Resea ch A icle
Po J Public Heal h 2017;35:132–140
Sel -Repo s o Heal h be o e and du ing
Imp isonmen in Female Inma es
Joana Al es Ângela Cos a Maia
School o Psychology, Uni e si y o Minho, B aga, Po ugal
Recei ed: Decembe 7, 2016
Accep ed: May 22, 2017
Published online: Decembe 1, 2017
Joana Al es
School o Psychology, Uni e si y o Minho
Campus de Gual a
PT–4710-057 B aga (Po ugal)
E-Mail joana0812 @ gmail.com
© 2017 The Au ho (s). Published by S. Ka ge AG, Basel
on behal o Escola Nacional de Saúde Pública
E-Mail ka ge @ka ge .com
www.ka ge .com/pjp
DOI: 10.1159/000481967
Keywo ds
Female inma es · Risk beha io s · Heal h su eillance ·
Heal h complain s · Heal h s a us
Abs ac
The heal h o emale inma es has been desc ibed as mo e
ulne able han ha o de ained male and he o e all emale
popula ion. The pu pose o his s udy is o desc ibe heal h
beha io s, his o y o diseases, heal h complain s, and heal h
s a us o 232 inca ce a ed women. The women epo ed isk
beha io s and unexpec ed heal h su eillance be o e hei
imp isonmen . In p ison, hei obacco use inc eased, d ug
consump ion dec eased and high a es o diseases, use o
medicines, heal h complain s, and poo heal h s a us we e
ound. The women’s pe cep ions o hei cu en heal h,
compa ed wi h he ime pe iod be o e p ison, e ealed di -
e en ypes o impac , wi h one- hi d epo ing heal h im-
p o emen s. These da a sugges ha women p isone s’
heal h and he p ison’s impac on hei heal h mus be be e
s udied in o de o enhance he heal h in e en ion p o-
g ams du ing imp isonmen .
© 2017 The Au ho (s). Published by S. Ka ge AG, Basel
on behal o Escola Nacional de Saúde Pública
Au o- ela os sob e a sua saúde de eclusas an es e
du an e a p isão
Pala as Cha e
Reclusas · Compo amen os de isco · Vigilância de
saúde · Queixas de saúde · Es ado de saúde
Resumen
A saúde das eclusas em indo a se desc i a como mais
ulne á el do que a dos homens eclusos e do que a da
população eminina em ge al. O obje i o des e es udo é
desc e e compo amen os elacionados com a saúde,
his ó ia de doenças, queixas de saúde e es ado ge al de
saúde de 232 mulhe es de idas. As pa icipan es ela a-
am compo amen os de isco e uma inespe ada igilân-
cia de saúde p é ios à eclusão. Na p isão, o uso de abaco
aumen ou e o consumo de d ogas diminuiu; e elou-se
ambém a ele ada p e alência de doenças, de consumo
de medicamen os e de queixas de saúde, assim como o
es ado ge al de saúde debili ado. A pe cepção das eclu-
sas sob e a sua saúde a ual, em compa ação com o pe ío-
do de empo an e io à eclusão, e elou di e en es ipos
This a icle is licensed unde he C ea i e Commons A ibu ion-
NonComme cial-NoDe i a i es 4.0 In e na ional License (CC BY-
NC-ND) (h p://www.ka ge .com/Se ices/OpenAccessLicense).
Usage and dis ibu ion o comme cial pu poses as well as any dis-
ibu ion o modi ied ma e ial equi es w i en pe mission.
Sel -Repo s o Heal h be o e and du ing
Imp isonmen in Female Inma es
133
Po J Public Heal h 2017;35:132–140
DOI: 10.1159/000481967
de impac o, com um e ço das mulhe es a ela a melho ia
do es ado de saúde. Es es dados suge em a impo ância
de ap o unda o es udo da saúde das mulhe es eclusas e
o impac o da p isão no es ado de saúde, a im de ap i-
mo a os p og amas de in e enção em saúde du an e a
eclusão. © 2017 The Au ho (s). Published by S. Ka ge AG, Basel
on behal o Escola Nacional de Saúde Pública
In oduc ion
The inma e popula ion has been he subjec o a num-
be o s udies ha demons a e speci ic cha ac e is ics,
ega ding hei amilial, social, demog aphic, economic,
educa ional and beha io al backg ounds, which make
hem highly ulne able [1]. This ulne abili y is e lec ed
on se e al domains, bu i has a special impac on heal h.
G owing up in ad e se en i onmen s, wi h less access o
educa ion, heal h se ices, and job oppo uni ies, acili-
a es he adop ion o isk beha io s and he de elopmen
o ad e se expe iences ha could esul in poo physical
and men al condi ions [2]. As a consequence, inma es
usually a i e in p ison p esen ing a debili a ed heal h
condi ion, including a highe p e alence o subs ance
abuse, men al diso de s, and in ec ious and ch onic dis-
eases [3, 4].
