Factors Affecting Psychological Well-Being of Three Groups of Suicide-Prone Prisoners COLIN COOPER and SINI~AD BERWICK The Queen's University, Belfast Being imprisoned appears to lead some individuals to commit suicide whereas others appear to suffer little stress. Previous research has identified three groups of male prisoners (young remand, young sentenced and those serving life sentences) where the incidence of suicide is high. The present study examined institutional and individual factors that were related to levels of anxiety, depression and psychological well-being within these groups. A psychiatric history, religious faith, feelings of guilt, lack of close friends outside prison, or disinclination to take part in sport, training or hobbies were found to be associated with high levels of anxiety, depression and psychological morbidity. So too were the severity of environmental hassles and worries. The impli- cations of these findings are discussed. Imprisonment is, by all accounts, a deeply unpleasant experience wherever in the world it takes place. Levels of anxiety and depression are much higher in prisoners than in the general population (Cooper and Livingston, 1991), the incidence of deliber- ate self harm and parasuicide in male prisoners is disproportionately high (Ivanoff, 1992; Pattison and Kahan, 1983, cited by Franklin, 1988), and the prison suicide rate is generally believed to be considerably higher than the norm. It is difficult to be more precise, as prisoners do not form a random sample of the general population, differing from it with respect to a host of background and demographic variables, including gender, age, psychiatric history, ethnicity, socio-economic status, marital status (on conviction) and employment status (e.g., Dooley, 1990; Franklin, 1988, Bonner and Rich, 1990; Sherman and Morschauser, 1989). All of these variables are known to be related to the incidence of suicide in the general population, and so it is clearly inappropriate to compare prison suicide rates directly with suicide rates in the general population. The one study that has attempted to control for these factors (Winfree, 1985) has found that the prison suicide rate is still several times higher than in a comparable population outside prison. Several explanations have been offered for this phenomenon, of which social or environmental models are the most popular. For example, the U.K.'s Chief Inspector of Prisons asserts that "the basic cause of depressing conditions is the continuing high level of overcrowding" (Tumim and Woolf, 1991, p. 17) and goes on to suggest several other environmental manipulations that may improve the quality of prison life. Such attention to crowding, sanitation, food, separation from loved ones etc. has the Current Psychology: Developmental ~ Learning Personality ~ Social Summer 200 l, Vol. 20, No. 2, 169-182.
Transcript
Factors Affecting Psychological Well-Being of Three Groups of Suicide-Prone
Prisoners
COLIN COOPER and SINI~AD BERWICK The Queen's Univers i ty , B e l f a s t
Being imprisoned appears to lead some individuals to commit suicide whereas others appear to suffer little stress. Previous research has identified three groups of male prisoners (young remand, young sentenced and those serving life sentences) where the incidence of suicide is high. The present study examined institutional and individual factors that were related to levels of anxiety, depression and psychological well-being within these groups. A psychiatric history, religious faith, feelings of guilt, lack of close friends outside prison, or disinclination to take part in sport, training or hobbies were found to be associated with high levels of anxiety, depression and psychological morbidity. So too were the severity of environmental hassles and worries. The impli- cations of these findings are discussed.
Imprisonment is, by all accounts, a deeply unpleasant experience wherever in the world it takes place. Levels of anxiety and depression are much higher in prisoners than in the general population (Cooper and Livingston, 1991), the incidence of deliber- ate self harm and parasuicide in male prisoners is disproportionately high (Ivanoff,
1992; Pattison and Kahan, 1983, cited by Franklin, 1988), and the prison suicide rate
is generally believed to be considerably higher than the norm. It is difficult to be more
precise, as prisoners do not form a random sample of the general population, differing from it with respect to a host of background and demographic variables, including gender, age, psychiatric history, ethnicity, socio-economic status, marital status (on conviction) and employment status (e.g., Dooley, 1990; Franklin, 1988, Bonner and Rich, 1990; Sherman and Morschauser, 1989). All of these variables are known to be related to the incidence of suicide in the general population, and so it is clearly inappropriate to compare prison suicide rates directly with suicide rates in the general population. The one study that has attempted to control for these factors (Winfree, 1985) has found that the prison suicide rate is still several times higher than in a comparable population outside prison.
