The use of exercise as an intervention to improve health in the general population is well documented. The purpose of this paper is to explore whether an exercise referral scheme can be an effective health promotion tool for male prisoners in Ireland, presenting with mental health symptoms.
This mixed methods study with a pre- and post-intervention design was conducted in Mountjoy Prison, Dublin, which has a capacity for approximately 790 prisoners. Reliable and validated symptom assessment scales were used to assess levels of depression, anxiety, stress, self-esteem and anger amongst a sample of 40 prisoners pre- and post-intervention. The scales used were 1) the Depression, Anxiety and Stress scale or DASS- 42 (Lovibond and Lovibond, 1995), 2) the Novaco Anger Scale (Novaco 1994), 3) the Rosenberg Self-Esteem Scale (Rosenberg 1964) and 4) the Zung Self-Rated Anxiety Scale (Zung 1971). Semi-structured interviews were also conducted with a subset of the participants post-intervention to further test and contextualise the symptom ratings. The data gathered from the self-rating scales were imported into SPSS 22 for statistical testing for significance. Wilcoxon’s signed rank test was then used to measure significance of changes. Thematic analysis was performed on the qualitative data.
Post-intervention, significant levels of improvement were achieved in the levels of depression, anxiety (DASS), anxiety (Zung), stress, anger, and self-esteem for 29 of the 30 prisoners who completed the study. The incidence of Normal Mood scores rose from 33% to 90% after the intervention; the incidence of Extremely Severe scores for Anxiety changed from 40% to 7%, Severe Stress scores changed from 27% to 3%, Normal Stress levels rose from 17% to 73%, Marked Anger ratings reduced from 40% to 3% and Low Self-Esteem levels reduced from 20% of participants pre-intervention to 7% post-intervention. In the main, participants perceived the experiences and outcomes of the intervention positively.
There are some limitations to the design of this study. Operational circumstances within the prison at the start of this study prevented the authors from accessing a larger sample. A control group would add greatly to the study but this was not possible within a single prison setting. The possible influence of extraneous variables such as increased attention and social contact, and more time out of one’s cell may have contributed to improved symptom scores as much as the exercise intervention in this study. This possibility was recognised from the outset but the authors proceeded because the aim was to test if an exercise referral package (and all that inevitably goes with that) would make a difference for symptomatic prisoners.
The organisation and smooth running of the intervention and the positive results therein underpinned the practicality of this project. The significantly positive results contribute new knowledge to the profile of Irish male prisoners’ mental health.
This study was the first of its kind to explore the effectiveness of exercise referral as a health promotion intervention for Irish male prisoners presenting with mental health symptoms.
Shay O’Toole, Jim Maguire, Pearse Murphy
International Journal of Prisoner Health, 2018