I heal h s a us in an imp isonmen en i onmen is
wo h highligh ing, he heal h o he emale p ison popu-
la ion equi es e en mo e dedica ion om bo h he sci-
en i ic communi y and cu en heal h policies. Al hough
gende is one o he mos signi ican demog aphic p edic-
o s o heal h s a us [3], i has been g ea ly neglec ed in
s udies on inma e popula ions. Because o his gap, many
au ho s ha e ocused on heal h condi ions in p ison en-
i onmen s and concluded ha emale inma es, when
compa ed wi h de ained men o wi h he o e all emale
popula ion, expe ience highe le els o ulne abili y and
ha e highe a es o heal h isk beha io s and heal h
p oblems, be o e and du ing imp isonmen [4–8].
Al hough in es iga ion o de ained women has been
inc easing in ecen yea s, a numbe o gaps emain in he
cha ac e iza ion o he gene al heal h s a us [9], sexual
beha io s, women’s speci ic heal h needs [6], and p e a-
lence o ch onic diseases [10]. As s a ed ecen ly by Mos-
che i e al. [11], desc ip i e s udies a e needed o aise
awa eness o he speci ic heal h issues o de ained women
and o suppo he decision-making abou he mos ap-
p op ia ed heal h se ices in emale p isons.
The e o e, his a icle in ends o cha ac e ize he
heal h o a sample o emale inma es in 4 ca ego ies:
heal h beha io s, his o y o heal h and disease ea men ,
heal h complain s, and gene al heal h s a us. The s udy o
hese ca ego ies pa es he way o add essing he ollow-
ing objec i es: (a) iden i ying heal h isk beha io s: o-
bacco, alcohol, d ug consump ion, and sexual beha io
be o e and du ing imp isonmen ; (b) moni o ing sel -de-
s uc i e beha io s: numbe o suicide a emp s du ing
li e ime and sel -ha m beha io s du ing imp isonmen ;
(c) e alua ing heal h su eillance, ha is, he use o heal h
se ices be o e imp isonmen ; (d) accessing li e ime his-
o ies o sexual and ep oduc i e heal h; (e) accessing li e-
ime his o ies o in ec ious, con agious and ch onic dis-
eases; ( ) moni o ing he consump ion o medicines
du ing imp isonmen ; (g) accessing physical and psycho-
logical heal h complain s du ing imp isonmen ; (h) cha -
ac e izing gene al heal h s a uses and indi idual sel -pe -
cep ions o heal h du ing imp isonmen , and compa ing
hese wi h he indi idual sel -pe cep ions o heal h be o e
imp isonmen .
Once he s udy has been ca ied ou in wo Po uguese
emale p ison es ablishmen s, i is ele an o cla i y ha ,
in Po ugal, he access o heal h ca e by he p isone s
should ollow he Eu opean ecommenda ions, conside -
ing he p isone as a ci izen, wi h ull igh o access o
heal h ca e. The Po uguese law s a es ha a p isone has
he igh o access he Na ional Heal h Se ices unde
iden ical condi ions o hose gua an eed o all ci izens;
e en mo e, p ison es ablishmen s mus be p epa ed wi h
adequa e acili ies and equipmen o he needs o daily li e
o p isone s, namely he heal h needs. The e o e, each e-
male p ison has i s own heal h se ices including nu ses,
a gene al p ac i ione (GP), a psychia is , a gynecologis ,
an in ec ologis , a psychologis , and a den is . This heal h
ca e acili y ope a es 24 h/day wi h a nu se p esen a all
imes. Immedia ely a e admission, all new de ainees a e
submi ed o a iage p ocess by a p ima y heal h ca e
nu se (wi hin he i s 24 h) and by a GP (wi hin he i s
72 h) in o de o iden i y any possible heal h p oblem.
Me hod
Pa icipan s
Two hund ed and hi y- wo inma es in Po uguese women’s
p isons pa icipa ed in his s udy. O he 596 women who we e
de ained in he only wo special eminine p isons du ing he e-
c ui men pe iod, 4 we e eleased be o e esea ch s a could ap-
p oach hem. O he women who we e sc eened, 71 did no mee
he ollowing inclusion c i e ia: abili y o communica e in Po u-
guese and no being in an inpa ien clinic condi ion due o uns able
physical o men al heal h. O he emaining 521, 250 (48%) wom-
en we e andomly selec ed. Two hund ed and hi y- wo women
Al es/Cos aMaia
Po J Public Heal h 2017;35:132–140
134
DOI: 10.1159/000481967
ag eed o pa icipa e in he s udy. The emaining 18 (7.2%) de-
clined o decided o in e up hei pa icipa ion du ing da a col-
lec ion. The esponse a e was 92.8%.
The mos common eason o de en ion (n = 131; 56.5%) was
subs ance- ela ed c imes. Jus o e hal (n = 122; 53.3%) o he
women had been de ained o 12 mon hs o mo e, and mos o
hem (n = 150; 65.2%) had al eady been sen enced. The mean sen-
ence leng h was 79.06 mon hs (wi h a minimum o 6 mon hs and
a maximum o 324 mon hs). A la ge majo i y (n = 179; 77.8%) had
been de ained o he i s ime and, among he ecidi is s, he
highes numbe o e-o enses was 4.