Several explanations have been offered for this phenomenon, of which social or
environmental models are the most popular. For example, the U.K.'s Chief Inspector
of Prisons asserts that "the basic cause of depressing conditions is the continuing high
level of overcrowding" (Tumim and Woolf, 1991, p. 17) and goes on to suggest several other environmental manipulations that may improve the quality of prison life. Such attention to crowding, sanitation, food, separation from loved ones etc. has the
Current Psychology: Developmental ~ Learning �9 Personality ~ Social Summer 200 l, Vol. 20, No. 2, 169-182.
170 Current Psychology / Summer 2001
appeal of being easier to alter than the psychological makeup of the inmates (e.g., their ability to cope with stress) or their family backgrounds. Several studies (e.g., Lester, 1990, Cox et al., 1984) do indeed find a link between such environmental factors and indices of pathology, of which suicide rate is one (but see also Ruback and Innes, 1988). However it seems unlikely that the high suicide rate is solely a consequence of the prison environment: suicides still occur in well-designed modern institutions, and suicide is (thankfully) not a universal response to the rigors of prison life. Some individuals are more at risk than others, and so it is important to study individual differences to determine which background factors, behaviors and psychological char- acteristics are associated with various indices of psychological well-being.
It is often claimed that psychological factors may determine how well individuals settle down to life in prison. A model that considers environmental and personal stressors, the appraisal of stress and the range and effectiveness of available coping mechanisms--following the stress/appraisal/coping model of Folkman & Lazarus (1980)--is perhaps the obvious choice: the "young prisoner-'s pathway to suicide" described by Liebling (1992 p. 235) is essentially this model stripped of the primary and secondary appraisal processes. Porporino & Zamble (1984), Flanagan (1981), Cooper and Livingston (1991) and Cooper & Berwick (1997) are among those who have examined whether individual differences in the number and nature of coping mechanisms used by prisoners is related to their psychological well-being. The latter two studies used standardised measures of coping strategies and found that most of the associations were small and negative, indicating that those who used the various cop- ing mechanisms extensively suffered more distress than those who did not. This sug- gested that the coping mechanisms were not always effective in reducing levels of stress, and encouraged the search for other factors that seem to allow some prisoners to better deal with the rigours of life in jail.
In studying the effects of stress upon psychological well-being, it is clearly desir- able to investigate groups whose high suicide rate suggests that they are indeed under stress: non-significant results might otherwise suggest nothing more than one has sampled a particularly contented group of prisoners. Several groups within the prison population are at above-average risk of committing suicide. It is well established that variables such as a history of self-harm, depression, or other psychiatric history are risk factors (Bland et al., 1990; Backett, 1987) as are the length of sentence, age, frequency of medical consultation, and number of weapons offences (Kerkhof and Bernasco, 1990; Arboleda-Florez and Holley, 1989) and bad news or problems with those outside (Dooley, 1990). Those convicted of violent crimes are sometimes found to be at higher risk (Bland et al., 1990; DuRand et al., 1995) and conviction for antisocial behavior or (according some studies) a sexual offence is related to suicide risk in prison. Prisoners are at particular risk of committing suicide within the first few weeks of imprisonment, thus making unsentenced ("remand") prisoners a high-risk group (e.g., DuRand et al., 1995). Young offenders, too, form a group in which the suicide rate is both high and rising (Dooley, 1990, Liebling, 1993).
