Factors Affecting Psychological Well-Being
of Three Groups of Suicide-Prone
Prisoners
COLIN COOPER and SINI~AD BERWICK
The Queen's University, 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 implications 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 deliberate 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 characteristics 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 coping mechanisms extensively suffered more distress than those who did not. This suggested 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 desirable 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 technique 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 prototypical '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 preceded 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 prisoners' failed attempts. Furthermore, there is evidence that successful suicides and unsuccessful 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 themselves. 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
Current Psychology /Summer 2001
172
life, family members' experiences of imprisonment) which could reasonably be presumed 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 education 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., overcrowding, 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 problems. 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 volunteers, randomly sampled from the prison records, who were approached as part of a
series of studies into social and psychological factors that mediate depression. Participation 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 accounts 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 conjunction 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 gathered orally to avoid problems of reading difficulties, and rapport was excellent, with
several prisoners later seeking extra sessions to talk about their experience of imprisonment.
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 examine 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 prisoners, 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 qualifications. 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 percent 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 sentence.
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 variable 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
Current Psychology / Summer 2001
176
TABLE 1
Relationships between background variables and measures of psychological functioning
ANOVA
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)
Spearman Correlations
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)
* P<0.05, **P<0.01, *** P<0.001
df
STAI
BDI
GHO
1,167
1,167
1,167
2,113
1.00
0.00
0.18
1.64
1.07
0.09
0.44
0.11
2.09
0.00
0.22
0.23
1,167
1,167
1,167
1,167
1,167
1,115
1 167
5.15"
1.03
2.58
4.27*
0.39
5.41"
3.87
13.02"*
9.14"*
3.38
4.25*
0.51
4.76*
1.02
0.05
0.06
2.57
3.47
1
l
1
1
1
1
1
1
167
167
167
167
167
167
167
167
1,167
1,108
1,108
2,166
2,130
df
169
169
169
169
169
109
109
109
109
0.60
0.21
8.42**
0.45
4.05*
2.10
2.81
6.50*
6.48*
6.6l*
0.19
0.29
0.40
0.16
3.54
0.20
1.37
5.41"
0.30
0.02
3.01
1.06
1.97
6.82
7.40
10.14
4.27
8.61
2.49
1.39
1.35
0.28
7.34
0.01
0.14
1.61
2.06
7.54***
6.16"*
5.16"*
1.80
5.79**
STAI
BDI
GHO
0.16"
0.08
0.04
0.03
-0.08
0.17
0.1l
-0.29**
-0.21"
0.04
0.06
-0.02
0.07
-0.14"
-0.08
0.12
-0.05
-0.05
0.10
0.06
0.07
0.07
-0.06
-0.08
0.12
-0.13
-0.18
Cooper and Berwick
177
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 depression 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 elevated 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 surprisingly, 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
Current Psychology / Summer 2001
178
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
%
differences recognising
hassle
Crowding
Noise
Food
Harshness
Violence
Bullying
Sanitation
Lack of creature comforts
Time to worry
Worry about family/friends
Worry about money
Worry about reputation
Worry about safety
Worry about loneliness
Worry about ability to cope
Worry about lack of purpose in life
Having no pride
Feeling guilty
Feeling angry
Feeling frustrated
Feeling out of control of life
number of environmental hassles
(items 1-9)
mean severity of environmental
hassles
number of feelings-based hassles
(items 10-21)
mean severity of feelings-based
hassles
*
*
*
*
*
F(1,168)
with STAI
42
82
91
59
57
55
55
80
65
96
55
66
55
67
58
48
55
71
71
71
61
F(1,168)
F(1,168)
with BDI with GHQ
1.37
1.53
2.25
0.47
3.89*
0.16
0.14
0.24
0.26
3.28
0.00
0.77
0.22
0.35
0.23
4.62*
0.69
0.30
0.02
0.17
0.10
0.32
1.10
1.68
0.54
3.99*
0.01
2.12
4.54*
0.39
2.82
8.04**
0.05
1.74
1.04
1.69
2.39
0.06
0.75
1.73
1.44
2.47
9.03***
0.53
2.00
0.85
1.06
4.52*
0.27
1.04
6.01"
0.48
5.43*
5.65*
0.68
6.64*
2.17
mean
s.d.
