Psychiatric disorders in prison: A study of 121 inmates in outpatient care

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Published Jun 21, 2026
https://doi.org/10.62438/tunismed.v104i06.6373
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Vol. 104 No. 06 (2026): Tunis Med Jun 2026

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Ahlem Hajri
Outpatient and Emergency Department, Razi Hospital, La Manouba, Faculty of Medicine of Tunis, Tunisia
Amal Hajjem
Outpatient and Emergency Department, Razi Hospital, La Manouba, Faculty of Medicine of Tunis, Tunisia
Amira Maamri
Outpatient and Emergency Department, Razi Hospital, La Manouba, Faculty of Medicine of Tunis, Tunisia
Emira Khelifa
Outpatient and Emergency Department, Razi Hospital, La Manouba, Faculty of Medicine of Tunis, Tunisia
Abdennour Karmous
Outpatient and Emergency Department, Razi Hospital, La Manouba, Faculty of Medicine of Tunis, Tunisia
Haifa Zalila
Outpatient and Emergency Department, Razi Hospital, La Manouba, Faculty of Medicine of Tunis, Tunisia

Abstract

Introduction: Incarcerated populations present heterogeneous profiles, making it essential to produce local and contextualized data to adapt healthcare policies.
The objectives of our study were to estimate the prevalence of psychiatric disorders among Tunisian inmates, to describe their clinical characteristics and to examine the associations between clinical and criminological characteristics.
Methods: We conducted a retrospective descriptive study of inmates referred for the first time in 2022 to the outpatient psychiatry department of Razi Hospital. Included were inmates seen in outpatient care. Excluded were hospitalized patients, those referred for forensic evaluation, and
incomplete clinical records.
Results: A total of 121 inmates were included, with a mean age of 33.26±11.57 years and a sex ratio (M/F) of 2.27. A history of suicide attempts was reported in 47.9% of patients (n=58). Cannabis was the most commonly used illicit substance (53.7%, n=65), followed by opioids (buprenorphine and heroin) in 14% (n=17).
The most frequent psychiatric diagnoses were depressive disorder (24.8%, n=30), antisocial personality disorder (21.5%, n=26), adjustment disorder (17.4%, n=21) and substance use disorders (14%, n=17). We did not find any statistically significant associations between the violent
nature of the offence, substance use disorders, type of psychiatric diagnosis and history of childhood trauma.
Conclusion: Our study highlights the high prevalence of psychiatric disorders and addictive behaviors among inmates. These findings underscore the need to strengthen screening, management, and psychological support in correctional settings.

Keywords:

Mental disorders , Outpatient hospital services , Prisoners , Correctional facilities , Ambulatory care