There are also several problems concerning the choice of dependent variable for research into prison suicide. The most popular design has been to compare the scores
Cooper and Berwick 171
of prisoners who report suicidal thoughts or have a history of attempted suicide with scores from appropriate control groups, such as non-suicidal prisoners, and this tech- nique has been used by Liebling (1992), amongst others. Although widely used, the methodology has three unrecognised difficulties. The first is statistical. This design assumes that suicides form a homogeneous group, whereas the literature suggests that suicide in prison may occur for a number of quite distinct reasons (Koslowsky, Bleich, Apter, Solomon et al., 1992)--for example as a result of depression, on an impulse or in imitation of others. The evidence therefore suggests that there may be several distinct types of "at risk" prisoner, and studying an outcome measure such as suicidal behavior fails to recognize this possibility. It is rather like trying to specify a prototypi- cal 'domestic pet' by averaging the physical characteristics of caged birds, dogs, snakes, cats and fish; the composite that emerges will bear no resemblance to any creature. The second problem is that although successful suicide is frequently pre- ceded by an unsuccessful attempt, a large proportion of those who attempt suicide do not eventually kill themselves. In the sample of prisoners tested by Bland et al. (1990), 23 percent claimed to have attempted suicide, Franklin (1988) reported that 50 percent of self-injuring prisoners reported manipulation of staff as their main goal and Power and Spencer (1987) also argue that it is dangerous to infer suicidal intent from prison- ers' failed attempts. Furthermore, there is evidence that successful suicides and unsuc- cessful suicides are predicted by rather different psycho-social factors (Buglass & Duffy, 1978), which may indicate that a sizable proportion of suicide attempters are qualitatively different from successful suicides. Thus it is dangerous to extrapolate findings from groups who have attempted suicide to those who actually kill them- selves. Finally, it has been claimed that the seriousness of suicidal intention bears little or no relationship to the severity of the actual attempt (Plutchik et al., 1989; Power and Spencer, 1987). This bodes ill for the validity of the questionnaire measures of severity of suicide intent, which have rarely been validated against actual suicidal behavior.
An alternative to analysing past behaviour (such as a suicide attempt) is to consider well-understood psychological constructs that are known to be closely linked to the act of suicide. Depression is the overwhelmingly obvious choice, being powerfully linked to subsequent successful suicide in two longitudinal studies (Hagnell & Rorsman, 1979 and Paffenbarger et al., 1994) with some evidence suggesting that depression is a better predictor of imminent successful suicide than is hopelessness (Fawcett, 1993). Regional and national variations in depression mirror regional and national differences in suicide rate (Lester, 1986, Rihmer et al., 1990) and suicide attempts are very frequently linked to feelings of depression or hopelessness (van Praag et al., 1984; Harlow et al., 1986; Hagnell and Rorsman, 1979). In addition, prison staff perceive depression to be the main cause of prison suicide (Liebling, 1992 p. 199), although it might also be prudent to monitor prisoners' feelings of anxiety and general well-being in order to evaluate their overall psychological health.
Somewhat surprisingly, almost nothing is known about variables that are associated with feelings of depression, anxiety or poor psychological functioning in prisoners. Such variables fall into three main groups. The first group comprises background variables that reflect lifestyle outside prison (employment, education, quality of family
172 Current Psychology /Summer 2001
life, family members' experiences of imprisonment) which could reasonably be pre- sumed to c a u s e differences in levels of depression, anxiety, etc. if differences are found. They are factual details that may shed some light on why certain individuals find prison life difficult to endure. The second group of variables reflects lifestyle in prison (making friends, physical exercise, taking advantage of opportunities for educa- tion and training); it would be dangerous to argue causality if these were found to relate to levels of depression or anxiety, as the behaviours may be influenced by these variables. Finally there are the affective reactions to prison life and one's own negative thoughts--an appraisal of both the number of aspects of prison life (e.g., overcrowd- ing, bullying, lack of purpose in life, feelings of guilt or remorse) that are identified as being difficult for the individual to deal with, and the severity of each of these prob- lems. Hassles theory (Kanner et al . , 1981) may be useful in this context: it has been found that relatively minor day-to-day annoyances can bring about disproportionately large shifts in negative mood. Once again it would be unwise to infer causality from any relationships that are found, although they may have diagnostic value.
The present study therefore explores which background factors, events, thoughts and feelings are associated with feelings of depression and anxiety, in an attempt to understand why some prisoners attempt suicide whilst others survive the experience of imprisonment relatively unscathed. It also took the opportunity to investigate whether the three, rather different, groups of suicide-prone prisoners differed on the sets of measures described above.
METHOD
Participants
The literature cited above identifies three groups of offenders who are particularly likely to commit suicide while in custody. These are male young offenders (both sentenced and held on remand, generally for comparatively short terms), and male prisoners serving life sentences. The initial shock of imprisonment is frequently thought to precipitate suicide in vulnerable individuals (Topp, 1979; DuRand et al . , 1995), which may explain the high incidence of suicides in short-term and remand prisoners.