r with
STAI
r with
BDI
r with
GHQ
6.0
2.7
-0.03
-0.05
0.00
2.0
0.49
0.22**
0.29**
0.21"*
7.7
3.94
0.11
0.08
0.13
1.8
0.54
0.48**
0.43**
0.47**
n=169 * p<0.05, ** p<0.01, *** p<O.O05
were a s k e d to d e c i d e w h e t h e r or not each o f these items was a source o f stress for
them. T h r e e - p o i n t ratings o f severity were o b t a i n e d for the items that were identified
as stressors. Thus each p r i s o n e r p r o d u c e d a score b e t w e e n 0 (item not v i e w e d as a
source o f stress) and 3 ( e x t r e m e l y severe source o f stress) from which two indices
were d e r i v e d - - t h e n u m b e r o f items with scores greater than zero ( " n u m b e r o f h a s s l e s " ' )
and the a v e r a g e score on these items ( " m e a n severity"),
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 d i f f e r e n c e s 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 perceived 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 psychological health. Day-to-day annoyances become crises lot depressed or anxious prisoners. 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' psychological well-being (assessed using standard psychometric tests) is related to their background, 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: "treatment 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 friendships with other prisoners, who were sustained by a religious faith, who had a generally 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 prisoners, 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 associated 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 associated 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 functioning. Prisoners with high scores on the STAI, G H Q or BDI viewed these problem areas
as much more important or severe than those who were not emotionally 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 unscathed; the results presented above clarify some of these issues.
ACKNOWLEDGEMENT
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.
NOTE
Address correspondence to Colin Cooper, School of Psychology, The Queen's University of Belfast, 10
Lennoxvale, Malone Row, Belfast BT7 INN, Northern Ireland
REFERENCES
Arboleda-Florez J. and Holley, H. (1989). Predicting Suicide Behaviours in Incarcerated Settings. Canadian Journal of Psychiatry 34, 668-674.
Backett, S. A. (1987). Suicide in Scottish Prisons. British Journal of Psychiatry 151,218-221.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erlbaugh, J. (1961). An Inventory for Measuring
Depression. Archives of General Psychiatry 4 561-571.
Bland, R. C., Newman, S. C., Dyck, R. J. and Orn, H. 1990: Prevalence of Psychiatric Disorders and
Suicide Attempts in a Prison Population. Canadian Journal of Psychiatry 35, 4074 13.
Bonner, R. L. and Rich, A. R. (1990). Psychosocial Vulnerability, Life Stress, and Suicide Ideation in a Jail
Population: A Cross-Validation Study. Suicide and Life Threatening Behavior 20, 213-224.
Buglass, D. and Duffy, J. C. (1978). The Ecological Pattern of Suicide and Parasuicide in Edinburgh.
Social Science and Medicine 12, 241-253.
Cooper, C. and Livingston, M. (1991). Depression and Coping Mechanisms in Prisoners. Work & Stress 5,
149-154.
Cooper, C. & Berwick, S. (1997). Stress and Coping in Prisoners. Manuscript submitted for publication.
Cox, V. C., Paulus, P. B. and McCain, G. 1984: Prison Crowding Research: The Relevance for Prison
Housing Standards and a General Approach Regarding Crowding Phenomena. American Psychologist
39, 1148-1160.
Dooley, E. 1990: Prison Suicide in England and Wales, 1972-87. British journal ~oCpsychiatry 156.
182
Current Psychology / Summer 2001
DuRand, C. J., Burtka, G. J., Federman, E. J., and Haycox, J. A. (1995). A Quarter Century of Suicide in a
Major Urban Jail: Implications for Community Psychiatry. American Journal of Psychiatry 152, 10771080.
Fawcett, J. (1993). The Morbidity and Mortality of Clinical Depression. Internatiomd Clinical Psychopharmacology 8, 217-220.
Flanagan, T. (1981). Dealing with Long-Term Confinement: Adaptive Strategies and Perspectives Among
Long-Term Prisoners. Criminal Justice and Behavior 8, 201-222.
Folkman, S. and Lazarus, R. S. (1980). An Analysis of Coping in a Middle-Aged Community Sample.
Journal of Health and Social Behavior 21,219-239.
Franklin, R. K. (1988). Deliberate Self-Harm: Self-lnjurious Behavior within a Correctional Mental Health
Population. Criminal Justice and Behavior 15, 210218.