Ma e ials
Demog aphic and Ju idical Ques ionnai e. The demog aphic
measu es comp ised age, na ionali y, e hnici y, educa ion, em-
ploymen , mo he hood, and ma i al s a us. The ju idical measu es
we e p ison, he ype o c ime, he du a ion o imp isonmen ,
whe he hey had been sen enced o we e on emand, he leng h o
he sen ence, and he numbe o imes he women had been a -
es ed.
Risk Beha io and Heal h His o y Assessmen Su ey. A isk be-
ha io and heal h his o y assessmen su ey was c ea ed o his
s udy. I con ained ques ions on heal h isk beha io s ( obacco,
alcohol and subs ance consump ion along wi h sexual beha io
be o e and du ing imp isonmen ); sel -des uc i e beha io s
(numbe o suicide a emp s du ing li e ime and sel -ha m beha -
io s du ing imp isonmen ); heal h su eillance (p e ious con ac
wi h heal h ca e se ices); sexual and ep oduc i e li e his o y; and
li e his o y o in ec ious, con agious and ch onic diseases. Pa ici-
pan s we e also asked whe he hey had aken any ype o medica-
ion du ing hei imp isonmen .
Ro e dam Symp om Checklis [12]. This ques ionnai e e alu-
a ed ecen heal h complain s and ea u ed a lis o 29 symp oms
di ided in o 2 ca ego ies: physical and psychological symp oms.
The i em esponses we e gi en on 4-poin Like - ype scales: “no
a all,” “a ew imes,” “some imes,” and “ e y o en.” Howe e , o
da a analysis pu poses, we dicho omized hese a iables and com-
bined “no a all” and “a ew imes” as 0 and “some imes” and “ e y
o en” as 1. The in e nal consis ency eliabili y coe icien o he
scale sco ed on he Po uguese sample was e y good (C onbach’s
alpha o 0.91) [13].
Sho -Fo m Heal h Su ey (SF-12) [14]. SF-12 measu es subjec-
i e heal h s a us in 8 heal h aspec s and esul s in a physical com-
ponen summa y (PCS – subscales o physical unc ion, physical
pe o mance, pain, and gene al heal h) and a men al componen
summa y (MCS – subscales o i ali y, social unc ion, emo ional
pe o mance, and men al heal h). Th ough a speci ic algo i hm,
we ob ained sco es anging om 0 o 100, whe e 100 co espond-
ed o he bes pe cep ion o heal h. The SF-12 sco e was p oduced
using he Heal h Ou comes Sco ing So wa e 4.0 (Quali yMe ic
Inco po a ed, New Yo k, NY, USA). Rega ding he in e nal con-
sis ency o he Po uguese e sion, he C onbach alphas we e 0.79
o he PCS and 0.81 o he MCS. Sensibili y es s ha e shown ha
he SF-12 appea s o be a alid measu emen o heal h s a us [15].
O e all Heal h and Heal h p io o Imp isonmen . Two i ems
we e c ea ed o measu e o e all heal h and heal h p io o imp is-
onmen . On he i s i em, inma es we e asked abou hei cu en
heal h: “O e all, how would you desc ibe you heal h?” This ques-
ion had 5 possible answe s: “excellen ,” “ e y good,” “good,”
“ ai ,” o “poo .” The second i em asked inma es o compa e hei
cu en heal h wi h hei heal h p io o being inca ce a ed (“Com-
pa ed wi h he ime be o e you we e a es ed, how would you de-
sc ibe you cu en heal h?”). The ques ion had he ollowing 5
possibili ies o answe s: “much be e ,” “be e ,” “app oxima ely
he same,” “wo se,” o “much wo se.”
P ocedu e
A e app o al om he E hics Commi ee o he Gene al Di-
ec o a e o P ison Se ices, he da a collec ion was scheduled wi h
he di ec ing boa ds o each p ison in ol ed in his s udy. Da a
we e collec ed indi idually by ained esea che s who we e no
pa o he p ison pe sonnel, allowing inma es o sha e in o ma-
ion in an en i onmen o con iden iali y. A he beginning o each
in e iew, he aims o he s udy we e explained, and da a we e col-
lec ed a e ob aining he in o med consen .
Analysis/S a is ical Me hods
Da a analysis was conduc ed using he s a is ics so wa e IBM
SPSS e sion 20. The means and s anda d de ia ions o he in e al
a iables and he equencies and pe cen ages o he nominal a i-
ables we e calcula ed in o de o pe o m he desc ip i e analysis
necessa y o accomplish he aims o his s udy. Fo he epo o
pe cen ages, we conside ed he alue o alid pe cen age o be e
exp ess he di e ences amoun o missing alues o each a iable.
The medians o he wo main componen s o he SF-12 we e also
calcula ed in o de o compa e hese esul s wi h he no ma i e
alues o he Po uguese popula ion [13]. Fo his compa ison,
he one-sample Wilcoxon signed- ank es was used.
Resul s
A summa y o he pa icipan s’ sociodemog aphic
cha ac e is ics is p esen ed in Table 1.