Three groups of subjects were therefore selected for the present study on the basis of their high risk of suicide within each group. Care was taken to ensure random sampling within each group to allow the results to be generalised The first group comprised 60 remand prisoners at a Young Offenders Institution in England who had been on remand for a median of four weeks; their ages ranged from 16-20 years. 59 sentenced young offenders at the same institution (median term served at time of testing = 11 weeks) comprised the second group. Their ages ranged from 17-20. The third group was of prisoners serving life sentences for violent crimes at a Category B prison in England (N=52 with ages ranging from 21-57). All prisoners were volun- teers, randomly sampled from the prison records, who were approached as part of a series of studies into social and psychological factors that mediate depression. Partici- pation rates were generally high (91 percent, 83 percent and 55 percent): these figures
Cooper and Berwick 173
include prisoners who became unavailable through being transferred elsewhere after being sampled from the records. The "lifers" were more suspicious of the aims of the research and the independence of the research team than were the younger prisoners, and many just wanted to serve out their sentence without being bothered. This ac- counts for the lower participation rate in this group.
Materials
Three standard measures of psychological functioning were used: the short version of the General Health Questionnaire (Goldberg & Williams, 1988), the trait anxiety scale of the State-Trait Anxiety Inventory (Spielberger et al., 1970) and the Beck Depression Inventory (Beck et al., 1961). These questionnaires have been extensively validated, and may be regarded as trustworthy measures of depression, anxiety and well-being. The biographical inventory shown in Table 1 was developed to in conjunc- tion with members of the prison psychological service to tap the main background factors that might affect psychological health in prison. Standard measures of daily hassles (Kanner et al., 1981) include many items that cannot apply to the prison population, and the items shown in Table 2 were written following interviews with a small sample of prisoners and with the help of staff from the prison psychological service to cover possible areas of worry or discontent with the prison environment. The items were piloted and refined on another small sample of prisoners, and rarely endorsed items were dropped.
Procedure
Prisoners were tested individually on the measures listed above and were assured that their individual responses were confidential to the research team. Data were gath- ered orally to avoid problems of reading difficulties, and rapport was excellent, with several prisoners later seeking extra sessions to talk about their experience of impris- onment.
RESULTS
The results are given in three sections. The first describes the sample with respect to a number of background/demographic variables and behaviors. The purpose of this analysis is to give some general information about the three groups of prisoners so that the rest of the results can be set in context, and so details of the group differences are not shown except where these are statistically significant. Differences in age, nature of offence (all the "lifers" but less than half of the young offenders being sentenced for violent crime) and the length of sentence served (which will influence the number of outside friendships and relationships) will in any case make it inappropriate to exam- ine all differences between groups.
The second set of results examines the relationship between each of these variables and standardised measures of psychological functioning: the GHQ- 12, STAI trait anxi-
174 Current Psychology /Summer 2001
ety scale and Beck Depression Inventory. Results are given for all three groups of prisoners combined; separate analyses were also performed for each group of prison- ers, but few differences were found between them. The third set of results examines the number of aspects of prison life that individuals regard as stressful; the number of such "hassles" that are perceived as stressful and the mean degree of annoyance of these aspects of prison life are then correlated with the measures of psychological
well-being.