Goldberg, D. and Williams, P. (1988). A User's Guide to the General Health Questionnaire. Windsor,
NFER-Nelson.
Hagnell, O. and Rorsman, B. (1979). Suicide in the Lundby Study: A Comparative Investigation of
Clinical Aspects. Neuropsychobiology 5, 61-73.
Harlow, L. L., Newcomb, M. D. and Bentler, P. M. (1986). Depression, Self-Derogation, Substance Use,
and Suicide Ideation: Lack of Purpose in Life as a Mediational Factor. journal of Clinical Psychology
42, 5-21.
Home Office Research & Statistics Department (1996). Prison Service Annual Report and Accounts, April
1994--March 1995. London, HMSO.
Ivanoff, A. (1992). Background Risk Factors Associated with Parasuicide Among Male Prison Inmates.
Criminal Justice and Behavior 19, 426-436.
Kanner, A. D., Coyne, J. C., Schaefer, C. and Lazarus, R. S. (1981). Comparison of Two Modes of Stress
Measurement: Daily Hassles and Uplifts versus Major Life Events. Journal o[" Behavioral Medicine 4,
1-39.
Kerkhof, A. J. and Bernasco, W. (1990). Suicidal Behavior in Jails and Prisons in The Netherlands:
Incidence, Characteristics, and Prevention. Suicide and Life Threatening Behavior 20, 123-137.
Koslowsky, M., Bleich, A., Apter, A., Solomon, Z., Wagner, B. and Greenspoon, A. (1992). Structural
Equation Modelling of some of the Determinants of Suicide Risk. British Jourmd (~f Medical Psychology 65, 157-165.
Lester, D. (1986). Level of Depression in Nations and their Suicide Rate. Psychological Reports 58,930.
Lester, D. (1990). Overcrowding in Prisons and Rates of Suicide and Homicide. Perceptual and Motor
Skills 71,274.
Liebling, A. (1992). Suicides in Prison. London: Routledge.
Liebling, A. 1993: Suicides in Young Prisoners: a summary. Death Studies 17, 381-409.
MacKenzie, D. L. and Goodstein, L (1985). Long-term Incarceration Impacts and Characteristics of LongTerm Offenders: an Empirical Analysis. Criminal Justice and Behavior 12, 395-414.
Paffenbarger, R. S., Lee, I. M. and Leung, R. 1994: Physical Activity and Personal Characteristics Associated with Depression and Suicide in American College Men. Acta Psychiatrica Scandinavica 89, 16-22.
Plutchik, R., van Praag, H. M., Picard, S., and Conte, H.R. (1989). ls there a Relation between the
Seriousness of Suicidal Intent and the Lethality of the Suicide Attempt? Psychiatry -Research 27, 7179.
Porporino F. J., and Zamble, E. (1984). Coping with Imprisonment. Canadian Journal ~[ Criminology 26,
403-421.
Power, K. G. and Spencer, A. P. (1987). Parasuicidal Behaviour of Detained Scottish Young Offenders.
International Journal of OfJender Therapy and Comparative Criminology 31,227-233.
Rihmer, Z., Barsi, J., Veg, K. and Katona, C. L. 1990: Suicide Rates in Hungary Correlate Negatively with
Reported Rates of Depression. Journal of,4ffective Disorders 20, 87-91.
Ruback, R. B. and Innes, C. A. 1988: The Relevance and Irrelevance of Psychological Research: The
example of Prison Crowding. American Psychologist 43,683--693.
Spielberger, C.D., Gorsuch, R. L. and Lushene, R. E. (1970). ManualJbr the State Trait Anxiety Inventory.
Palo Alto, Consulting Psychologists Press.
Tumim, S. and Woolf, H. (1991). Prison Disturbances April 1990. London, HMSO.
Sherman, L. G. and Morschauser, P.C. (1989). Screening for Suicide Risk in Inmates. Psychiatric Quarterly60, 119-138.
Topp, D. O. (1979). Suicide in prison. British Journal qfPsychiat~ 134, 24-27.
van Praag, H. M. and Plutchik, R. (1984). Depression Type and Depression Severity in relation to risk of
Violent Suicide Attempt. Psychiatry Research 12, 333-338.
Winfree, L. T. (1985) American Jail Death-Rates: A Comparison of the 1978 and 1983 Jail Census Data.
Paper presented at the conference of the American Society of Criminology, San Diego, CA.