Heal h Risk Beha io s
Rega ding obacco consump ion, 56.9% (n = 132) o
he pa icipan s we e smoke s, and he mean age o ini-
ia ing smoking was 16.73 yea s (SD = 6.50), anging om
9 o 43 yea s. Among hese inma es who smoke, 62.9%
(n = 83) epo ed smoking mo e since being de ained,
wi h a mean o 15 ciga e es a day (SD = 9.89).
Mos pa icipan s (n = 188; 81%) decla ed hey had
consumed alcohol a leas once. Among hese, 14% (n =
26) a i med ha hei consump ion was p oblema ic,
and 6.5% (n = 12) said hey had a some poin been de-
penden on his subs ance. Du ing he 6 mon hs p io o
imp isonmen , alcohol consump ion was conside ed p e-
dominan ly occasional (n = 134; 71.3%). Since hei im-
p isonmen , only 17.2% (n = 39) o inma es men ioned
alcohol consump ion; among hese, 86.8% (n = 33) had
consumed small po ions wi h he consen o p ison s a ,
and 13.2% (n = 5) epo ed hey had consumed alcohol
du ing empo a y lea es.
Sel -Repo s o Heal h be o e and du ing
Imp isonmen in Female Inma es
135
Po J Public Heal h 2017;35:132–140
DOI: 10.1159/000481967
Thi y- i e pe cen (n = 80) o he pa icipan s epo -
ed ha ing consumed illegal subs ances, and among hose,
58.8% (n = 47) conside ed hei illegal subs ance use
p oblema ic. Fu he mo e, 57.5% (n = 46) epo ed being
addic ed. The mean age o ini ial consump ion was 19.86
yea s (SD = 7.90), wi h cannabis (n = 48; 60%), cocaine
(n = 50; 62.5%), he oin (n = 30; 37.5%), and me hadone
(n = 21; 26.3%) being he mos used subs ances p io o
imp isonmen . Among all inma es who epo ed ha -
ing consumed hese subs ances, 27.5% (n = 22) ha e done
i in a enously (6 on hei las day be o e being a es ed,
1 du ing he week be o e, ano he du ing he mon h be-
o e, and 14 mo e han 2 mon hs be o e). The a e age
ini ial age o in a enous consump ion was 24.86 yea s
(SD = 9.02). Six een inma es (6.9%) said hey had con-
sumed d ugs du ing imp isonmen , wi h cannabis being
he mos used subs ance. None o he inma es answe ed
posi i ely o in a enous d ug consump ion.
The majo i y o pa icipan s (n = 195; 84.1%) epo ed
ac i e he e osexual beha io du ing he yea p io o he
imp isonmen . Among hese, only 22.7% (n = 44) epo -
ed always using a condom. Du ing he de en ion pe iod,
only 13.8% (n = 32) e ealed ac i e he e osexual beha io ,
wi hin which 23.3% (n = 7) had always used a condom.
Ac i e homosexual beha io in he yea p io o he im-
p isonmen was epo ed by 4.4% (n = 10) o he women,
om which only 3 (30%) had always used a condom. In-
side he p ison es ablishmen , 9.9% (n = 23) o he pa -
icipan s epo ed ac i e homosexual beha io , wi hin
which 17.4% (n = 4) had always used a condom. Table 2
shows de ailed da a on he inma es’ sexual beha io s be-
o e and du ing imp isonmen .
Only 1 o he pa icipan s epo ed ha ing been paid
wi h money, goods o d ugs o sex du ing imp ison-
men , al hough 23 (10%) said hey had been paid wi h
money, goods o d ugs o he same pu pose a some
poin in hei li es.
Sel -Des uc i e Beha io
Rega ding suicide, 31% (n = 72) epo ed a leas 1 a -
emp ; he mean numbe o suicide a emp s was 2.3
(SD = 1.46), and he mean age o occu ence was 29 yea s
(SD = 9.97). Wi hin his g oup, 43.1% (n = 31) said hey
had a emp ed suicide a leas once while hey we e al-
eady in p ison.
Sel -ha ming beha io s du ing he mon h ha p eced-
ed he in e iew, i.e., when inma es we e al eady in p is-
on, we e epo ed by 10 (4.3%) pa icipan s, and in each
case, he de ainees epo ed ha ing inju ed hemsel es o
add ess eelings o age, ension, anxie y, o dep ession.
Six o hese had ecei ed medical a en ion and/o psy-
chological suppo in he p ison’s medical acili ies im-
media ely a e he sel -ha m episode.
Heal h Su eillance be o e Imp isonmen
Among he pa icipan s in his s udy, 90.9% (n = 211)
we e egis e ed a a p ima y heal h ca e cen e wi h a GP,
and among hose, 73.9% (n = 156) had isi ed hei GPs
n% Mean SD
Age, yea s 36.86 10.72
Po uguese na ionali y 177 76.3
E hnici y
Whi e
Black
Gipsy
159
37
30
68.8
16.0
13.0
Educa ion
Ne e a ended school
Fewe han 4 yea s
Comple ed p ima y school
Comple ed he six h g ade
Comple ed he nin h g ade
Comple ed seconda y educa ion
Uni e si y deg ee
10
21
46
53
51
30
20
4.3
9.1
19.9
22.9
22.1
13.0
8.7
Had been employed be o e de en ion 138 59.5
Housekeepe 31 22.6
Had a leas 1 child 191 82.3
Numbe o child en 2.86 1.81
Had been ma ied o li ed in a ci il pa ne ship 160 69
Table 1. Pa icipan s’ sociodemog aphic
cha ac e is ics (n = 232)
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Po J Public Heal h 2017;35:132–140
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DOI: 10.1159/000481967
a leas once in he las 6 mon hs be o e imp isonmen ,
41.7% (n = 108) had had an eme gency hospi aliza ion,
and 19.6% (n = 44) we e being ollowed by a psychia is .