Characteristics of the samples
The mean level of depression was significantly higher in each of these groups than in the general population, while the variance was also larger, although not significantly so: full details are given in Cooper and Berwick (1997). The three groups of prisoners often showed similar backgrounds. For example, only five members of the total sample had continued in education beyond age 16, and 74 percent had no academic qualifica- tions. Despite this, at least 85 percent of the members of each group had at some time worked in a regular job outside the prison. Forty percent of the sample came from families where a brother or sister had a criminal conviction, and 9 percent of the sample had a parent with at least one conviction. Most (64 percent) came from Social Class 3, as assessed by the father's last occupation, and approximately half of the sample had served at least one previous sentence. Ten percent claimed to have poor physical health, with 21 percent of the lifers and l0 percent of the young prisoners claiming to have had treatment for "nerves" at some stage. Just under half claimed to have some religious belief, 72 percent enjoyed sport or exercise in prison, and the same number enjoyed education, training or reading in prison. There was a huge within-group variation in the number of (named) people who visited each group of prisoners; the median for each group being three--but with some 15 percent of each group of young offenders and 8 percent of the lifers having no one to visit them whilst others in each group named 15 or more people who visited them. The lifers and sentenced young offenders actually received a median of two visits per month (the maximum allowed). There was an equally startling variation in the number of letters received per month, with each group ranging from 0 or 1 to more than 30. Half the lifers and two-thirds of each group of young offenders reported having had a happy family life (the difference between groups being a non-significant )(2(2)=4.25, P>0.05). Despite possible effects of sentence length on relationships outside the prison 70 percent of the lifers and 83 percent of each of the young offender groups claimed to have at least one friend outside prison (the difference being just non-significant) and 77 percent of the young remand, 59 percent of both the young sentenced and lifer groups feel that they have close friends in prison. Relationships with prison staff appeared to be generally good, with at least 50 percent of each group of prisoners reporting positive feelings towards staff, the proportion of "lifers" reporting negative attitudes was larger than the other two groups (17 percent as opposed to 5 percent and 10 percent) but there was no overall difference in the way these three groups of prisoners evaluated the staff (X2(4)=9.27, P>0.05).
Cooper and Berwick 175
The next set of questions related to activities that may affect coping when prisoners were in their cells. They were asked which activities they performed in a conscious effort to keep their minds off their problems. Far more of the younger prisoners performed physical exercise--38 percent of each group doing so as opposed to only 13 percent of lifers (X2(2)=11.47, P<0.01); over 80 percent of each group used mental activities (puzzles, crosswords, etc.) to occupy their time, and half of each group identified a hobby (e.g., making matchstick models) which they carried out in their cell. Daytime sleeping was far more common in the two younger groups (35 percent of remands, 19 percent of sentenced) than in the lifers, (8 percent), this difference being highly significant (Z2(2)=12.81 P<0.01). When asked with whom in prison they would talk if they felt worried or upset, at least 40 percent of each group responded "no one", with hardly anyone being prepared to talk to other prisoners about their problems or worries (2 percent, 5 percent and 7 percent); the remainder said they would talk to prison officers, chaplains, psychology staff, etc. At the time of collecting these data there the Samaritans had not introduced their prison befriending or "listener" schemes to any of these institutions.
35 percent of the lifers had talked through their problems with someone inside or outside the prison within the previous month, although 60 percent had never done so. The young offenders who had been in prison for more than 1 month were identified: 8 percent of the remand and 12 percent of the sentenced prisoners had talked through their problems during the previous month, with an additional 17 percent and 21 per- cent having done so during the previous year. Over two-thirds of each of these samples had never talked about any problems. Most prisoners missed being able to make small day-to-day decisions. When asked how frequently they thought of the effect which prison was having on them, 60 percent of the lifers said that this worried them often, as opposed to 27 percent of each young offender group. Only 17 percent of the lifers said that they never worried about the effects of imprisonment, as opposed to 45 percent and 31 percent of the young prisoners: these differences were statistically significant (X2=13.39, dr=4, P<0.01) although no doubt influenced by length of sen- tence.
Background variables and psychological well-being
Analysis of variance and correlations were used to determine how these background variables were related to levels of anxiety, depression and psychological functioning in prison. One-way analysis of variance was used when scores on the demographic vari- able were limited to two or three categories (e.g., whether a parent had any criminal conviction): categories were grouped where necessary to ensure that the minimum "n" in any cell was 20. Correlations were computed where the demographic variable was interval-scaled (e.g., number of sibs).
