Measuring depression, and its association with substance use, during an adherence study of patients treated for...

Depression is commonly diagnosed in prisons of affluent countries; literature on depression screening in prisons of low-resource nations is sparse. Haiti has experienced multiple recent disasters, which could have both somatic and mental health consequences. This study aims to investigate how ethnoculturally appropriate scales could be helpful in surveilling prison populations for depression.

The authors performed a cross-sectional analysis of symptoms of depression and its associations among participants in a 2019-2020 tuberculosis treatment adherence project across six Haitian prisons. To measure depression, the authors piloted the use of the Zanmi-Lasante Depression Symptom Inventory (ZLDSI) scale in a carceral setting. The authors calculated its Cronbach's alpha in this setting and generated binary logistic models to study the associations of depression with basic demographic variables; use of cigarettes, marijuana and alcohol; and incarceration history. The authors then performed a multivariate logistic regression to determine if substance use and education predicted depression after adjusting for age.

Fifty participants were recruited; age ranged from 18 to 59 years. Adherence to tuberculosis medication was recorded as above 99% in all participants. The Cronbach's alpha score for the ZLDSI scale in this population was 0.77, signifying the good fit of the scale for this population. A ZLDSI score = 13.0 has been associated with depression; 66% of participants had scores of 13.0 or greater, with a mean of 13.9 (S.D. 8.2). Multivariate analysis showed significant associations between depression, alcohol consumption, younger age and income.

To the best of the authors' knowledge, this study represents the first measurement of depressive symptoms in a Haitian prison population; it found symptoms common.