Sexual and Rep oduc i e Heal h His o y
Mos inma es (n = 205; 88.4%) had been p egnan a leas
once. Rega ding mens ua ion, 82.8% (n = 192) we e s ill
mens ua ing a he ime o he s udy and 45.8% (n = 88)
epo ed hey had mens ua ion- ela ed p oblems. The
mos e e enced p oblems we e i egula mens ual cycles
(n = 58, 65.9%) and e y hea y bleeding (n = 29, 33%). Be-
o e imp isonmen , 51.3% (n = 119) o inma es had been
using some o m o bi h con ol me hods, wi h o al con-
acep i e pills being he mos common me hod (n = 72;
50.7%), ollowed by condoms (n = 35, 18.3%). Twen y- wo
pe cen (n = 51) o inma es s a ed hey we e s ill using a
con acep i e me hod du ing imp isonmen , wi h o al
bi h con ol pills being again he mos common me hod
(n = 22; 38.6%). Six een (6.9%) pa icipan s said hey had
been ea ed a leas once o a sexually ansmissible disease.
P e alence o Diseases
The numbe o pa icipan s ecei ing, a leas once in
hei li e, diagnos ic es s o in ec ious diseases and he
p e alence o hese diseases a e shown in Table 3.
Table 4 shows he da a on epo ed ch onic diseases
p esen a he momen o he su ey, om he mos o he
leas equen .
Medica ion
Rega ding pha maceu ical d ugs consumed du ing
imp isonmen , 71.6% (n = 166) o inma es epo ed hey
we e aking a p esc ibed d ug.
Heal h Complain s
Table 5 lis s he heal h complain s, including he e-
sul s om he Ro e dam Symp om Checklis , ha in-
ma es had expe ienced du ing he week be o e he su ey,
by o de and equency. The mos epo ed heal h com-
plain s we e essen ially psychological, wi h wo ying,
anxie y, ne ousness, di icul y sleeping, despai abou
he u u e, ension, i edness, and i i abili y epo ed by
mo e han hal o pa icipan s.
Gene al Heal h S a us
The global esul s om he SF-12 showed ha he PCS
sco es a ied be ween 15.15 and 71.82, wi h a mean o
49.93 (SD = 10.40) and a median o 52.37 (IQR = 14.46),
and he MCS sco es a ied be ween 8.89 and 64.38, wi h
a mean o 39.84 (SD = 12.84) and a median o 40.26
(IQR = 20.66). The compa ison be ween his s udy’s me-
dian PCS and MCS alues and hose o he e e ence pop-
ula ion, using he one-sample Wilcoxon signed ank es ,
showed a signi ican di e ence (z = –13.202, p = 0.05; z =
–13.205, p = 0.05). Female p isone s had lowe sco es on
Table 2. Sexual beha io s be o e and du ing imp isonmen
Yea be o e
imp isonmen
Du ing
imp isonmen
n%n%
Ac i e he e osexual beha io 195 84.1 32 13.8
Numbe o pa ne s
One
Two
Th ee o mo e
164
21
10
70.7
9.1
4.4
31
1
0
13.5
60.4
–
Condom usagea
Always
Some imes
Ne e
44
28
122
22.7
14.4
62.9
7
3
20
23.3
10
66.7
Ac i e homosexual beha io 10 4.4 23 9.9
Numbe o pa ne s
One
Two
Th ee o mo e
8
1
1
3.4
0.4
0.4
17
3
3
7.6
1.3
1.3
Condom usagea
Always
Some imes
Ne e
3
–
7
30
–
70
4
1
18
17.4
4.3
78.3
aOnly conside ing sexually ac i e inma es.
Table 3. Repo ed con agious and in ec ious diseases du ing li e-
ime
n%
HIV
Took he es
Tes ed posi i ea178
14
76.7
7.9
Hepa i is B
Took he es
Tes ed posi i ea169
4
72.8
2.4
Hepa i is C
Took he es
Tes ed posi i ea121
18
52.2
15.0
Tube culosis
Took he es
Tes ed posi i ea137
6
59.1
4.4
aOnly conside ing inma es who ook he es s.
Sel -Repo s o Heal h be o e and du ing
Imp isonmen in Female Inma es
137
Po J Public Heal h 2017;35:132–140
DOI: 10.1159/000481967
bo h summa ies, indica ing poo e physical and men al
heal h.