Table 1 shows that levels of depression, anxiety and psychological functioning (as measured by the Beck Depression Inventory, Trait anxiety scale of the State Trait Anxiety Inventory, and General Health Questionnaire) showed no relationship with
176 Current Psychology / Summer 2001
TABLE 1 Relationships between background variables and measures of psychological functioning
ANOVA df STAI BDI GHO
Any parent convicted of any offence Any sib convicted of any offence Ever employed (outside prison) Social class by father's last occupation (excludes not employed/sick) coded 1-2/3/4-5 Educational qualifications (none/any) Sentenced or charged for a violent offence? If stressed, who would you talk to? someone/no-one Happy family life? Any close friends in prison? An close friends outside? (young prisoners only) Physical health good/poor? Ever had treatment for "nerves"? Ever in psychiatric care? Are you religious? Enjoy sport/exercise in prison? Physical exercise in cell? Mental activities in cell? (crosswords etc.) Use radio/tv in cell? Hobbies in cell? (model-making etc.) Sleep during day? Job in prison? (Exc. remand) Education/training/reading in prison yes/no (excluding remand) Attitude to staff (negative/neutral/positive) Date when last talked about problems (last month/ last year/never: excludes prisoners who had served less than 4 weeks)
Family size Position in family Proportion of sentence served Age at first conviction Number of previous times in prison Years sentenced (excluding remand) Number of named visitors (excluding remand) Number of visits received per month (exc. remand) Number of letters received per month (exc. remand)
variables such as the number of previous prison terms, the length of the sentence (for the sentenced prisoners) whether the crime for which the prisoner was sentenced/ remanded was violent. A religious faith is associated with increased levels of depres- sion and an elevated GHQ score, and previous psychiatric in-patient treatment, or any form of treatment for "nerves" proves, unsurprisingly, to be associated with elevated levels of all three variables.
Those prisoners who said they would talk to no one about their problems had significantly lower depression scores than those who would happily confide in a friend or member of the prison staff: members of this sample seem not to "bottle up" strong negative feelings. Those who actually had talked about their problems within the previous month or year showed higher scores on all three measures than those who had not. It is reasonable to infer from this that the prisoners who chose not to talk about their problems were those who felt that they had few problems, while those who actually did talk about problems still felt depressed and anxious having done so. Young prisoners who felt that they had no close friends outside prison showed el- evated scores on the STAI and GHQ (the item would not have been appropriate for some prisoners serving life sentences).
Three of remaining variables showed links with measures of well-being that were significant beyond the 0.01 level, and so which may be genuine. Somewhat surpris- ingly, the prisoners who had negative or neutral opinions about the attitude of the prison staff were much less depressed than the majority who held them in good regard. Prisoners who have some sort of hobby that they perform in their cells have GHQ scores that are much lower than the norm. The more visits that remand prisoners received per month the lower their level of anxiety appears to be, however the number of named visitors was not significantly related to mood. A similar result is noted for the number of letters received. (Remand prisoners enjoy different privileges, and so other groups are not included in this analysis.)
There are some other significant results that were neither significant at the 0.01 level nor consistent across the three dependent variables. Given the large number of tests performed, it is probably unwise to make too much of them: they do suggest that prisoners who claim to have some close friends in prison are more depressed than the "loners" (a finding that runs against most of the published literature), that previous experience of prison is associated with lowered anxiety, and that those who have a job or who take part in training or educational programmes in prison are less depressed than those who do not. The 14 percent minority who do not take part in mental activities during periods of confinement have above-average levels of depression. However the present study cannot determine whether these behaviours are causes or consequences of depressed mood.
Daily "hassles" and psychological well-being
Table 2 shows the mean endorsement rate of 21 potential areas of "hassle" in the prison environment. The first nine refer to aspects of the prison environment, and the second 12 deal with thoughts and feelings that may be perceived as stressful. Prisoners
178 Current Psychology / Summer 2001
TABLE 2 Group differences in hassles, per-centage of prisoners viewing each item as a source of hassle, and ANOVAs to test whether those who endorsed items as a source of hassle differed in levels
of anxiety, depression or well-being from those who did not.