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References

  1. Hsini ép Daira A. Assessment of psychopathy in a Tunisian sample of incarcerated women [thesis]. Tunis: Université de Tunis El Manar,
  2. Faculté de Médecine; 2020.
  3. Gómez-Figueroa H, Camino-Proaño A. Mental and behavioral disorders in the prison context. Rev Esp Sanid Penit. août
  4. ;24(2):66.
  5. Global Prison Trends 2020 [Internet]. Penal Reform International. [cité 6 avr 2025]. Disponible sur: https://www.penalreform.org/
  6. resource/global-prison-trends-2020/
  7. Fazel S, Baillargeon J. The health of prisoners. Lancet Lond Engl. 12 mars 2011;377(9769):956-65.
  8. The Lancet Public Health. Promoting health beyond prison walls. Lancet Public Health. juill 2022;7(7):e573.
  9. Gaddas M, Ben Saad H. L’expérimentation médicale sur les prisonniers (partie 6): Situation en Afrique, Moyen-Orient et partie
  10. du monde Arabe (Tunisie en particulier). Tunis Médicale. déc 2022;100(12):819-23.
  11. Caravaca Sánchez F, Navarro Zaragoza J, Fearn NE, Vaughn MG. The Nexus of Trauma, Victimization, and Mental Health
  12. Disorders Among Incarcerated Adults in Spain. Psychiatr Q. déc 2017;88(4):733-46.
  13. Kumar V, Daria U. Psychiatric morbidity in prisoners. Indian J Psychiatry. 2013;55(4):366.
  14. Feuille de route pour l’élaboration de programmes de réadaptation en milieu carcéral.
  15. Svendsen VG, Stavseth MR, Skardhamar T, Bukten A. Psychiatric morbidity among women in Norwegian prisons, 2010–2019: a
  16. register-based study. BMC Psychiatry. 2 juin 2023;23(1):390.
  17. Aon M, Levinsen AKG, Abtal T, Regragui M, Ngwa CH, Leth-Sørensen DB, et al. Suicide, suicide attempts and self-harm in Moroccan
  18. prisons. Int J Prison Health. 6 févr 2024;20(1):88-101.
  19. Favril L, Shaw J, Fazel S. Prevalence and risk factors for suicide attempts in prison. Clin Psychol Rev. nov 2022;97:102190.
  20. Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S. Suicide and suicidal behavior. Epidemiol Rev. 2008;30(1):133-54.
  21. Castillejos MC, Huertas P, Martín P, Moreno Küstner B. Prevalence of Suicidality in the European General Population: A Systematic
  22. Review and Meta-Analysis. Arch Suicide Res Off J Int Acad Suicide Res. 2021;25(4):810-28.
  23. Larney S, Topp L, Indig D, O’Driscoll C, Greenberg D. A cross-sectional survey of prevalence and correlates of suicidal ideation and suicide attempts among prisoners in New South Wales, Australia. BMC Public Health. 6 janv 2012;12:14.
  24. Favril L. Epidemiology, Risk Factors, and Prevention of Suicidal Thoughts and Behaviour in Prisons: A Literature Review. Psychol
  25. Belg. 2021;61(1):341-55.
  26. Favril L, O’Connor RC. Distinguishing prisoners who think about suicide from those who attempt suicide. Psychol Med. janv
  27. ;51(2):228-35.
  28. Jenkins R, Bhugra D, Meltzer H, Singleton N, Bebbington P, Brugha T, et al. Psychiatric and social aspects of suicidal behaviour in prisons. Psychol Med. févr 2005;35(2):257-69.
  29. Fazel S, Seewald K. Severe mental illness in 33,588 prisoners worldwide: systematic review and meta-regression analysis. Br J
  30. Psychiatry J Ment Sci. mai 2012;200(5):364-73.
  31. Chassay L, Kremer KP. Association Between Social Support and Mental Health of Incarcerated Individuals. J Correct Health Care Off
  32. J Natl Comm Correct Health Care. févr 2022;28(1):47-53.
  33. Zhong S, Senior M, Yu R, Perry A, Hawton K, Shaw J, et al. Risk factors for suicide in prisons: a systematic review and meta-analysis.
  34. Lancet Public Health [Internet]. 2021 [cité 9 avr 2025];6(3).
  35. Favril L. Epidemiology, risk factors, and prevention of suicidal thoughts and behaviour in prisons: a literature review. Psychol