Table 6 shows how inma es e alua ed hei heal h a
he ime o he su ey. In ega d o hei global assess-
men o heal h, in compa ison wi h heal h be o e im-
p isonmen , 33.2% (n = 138) o pa icipan s said hey
had el a posi i e shi , desc ibing hei heal h a he
ime o he su ey as much be e (16.8%; n = 39) o be -
e (16.4% n = 38) han he pe iod be o e p ison; ano h-
e 26.3% (n = 61) epo ed no change, conside ing ha
hei heal h had emained oughly he same, and 40.5%
(n = 94) epo ed a nega i e change, assessing hei
heal h s a uses as wo se (22.8%, n = 53) o much wo se
(17.7%, n = 41).
Discussion
This s udy co e ed a comp ehensi e ange o heal h
and heal h beha io s in emale inma es, be o e and du -
ing imp isonmen . The e is a consensus in he li e a u e
ha hese inma es b ing ou a en ion because o hei
ulne able heal h condi ions and hei high p e alence o
heal h- ela ed isk beha io s. In ac , pa icipan s epo -
ed some heal h isk beha io s p io o imp isonmen ,
such as obacco consump ion, d ug use, and sexual isk
beha io s, bu con a y o wha o he s udies [6] ha e e-
ealed, alcohol abuse be o e p ison was e y low, and a -
e imp isonmen , i was nea ly nonexis en .
Tobacco consump ion inc eased du ing he women’s
imp isonmen . Condon e al. [2] s a ed ha he ac o s
b ough on by imp isonmen condi ions, such as inc eased
Table 4. Repo ed ch onic diseases p esen a he momen o he
su ey
n%
Mig aine 109 47.0
Sleep p oblems 106 45.7
Anxie y 101 43.5
Low back pain 85 36.6
Dep ession
Hype ension
74
48
31.9
20.7
Diges i e p oblems 41 17.7
Acciden s 33 14.2
Skin p oblems 32 13.8
Vascula diseases 31 13.4
Ca dio ascula diseases 29 12.5
In es inal p oblems 20 8.6
Diabe es 18 7.8
Epilepsy 11 4.7
Oncological diseases 9 3.9
O he 75 32.3
Table 5. Ro e dam Symp om Checklis ’s heal h complain e-
quenciesa
Symp oms in he week be o e su ey n%
Wo ying 207 89.2
Anxie y 171 73.7
Ne ousness 163 70.3
Di icul y sleeping 152 65.5
Despai ing abou he u u e 135 58.2
Tension 133 57.3
Ti edness 127 54.7
I i abili y 126 54.3
Tingling hands o ee 120 51.7
Low back pain 114 49.1
Dep essed mood 111 47.8
So e muscles 110 47.4
Lack o appe i e 109 47.0
Headaches 109 47.0
D y mou h 105 45.3
Di icul y concen a ing 100 43.1
Lack o ene gy 97 41.8
Dec eased sexual in e es 85 36.6
Bu ning/so e eyes 78 33.6
Cons ipa ion 75 32.3
Shi e ing 73 31.5
Dizziness 71 30.6
Abdominal aches 64 27.6
Loss o ai 63 27.2
Hea bu n/belching 61 26.3
Nausea 48 20.7
Vomi ing 35 15.1
So e mou h/pain when swallowing 24 10.3
Dia hea 17 7.3
aIn he week be o e su ey.
Table 6. Global assessmen s o cu en heal h
n%
Excellen 22 9.5
Ve y good 22 9.5
Good 69 29.7
Fai 75 32.3
Poo 44 19.0
Al es/Cos aMaia
Po J Public Heal h 2017;35:132–140
138
DOI: 10.1159/000481967
s ess and spa e ime, along wi h he a ailabili y o he sub-
s ance i sel con ibu e o his endency. The consump ion
o illegal subs ances, which was signi ican ly high be o e
de en ion − in acco dance wi h he indings o S a on e al.
[16] − was educed o spo adic occu ences du ing imp is-
onmen , wi h no e iden signs o addic ion. This seems o
be ela ed o p isons’ ac i e oles in de oxi ica ion om
subs ances. Condon e al. [2] highligh ed he ac ha mos
subs ance use s hal hei consump ion du ing imp ison-
men and, al hough Plugge e al. [17] co obo a ed his
idea, hey no ed ha he e is a high pe cen age o eplace-
men o illegal subs ances by p esc ibed medicines such as
benzodiazepines and opia es.
Rega ding sexual beha io be o e imp isonmen , mos
o he sexually ac i e pa icipan s in his s udy had had
in e cou se wi h only one pa ne . Howe e , he incon-
sis en use o condoms combined wi h he consump ion
o in a enous subs ances and p os i u ion beha io s
(e en bo h occu in a lowe equency) inc eased he pos-
sibili y o being in ec ed wi h sexually ansmi ed dis-
eases.
