Measuring Depression, and Its Association with Substance Use, during an Adherence Study of Patients Treated for Tuberculosis in Haitian Prisons

Abstract

Purpose: Diagnosed depression is prevalent 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. To surveil its prisons for depression, ethnoculturally appropriate scales could be helpful. Design/methodology/approach: We performed a cross-sectional analysis of symptoms of depression and its associations among participants in a 2019-2020 tuberculosis treatment adherence project across 6 Haitian prisons. To measure depression, we piloted the use of the Zanmi-Lasante Depression Symptom Inventory (ZLDSI) scale in a carceral setting. We calculated its Cronbach 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. We then performed a multivariate logistic regression to determine if substance use and education predicted depression, after adjusting for age. Findings: Fifty subjects were recruited; age ranged from 18 to 59 years. Adherence to TB medication was recorded as above 99% in all subjects. The Cronbach 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, mean 13.9 (S.D. 8.2). Multivariate analysis showed significant associations between depression, alcohol consumption, age, and income. Originality/Conclusion: We believe this study represents the first measurement of depressive symptoms in a Haitian prison population; it found symptoms common.