  36. Belg. 2021;61(1):341 55.
  37. Kacem M, Bouali W, Karkeni N, Faouel N, Zarrouk L. Epidemiological and clinical aspects of psychiatric disorders in Tunisian prisons. Eur Psychiatry. 1 sept 2022;65(Suppl 1):S605-6.
  38. Fazel S, Danesh J. Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys. Lancet Lond Engl. 16 févr
  39. ;359(9306):545-50.
  40. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis - PubMed [Internet].
  41. [cité 16 avr 2025]. Disponible sur: https://pubmed.ncbi.nlm.nih. gov/29253477/
  42. Spilka S. Les consommations de drogues en prison - Résultats de l’enquête ESSPRI 2023. 2024;
  43. Ahalt C, Buisker T, Myers J, Williams B. Smoking and Smoking Cessation Among Criminal Justice–Involved Older Adults. Tob Use
  44. Insights. 12 mars 2019;12:1179173X19833357.
  45. Haile YG, Kebede KB, Limenhe A, Habatmu K, Alem A. Alcohol use disorder among prisoners in Debre Berhan prison, Ethiopia: a cross- sectional study. Subst Abuse Treat Prev Policy. 3 avr 2020;15(1):26.
  46. Fazel S, Bains P, Doll H. Substance abuse and dependence in prisoners: a systematic review. Addict Abingdon Engl. févr
  47. ;101(2):181-91.
  48. Mason D, Birmingham L, Grubin D. Substance use in remand prisoners: a consecutive case study. BMJ. 5 juill
  49. ;315(7099):18-21.
  50. Yitayih Y, Abera M, Tesfaye E, Mamaru A, Soboka M, Adorjan K. Substance use disorder and associated factors among prisoners
  51. in a correctional institution in Jimma, Southwest Ethiopia: a cross- sectional study. BMC Psychiatry. 27 sept 2018;18(1):314.
  52. Baranyi, G., Scholl, C., Fazel, S., Patel, V., Priebe, S., & Mundt, A. P. (2018). Severe Mental Illness and Substance Use Disorders in
  53. Prisoners in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis of Prevalence Studies. Social Science
  54. Research Network. https://doi.org/10.2139/SSRN.3235631
  55. Spilka S. Les consommations de drogues en prison - Résultats de l’enquête ESSPRI 2023. 2024.
  56. Ritter C, Broers B, Elger BS. Cannabis use in a Swiss male prison: qualitative study exploring detainees’ and staffs’ perspectives. Int J
  57. Drug Policy. nov 2013;24(6):573-8.
  58. Jiménez-Vinaja R, Imbernón M, Parés-Bayerri A, Ona G, Parés O, Bouso JC. Jailhouse rock: health status, patterns of use, and
  59. subjective benefits of cannabis use in a sample of inmates in Spanish prisons. Rev Espanola Sanid Penit. 2022;24(1):9-14.
  60. Calzavara LM, Burchell AN, Schlossberg J, Myers T, Escobar M, Wallace E, et al. Prior opiate injection and incarceration history
  61. predict injection drug use among inmates. Addict Abingdon Engl. sept 2003;98(9):1257-65.
  62. Kouyoumdjian FG, Calzavara LM, Kiefer L, Main C, Bondy SJ. Drug use prior to incarceration and associated socio-behavioural
  63. factors among males in a provincial correctional facility in Ontario, Canada. Can J Public Health Rev Can Sante Publique. 9 mai
  64. ;105(3):e198-202.
  65. Källmén H, Gustafson R. Alcohol and disinhibition. Eur Addict Res.déc 1998;4(4):150-62.
  66. Bernstein MH, McSheffrey SN, van den Berg JJ, Vela JE, Stein L, Roberts MB, et al. The Association Between Impulsivity and
  67. Alcohol/Drug Use Among Prison Inmates. Addict Behav. mars 2015;42:140-3.
  68. Collins JJ, Schlenger WE. Acute and chronic effects of alcohol use on violence. J Stud Alcohol. nov 1988;49(6):516-21.
  69. Sontate KV, Rahim Kamaluddin M, Naina Mohamed I, Mohamed RMP, Shaikh MF, Kamal H, Kumar J. Alcohol, Aggression, and
  70. Violence: From Public Health to Neuroscience. Frontiers in Psychology. 2021;12:699726. doi:10.3389/fpsyg.2021.699726.