Group % F(1,168) F(1,168) F(1,168) differences recognising with STAI with BDI with GHQ
Bullying 55 0.26 0.23 0.10 Sanitation * 55 3.28 4.62* 0.32 Lack of creature comforts * 80 0.00 0.69 1.10 Time to worry 65 0.77 0.30 1.68 Worry about family/friends * 96
Worry about money 55 0.54 1.69 1.06 Worry about reputation * 66 3.99* 2.39 4.52* Worry about safety 55 0.01 0.06 0.27 Worry about loneliness 67 2.12 0.75 1.04
Worry about ability to cope 58 4.54* 1.73 6.01" Worry about lack of purpose in life 48 0.39 1.44 0.48 Having no pride * 55 2.82 2.47 5.43* Feeling guilty 71 8.04** 9.03*** 5.65* Feeling angry 71 0.05 0.53 0.68 Feeling frustrated 71 1.74 2.00 6.64* Feeling out of control of life 61 1.04 0.85 2.17
mean s.d. r with r with r with STAI BDI GHQ
number of environmental hassles 6.0 2.7 -0.03 -0.05 0.00 (items 1-9) mean severity of environmental 2.0 0.49 0.22** 0.29** 0.21"* hassles
number of feelings-based hassles 7.7 3.94 0.11 0.08 0.13 (items 10-21)
mean severity of feelings-based 1.8 0.54 0.48** 0.43** 0.47** hassles
n=169 * p<0.05, ** p<0.01, *** p<O.O05
were asked to dec ide whether or not each o f these i tems was a source of stress for
them. Three-poin t rat ings of severi ty were obta ined for the i tems that were ident i f ied
as stressors. Thus each pr i soner p roduced a score be tween 0 ( i tem not v iewed as a
source o f stress) and 3 (ext remely severe source o f stress) f rom which two indices
were d e r i v e d - - t h e number of i tems with scores greater than zero ("number of hass les" ' )
and the average score on these i tems ("mean severi ty") ,
Cooper and Berwick 179
Different groups of prisoners sometimes produced different distributions of scores on the hassles items according to a chi-square test with 6 df. These items are marked
with an asterisk in the second column of Table 2. These differences are not discussed
in detail because the pattern of these di f ferences was the same in every case, with the two young offenders groups reporting more extreme annoyance than the "liters". It
seems likely that this is due to those serving life sentences being more accustomed to
the prison regime. Independent sample t-tests were used to determine whether individuals who per-
ceived each aspect of prison life as stressful tended to have above-average scores on the three measures of psychological functioning, except for the two variables where group size fell below 30. Correlations were computed between these three variables
and the three overall measures of perceived stress described above. These showed that the number of sources of daily hassle that prisoners identify in their daily lives and introspections is not in any way related to levels of anxiety or depression. However when events are identified as "hassles," the more anxious or depressed prisoners
identify view them as being much more severe than do those who are in better psycho-
logical health. Day-to-day annoyances become crises lot depressed or anxious prison- ers. This is particularly clear ti)r hassles due to feelings, where the correlations were all above 0.4.
DISCUSSION
The primary purpose of this study has been to examine whether prisoners' psycho- logical well-being (assessed using standard psychometric tests) is related to their back-
ground, behavior in prison or affective reactions. Several such links were found. The
family background of these vulnerable prisoners seems to have rather little relationship to their ability to cope with life in prison, although there is a suggestion that those who have some educational qualifications are less anxious than those who have no such qualifications. Previous psychiatric history is the exception to this generalisation: "treat- ment for nerves"' or other forms of psychiatric care are strongly associated with levels of anxiety and depression in prison, as found in numerous other studies such as Bland (1990) and Dooley (1990).
Activity seems to be important, as discussed in chapter six of Liebling (1992). Participation in sport, hobbies or mental activities, or educational or training programmes is associated with below-average levels of anxiety and/or depression (c f Paffenbarger
et al., 1994). However such activities cannot be said to promote feelings of well-being, for it is just as likely that the severely anxious or depressed prisoners feel unable to
find the energy or enthusiasm to initiate or take part in these activities.
One might have expected that prisoners who felt that they had formed close friend- ships with other prisoners, who were sustained by a religious faith, who had a gener- ally positive attitude towards the prison staff, and who discussed their problems would experience below-average levels of anxiety and depression. The data show that the precise opposite is true: such prisoners are likely to be more depressed and anxious
than the norm. Being troubled by feelings of guilt has a very considerable impact on
180 Current Psychology / Summer 2001
psychological well-being, as found by Dooley (1990) in connection with suicide, and this may possibly explain why a (mainly Christian) religious belief seemed to be less than supportive. These results also imply that prisoners appreciate the value of talking about problems (since those who do so are the more anxious and depressed members of the samples), but that those who do so still have significantly elevated levels of anxiety and depression. The quality of listening and support which they received from other prisoners is of course unknown, and at the time of the investigation, prisoners had no easy means of access to Samari~n volunteers or Samaritan-trained prison "listeners." There were some consistent differences between the three groups of pris- oners, with worries and the daily "hassles" of prison life having a more severe impact on younger prisoners than those serving life sentences, a finding that is consistent with the literature (MacKenzie, 1985).