As expec ed, du ing imp isonmen , he e osexual ac-
i i y was signi ican ly educed, and mos inma es had
had sexual in e cou se wi h a single pa ne . Howe e ,
sexual isk beha io s a e s ill p esen since condom usage
was low. On he o he hand, i is wo h highligh ing ha
unp o ec ed homosexual in e cou se du ing imp ison-
men had inc eased. One possible explana ion o he in-
c ease in he unp o ec ed homosexual ela ionships is he
una ailabili y o emale condoms in he p ison and he
low in es men in his domain by he heal h p omo ion
policies. Al hough s udies on sexual isk beha io among
emale inma es a e sca ce [6], he e ealed beha io al pa -
e n is consis en wi h wha has been obse ed in he e-
male inma e popula ion, ha is, inconsis en condom
use, high- isk sexual pa ne s, and p os i u ion [18–20].
Conce ning sel -ha ming beha io s, while sel -ha m
du ing imp isonmen was epo ed by a small numbe o
pa icipan s, he p e alence o suicide a emp s be o e
and du ing imp isonmen was no able. The pe cen age o
inma es who epo ed a leas one suicide a emp
h oughou hei li e ime was high, emphasizing he e-
male inma e popula ion’s ulne abili y o his ype o be-
ha io , which has been ound in p e ious s udies [6, 21,
22]. This inc eased ulne abili y o he isk o suicide is
la gely ela ed o he high p e alence o men al illness
among he imp isonmen popula ion [23], as well as o
he high p e alence o ad e se expe iences. As an exam-
ple, he esul s om women inma es’ esea ch indica e
ha hose who ha e a emp ed suicide we e exposed o
mo e ad e si y [24, 25]. Conside ing hese da a, suicide is
a opic ha dese es special a en ion om p ison policies
in he ea ly iden i ica ion o emale p isone s a isk and
he c ea ion o p e en ion s a egies.
Rega ding heal h su eillance be o e imp isonmen ,
mos inma es epo ed hey had seen hei GP and/o a
heal h p o essional in eme gency se ices a leas once du -
ing he 6 mon hs p io o imp isonmen , sugges ing ha
access o communi y heal h se ices is equen , con a y o
wha o he s udies ha e documen ed [16, 21, 26, 27]. How-
e e , he eason o his beha io is no included in his
s udy. Fu u e s udies should explo e he easons o his ac-
i e con ac wi h heal h se ices p io o imp isonmen .
Conce ning sexual and ep oduc i e heal h, mens ual
p oblems we e he mos ele an issue, which is in line wi h
he indings o a ep oduc i e heal h s udy ha indica ed a
highe p e alence o his ype o dys unc ion among he in-
ma e popula ion in compa ison wi h women in he la ge
communi y [28]. In con as , he low pe cen age o pa ici-
pan s who epo ed ha ing been ea ed o sexually ans-
mi ed diseases seems o indica e, gi en he endency o-
wa d sexual isk beha io s ha was p e iously no ed, a lack
o medical ca e and/o in o ma ion on his subjec [19].
The e o e, conside ing he isk beha io s o bo h sexually
ansmi ed and ch onic diseases (such as u e ine cance )
and he lack o medical ollow-up and heal h in o ma ion,
sexual and ep oduc i e heal h should be an a ea o a en-
ion wi hin p ison ins i u ions [29, 30] h ough he p omo-
ion o sc eening measu es and sex educa ion p og ams.
Mo eo e , in addi ion o p isons’ ac i e oles in heal h
educa ion, hese ins i u ions a e also conside ed unda-
men al in he sc eening and ea men o in ec ious dis-
eases [31]. Following he indings by Ba os e al. [31], he
p e alence o epo ed hepa i is C and HIV is p ominen .
Fu he mo e, hough hese diseases ha e inc easingly be-
come he subjec o a en ion o bo h p ison heal h poli-
cies and esea che s [21], he high numbe o inma es
wi h hepa i is C and HIV emains a ma e o conce n o
public heal h [21, 32, 33], being he emale p ison popula-
ion he mos a ec ed [34, 35].
The mos equen ly epo ed ch onic diseases we e
mig aines, sleeping p oblems, anxie y, low back pain, and
dep ession, wi h a no able p ominence o men al heal h
complain s and men al diso de s, ein o cing, hus, he
high p e alence o psychopa hology among inca ce a ed
women ha has al eady been epo ed in nume ous s ud-
ies [7, 9, 26, 36, 37].
S ill bea ing in mind he high numbe o epo ed
heal h complain s and illnesses, i is no su p ising ha
he e we e also a e y high pe cen age o pa icipan s in
Sel -Repo s o Heal h be o e and du ing
Imp isonmen in Female Inma es
139
Po J Public Heal h 2017;35:132–140
DOI: 10.1159/000481967
pha macological he apy. Howe e , i is impo an o
highligh ha du ing he da a collec ion, mos pa ici-
pan s we e unable o speci y he subs ances hey we e ak-
ing, which demons a es he low inma e knowledge abou
he medical ea men s hey we e being subjec ed o.
Langne e al. [38] also concluded ha he e is a highe
p e alence o medicine consump ion in he emale in-
ma e popula ion when compa ed wi h he communi y; in
he same way, Bu le e al. [5] showed ha inca ce a ed
women ha e a highe pe cen age o consump ion o hese
subs ances han hei male coun e pa s. This migh hap-
pen due o he ac ha emale de ainees ha e a highe
endency o pu sue medical se ices [27, 39], which is e-
la ed o he p e iously men ioned high a es o diseases
and heal h complain s, as well as he eplacemen o ille-
gal d ugs by psycho opic medica ion.
