópicos prescritos em uma unidade prisional de Belo Horizonte - Minas Gerais, to be presented to the Professional Master’s Postgraduate Program in Technology and Innovation in Nursing, at the Universidade de São Paulo, in 2024.

• FUNDING INFORMATION

  This work was carried out with the support of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Financing code 001, and financed by the Acordo CAPES/COFEn Edital 8/2021 - Postgraduate Development Program (PDPG).

• APPROVAL OF ETHICS COMMITTEE IN RESEARCH

  Approved by the Ethics Committee in Research of the Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, opinion no. 5.601.720/2022, Certificate of Presentation for Ethical Review 58541922.1.0000.5393.

• TRANSLATED BY

  Christopher J. Quinn.

Edited by

EDITORS

Associated Editors: Glilciane Morceli, Ana Izabel Jatobá de Souza. Editor-in-chief: Elisiane Lorenzini.

Publication Dates

• Publication in this collection
  23 Aug 2024
• Date of issue
  2024

History

• Received
  16 Feb 2024
• Accepted
  15 May 2024