The Association of Substance Use and Depression Among TB Infected Persons Incarcerated in Haitian Prisons Open Access

Abstract

Background: Persons in low- and middle-income countries experience depression, but less attention is paid to mental health than in higher income countries. Incarcerated persons have high prevalence of mental illness, but little attention has been paid to psychiatric epidemiology in the prisons of low resource nations. Haiti, considered one of the lowest-income countries in the Western hemisphere, has been affected by multiple natural disasters within the past decade, which could predict new sets of both somatic as well as mental health consequences. To surveil for depression, we need to use tools that are ethnoculturally appropriate. 

Objective: This cross-sectional analysis assessed the shape and strength of associations with depression measured by the Zanmi-Lasante Depression Symptom Inventory (ZLDSI) scale and its possible markers during a trial to improve TB adherence to TB treatment in a prison.

Methods: We calculated the Cronbach alpha for the scale and then generated binary logistic models to study for association of depression that are associated with cigarette use, marijuana use, and alcohol, accounting for first incidence of incarceration, age, household income, and prison site. This cross-sectional study in 6 prisons across Haiti undergoing a TB treatment study included 50 adults who were aged 18 to 59 years.

Results: Fifty subjects were recruited; age ranged from 18-59 years. The Cronbach alpha score for the ZLDSI scale in this population was 0.77. The overall mean depression score among subjects on the ZLDSI scale was 13.9 (threshold score for depression of 13). Univariate associations were seen between cigarette use, marijuana use, and alcohol consumption with depression. Multivariate analysis showed an association between education and alcohol use, controlling for age.

Conclusion: Our findings suggest an association between substance use and depression; however, our small sample size precluded a significant model that could show a strong association. More research should be conducted to look at the effects of substance use as a proxy for mental disorders on medication adherence.

Table of Contents

Introduction 1

Tuberculosis Burden 1

Prison Health in Low- and Middle-Income Countries 1

Issues of Adherence to TB Medications in (Haitian) Prisons 2

Video Directly Observed Therapy 5

Mental Health in Prisons 6

Substance Use 7

Assessing Mental Health in Cross-Cultural Contexts 9

Zanmi-Lasante Depression Symptom Inventory 10

Cronbach alpha 12

Methods 13

Data Collection 13

Data Analysis 14

Results 15

Baseline Characteristics of Participants by VDOT and DOT Sites 15

Table 1: Study Characteristics 16

Linear Regression Analyses 17

Table 2: Simple Linear Regression Results Looking at Associations of Variables with Depression 18

Univariate and Multivariate Analysis for Depression 18

Alcohol Use 19

Table 3: Results of Binary Logistic Regression Analysis for Associations with Depression a 20

Cigarette Use 21

Marijuana Use 21

Discussion 22

Limitations 26

Conclusion 27

Next Steps/Future Research 28

References 29

Appendix 33

Other Tables

Table 4: Multivariate Analysis of the Association with Depression for Individuals with Some or No Education Level 33

Table 5: Study Characteristics of Participants with Substance Use 34

Table 6: Cronbach Alpha for Stigma Scale and ZLDSI Depression Scale 35

Table 7: Baseline Characteristics for Sites utilizing TB Directly Observed Therapy (DOT) and Video Directly Observed Therapy (VDOT) 36

Figures

Figure 1: Pearson Correlation between Stigma and ZLDSI Depression Score 39

Figure 2: Pearson Correlation between Hours Worked Prior to Incarceration and ZLDSI Depression Score 39

Figure 3: Pearson Correlation between Years of Education and ZLDSI Depression Score 40

Figure 4: Pearson Correlation between Age and ZLDSI Depression Score 40

Figure 5: Pearson Correlation between Number of Dependents and ZLDSI Depression Score 41

Figure 6: English translation ZLDSI scale from Rasmussen et al. (2014) paper 42

Figure 7: Original ZLDSI scale from Partners in Health in Haitian Creole (Partners in Health Curriculum Toolkit, 2016) 42

Figure 8: Stigma scale used for this study - A Rendition of Stigma Study found in Coreil et al. (2010) paper 43

Figure 9: Original Full stigma scale from Coreil et al. (2010) paper 44

Figure 10: Original stigma scale from Coreil et al. (2010) paper that was formulated for their Haitian community 45

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Caribbean Studies Health Sciences, Mental Health
Keyword	Marijuana Use Depression Tuberculosis Substance Use Incarceration Global Health Cigarette Use Prisons Health Disparities Haiti Medication adherence Drugs Alcohol Consumption Social Determinants of Health Infectious Disease Drug Use Low-Middle Income Countries Continuity of Care
Committee Chair / Thesis Advisor	Spaulding, Anne, Emory University

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