The epo ed heal h complain s we e equen , which
co obo a es he indings o Bu le e al. [5] and Robe e
al. [27], indica ing ha heal h complain s among emale
inma es a e equen du ing imp isonmen . This migh
be a esul no only o hei ulne abili y in e ms o men-
al and physical heal h, bu also o he inc ease in sel -
awa eness due o hei imp isonmen [27]. The high
p e alence o anxie y- ela ed complain s is a sign o psy-
chological s ess among emale inma es.
Finally, conside ing he pa icipan s’ gene al heal h, i is
possible o conclude ha hey ha e lowe le els o physical
and men al heal h compa ed wi h he communi y emale
popula ion, which is simila o he indings o Plugge and
Fi zpa ick [9] in he Uni ed Kingdom and o Bu le e al.
[5] in Aus alia. In addi ion, i is no su p ising ha mo e
han hal o he pa icipan s in his s udy epo ed nega i e
pe cep ions o hei heal h no only because o he pa e n
o heal h isk beha io s, bu also due o he p e alence o
in ec ious and men al diseases, he high consump ion o
p esc ibed d ugs, and he ple ho a o heal h complain s.
Howe e , we need o no e some indings ha could be
ela ed o a posi i e impac o p ison on pa icipan heal h,
such as he abo e-men ioned dec ease in he consump ion
o illegal subs ances and alcohol. These ac s could con ib-
u e o he high pe cen age o women who epo ed heal h
s a us imp o emen du ing imp isonmen . In con as ,
some indings could be ela ed o he nega i e impac o
p ison on pa icipan s’ heal h, such as he al eady men-
ioned inc ease in smoking and he psychological s ess e-
la ed o imp isonmen , which can explain he pe cen age o
women who e alua e hei heal h as wo se o much wo se.
These esul s e eal how p ison impac can be a iable [2].
This s udy had some limi a ions, o which he mos im-
po an was he numbe o pa icipan s, which ep esen ed
only 31.1% o he imp isoned emales in Po ugal in he i s
qua e o 2012. Ne e heless, he sociodemog aphic and ju-
idical cha ac e is ics o he s udied sample a e simila o he
mos common among he o e all Po uguese emale inma e
popula ion a he ime o he da a collec ion. Ano he limi a-
ion conce ns he ques ionnai e on isk beha io and heal h
eco ds ha had no consis en imeline ha de e mines
when he issues add essed had occu ed, making i mo e di -
icul o ho oughly analyze hese pa icipan s’ isk beha -
io s and heal h his o ies be o e and du ing imp isonmen .
The ac ha his s udy is based on sel - epo ing is mos
likely i s g ea es limi a ion, due o he implied bias associ-
a ed wi h his ype o measu e. E en so, he e a e no signs
ha inma es a e less us wo hy han he o e all popula-
ion, and sel - epo ing ins umen s such as he SF-12 a e
alid when applied o he inca ce a ed popula ion [9, 17].
Gi ing he ele ance o ob aining heal h ou comes h ough
o he sou ces o in o ma ion a he han sel - epo , an a
pos e io i s udy was ca ied ou on he emale p isone s’
heal h in Po ugal on he basis o in o ma ion con ained in
he clinical ials [Al es and Cos a Maia, in p ess].
Ou esul s emphasized he ulne able heal h s a us o
de ained women and he a iable impac o imp isonmen
on heal h. These seemingly agile heal h condi ions o he
women con inue o d aw a en ion o he need o poli i-
cians, p ison managemen , heal h ad oca es, and p ison
s a o in es in p og ams and measu es ocused on im-
p o emen s in emale inma es’ heal h. Be gh e al. [40]
men ioned he need o change c iminal jus ice sys ems,
conside ing he ailu es in gende sensi i i y. They high-
ligh 4 c ucial s eps o ac ion ha we would also like o un-
de line since hey syn hesize some o he mos impo an
changes, conside ed in he li e a u e, o heal h imp o e-
men s o women p isone s: imp isonmen o women
should be conside ed only when all o he al e na i es a e
una ailable o unsui able; all s a wo king wi h women
p isone s should ha e ollowed gende sensi i i y aining
o aise awa eness o and imp o e esponse o hese gende -
ela ed issues; he Eu opean P ison Rules a e o i al impo -
ance, bu hey need a e ision o gua an ee he p o ision
o se ices o mee women p isone s’ speci ic needs; heal h
se ices o women in p ison should be indi idualized as a
as possible o mee hei speci ic exp essed needs. These e -
o s will p omo e imp o emen no only in hese women’s
li es bu also hose o hei communi ies because hei e-
en ies will po en ially be mo e success ul. Finally, ou ind-
ings should encou age u u e esea ch using quali a i e
me hods in o de o be e unde s and how hey pe cei e
hei heal h and which ac o s a e in ol ed in he emo ion-
al and physical changes ha a ec hese pe cep ions.
Al es/Cos aMaia
Po J Public Heal h 2017;35:132–140
140
DOI: 10.1159/000481967
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