Contact with the outside world through visits and letters is associated with lowered levels of anxiety, though there is no evidence that visits and letters are related to feelings of depression. Most other aspects of prison life show modest relationships with the measures of psychological well-being, although there is some suggestion of higher GHQ scores in those who complain of crowding, and high levels of depression in those who complain about sanitation. Individual differences in the emotional impact of other variables (such as violence, noise and lack of creature comforts) do not seem to be linked in any way to the prisoners' levels of depression and anxiety.
Those prisoners who worry about their reputation, their ability to cope with prison life and (as already discussed) feelings of guilt show elevated scores on at least two of the three dependent variables; the results also suggest that low pride and feelings of frustration are associated with psychological distress. Worries about other aspects of prison life (e.g., feelings of anger, lack of control, personal safety and lack of purpose in life and concerns about violence, bullying and noise) were not associated with increased pathology in these groups, despite some early studies suggesting factors such as these contribute to "prison-induced distress" and thence to suicide in some vulnerable inmates (Liebling, 1992, p.54). A sizable number of prisoners express concern about each of these issues, indicating that the problems have not vanished through the process of reform; they simply do not seem to be reliably associated with feelings of anxiety, depression or general well-being.
The number of aspects of prison life which prisoners saw as annoying was not related to any of the measures of psychological functioning. However the perceived severity of each of these annoyances was strongly related to all three measures of psychological well-being. Those who felt strongly negative about few or many aspects of prison life showed signs of distress: the prisoner who has strong negative feelings about just one or two aspects of prison life is likely to be much more anxious and depressed than another who can recite a litany of relatively minor annoyances. Much the same thing was found when prisoners were asked to issues about which they worried. Prisoners who experienced any number of really intense worries were associ- ated with high levels of pathology.
Prison suicide rates in the U.K. are high and rising (Home Office, 1996), and so it is important to understand which aspects of prison life are most closely linked to m e a -
Cooper and Berwick 181
sures o f psychological distress. Background variables and behaviors that were associ-
ated with anxiety, depression and general well-being included any torm of psychiatric
history, feelings o f guilt, a tendency to talk about problems, a religious faith, a lack o f
friends outside prison, a disinclination to take part in training, mental activities, sport
or hobbies and a positive attitude toward the prison staff. Visits and letters, happiness
o f family life outside, and pursuit o f hobbies or mental activities affect may reduce
levels of anxiety, but there is no evidence that they affect levels o f depression. Neither
the number o f aspects o f prison life that were viewed as stressful nor the number o f
areas of worry that the prisoners identified was related to their psychological function-
ing. Prisoners with high scores on the STAI, GHQ or BDI viewed these problem areas
as much more important or severe than those who were not emotional ly affected by
imprisonment.
Ensuring welfare of vulnerable individuals is an important issue, and one that is of
great concern to prison authorities world wide. In the U.K., for example, the prison
service has given enthusiastic support of schemes that allow signs of suicide to be
detected, and which provide emotional support for depressed, anxious, or suicidal
prisoners. It is also important to try to understand why some prisoners experience
feelings o f depression, anxiety or despair while others survive the experience un-
scathed; the results presented above clarify some of these issues.
A C K N O W L E D G E M E N T
This research was supported by the Leverhulme Trust through Grant F403C to the senior author. We offer grateful thanks to the staff of the prison service Suicide Awareness Unit, to the prison psychological staff, governors and inmates lbr their support, time and insights.
N O T E
Address correspondence to Colin Cooper, School of Psychology, The Queen's University of Belfast, 10 Lennoxvale, Malone Row, Belfast BT7 INN, Northern Ireland
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Paper presented at the conference of the American Society of Criminology, San Diego, CA.
