Fatores associados a transtornos mentais graves no contexto prisional

• Ano de defesa: 2018
• Autor(a) principal: Marques, Maíra Mendes dos Santos
• Orientador(a): Andreoli, Sergio Baxter
• Banca de defesa: Andreoli, Sérgio Baxter, Barros, Claudia Renata dos Santos, Inoue, Silvia Regina Viodres, Moreira , Fernanda Gonçalves, Andrade, Mario Cesar Rezende
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Católica de Santos
• Programa de Pós-Graduação: Doutorado em Saúde Coletiva
• Departamento: Centro de Ciências Sociais Aplicadas e Saúde
• País: Brasil
• Palavras-chave em Português: drogas; presos; reincidência; crime; problemas de saúde
• Área do conhecimento CNPq: CIENCIAS DA SAUDE::SAUDE COLETIVA
• Link de acesso: https://tede.unisantos.br/handle/tede/4461

Introduction: Studies have shown high prevalence of psychiatric morbidity among prisoners compared to the general population worldwide. The burden of incarcerated adults with mental disorders draw attention to the severity of the clinical conditions of these people living in a prison system that may aggravate their mental problems. Incarcerated adults with severe mental disorders are more vulnerable to physical health problems. Among these mental disorders, severe depressive disorders are more common and are associated with suicidal behavior. Some studies have shown that serious mental disorders are risk factors for violent behavior and criminal recidivism, classified by the greated chance of reencarceration. Other studies have shown that the association with criminal behavior is mediated by comorbidities with drug use disorders. Aim: to analyze the criminal and clinical factors associated with severe mental disorders, with and without drug-related disorders (DRD) comorbidity in a prison population of São Paulo. The specific aims are: To describe the demographic profile of the population; to estimate prevalence of lifetime severe mental disorders; to analyze the clinical and criminal factors related to severe mental disorders by taking into consideration the sex particularities; to analyze the associated factors of incarcerated adults with severe mental disorders in comparison to those with comorbidity with drug use disorders, and to analyze the associated factors of severe depressive disorders by taking into account the particularities of each sex. Method: a descriptive, cross-sectional survey was conducted between May 2006 and January 2007, the details of which have been described in detail elsewhere. 1809 incarcerated adults (¿18 years) were recruited via random, proportional, multistage sampling from 105 prison units in the State of São Paulo. They were evaluated for the presence of a psychiatric diagnosis by the ""Composite International Diagnostic Interview - 2.1"" (ICD-10). The prevalences and 95% CI were calculated for life and adjusted by the analysis of complex samples. For the analysis of the correlated factors with severe mental disorders, two models of multinomial logistic regression were used, one for severe mental disorders (SMD) in general and another for severe depressive disorders (SDD), with specific analyses plan for male and female population. The dependent variable was cathegorized into: 1) SMD only / SVD only; 2) Comorbidity with drug use disorders; 3) Any other mental illness; 4) no mental illness.Results: Health problems were associated with severe mental disorders, severe depressives and the two analysed comorbidities among women and severe mental disorders and SDD-TUD in men. Recidivism and disciplinary penalty were associated with both TUD comorbidity in both men and women. Being imprisoned in prison was directly associated with SDD among men and inversely associated in women. Having committed a drug-related crime increased the chances of having SDD-TUD in men, whereas having committed violent crime was associated in women with this comorbidity. Conclusion: severe mental disorder only was not associated with recidivism, whereas the comorbidity with drug-related disorder was directly associated with it and with worsen physical health condition. These results show the need of health policies making toward the people with comorbidity in order to meet their specific needs.