  71. Håkansson A, Jesionowska V. Associations between substance use and type of crime in prisoners with substance use problems - a
  72. focus on violence and fatal violence. Subst Abuse Rehabil. 2018 Jan 15;9:1-9. doi: 10.2147/SAR.S143251. PMID: 29391843; PMCID:
  73. PMC5774467.
  74. Andersen HS, Sestoft D, Lillebaek T, Gabrielsen G, Kramp P. Prevalence of ICD-10 psychiatric morbidity in random samples of
  75. prisoners on remand. Int J Law Psychiatry. 1996;19(1):61-74.
  76. Birmingham L, Mason D, Grubin D. Prevalence of mental disorder in remand prisoners: consecutive case study. BMJ. 14 déc
  77. ;313(7071):1521-4.
  78. Brooke D, Taylor C, Gunn J, Maden A. Point prevalence of mental disorder in unconvicted male prisoners in England and Wales. BMJ.
  79. déc 1996;313(7071):1524-7.
  80. Timmerman IGH, Emmelkamp PMG. The prevalence and comorbidity of Axis I and Axis II pathology in a group of forensic
  81. patients. Int J Offender Ther Comp Criminol. 2001
  82. Joukamaa M. Psychiatric morbidity among Finnish prisoners with special reference to socio-demographic factors: results of the
  83. Health Survey of Finnish Prisoners (Wattu Project). Forensic Sci Int. 22 mai 1995;73(2):85-91.
  84. Psychological Disturbance in the Scottish Prison System: Prevalence, Precipitants and Policy | Office of Justice Programs
  85. [Internet]. [cité 13 avr 2025]. Disponible sur: https://www.ojp.gov/ ncjrs/virtual-library/abstracts/psychological-disturbance-scottish-
  86. prison-system-prevalence-0
  87. Joukamaa M. Psychiatric morbidity among Finnish prisoners with special reference to socio-demographic factors: results of the
  88. Health Survey of Finnish Prisoners (Wattu Project). Forensic Sci Int. 22 mai 1995;73(2):85-91.
  89. Prins SJ. The Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review. Psychiatr Serv Wash DC. juill 2014;65(7):862-72.
  90. Torrey EF. Jails and prisons--America’s new mental hospitals. Am J Public Health. déc 1995;85(12):1611-3.
  91. Charfi S. Profil sociodémographique et clinique des détenus pour soins : à propos de 35 cas [thèse]. Tunis: Université de Tunis El
  92. Manar, Faculté de Médecine; 2011
  93. Blaauw E, Roesch R, Kerkhof A. Mental disorders in European prison systems. Arrangements for mentally disordered prisoners in
  94. the prison systems of 13 European countries. Int J Law Psychiatry. 2000;23(5-6):649-63.
  95. Pondé MP, Caron J, Mendonça MS, Freire AC, Moreau N. The relationship between mental disorders and types of crime in
  96. inmates in a Brazilian prison. J Forensic Sci. 2014 Sep;59(5):1307-14. doi: 10.1111/1556-4029.12462. Epub 2014 Apr 8. PMID:
  97. Forry JB, Kirabira J, Ashaba S, Rukundo GZ. Crime, recidivism and mental disorders among prisoners in Mbarara municipality,
  98. southwestern Uganda. Int J Law Psychiatry. 2019 Jan-Feb;62:1-6. doi: 10.1016/j.ijlp.2018.10.006. Epub 2018 Nov 10. PMID:
  99. White HR, Frisch-Scott NE. Childhood Victimization and Adult Incarceration: A Review of the Literature. Trauma Violence Abuse.
  100. Jul;24(3):1543-1559. doi: 10.1177/15248380211073841. Epub 2022 Mar 31. PMID: 35354348.
  101. Roos LE, Afifi TO, Martin CG, Pietrzak RH, Tsai J, Sareen J. Linking typologies of childhood adversity to adult incarceration: Findings
  102. from a nationally representative sample. Am J Orthopsychiatry. 2016;86(5):584-93. doi: 10.1037/ort0000144. Epub 2016 Apr 14.PMID: 27078049.
  103. Skarupski KA, Parisi JM, Thorpe R, Tanner E, Gross D. The association of adverse childhood experiences with mid-life depressive
  104. symptoms and quality of life among incarcerated males: exploring multiple mediation. Aging Ment Health. 2016;20(6):655-66. doi:
  105. 1080/13607863.2015.1033681. Epub 2015 Apr 21. PMID: 25897485.