International Journal of Africa Nursing Sciences 14 (2021) 100289

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International Journal of Africa Nursing Sciences

journal homepage: www.elsevier.com/locate/ijans

The magnitude of depressive disorder and associated factors among

prisoners in Ethiopia; implications for nursing care: A systematic review
and meta-analysis
Reta Tsegaye a, *, Diriba Mulisa a, Bizuneh Wakuma a, Werku Etafa a, Getu Mosisa a, Ebisa Turi b,
Getahun Fetensa a, Adugna Oluma a, Dejene Seyoum b, Ginenus Fekadu c, Tadesse Tolossa b
a
Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
b
Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
c
Department of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Different studies with varying magnitudes were conducted on depression among inmates and
Depressive disorder associated factors in Ethiopia. However, there is no consistent finding of the magnitude and factors associated
Inmates with it. Thus, this systematic review and meta-analysis was intended to draw the pooled magnitude of depressive
Prisoners
disorder and associated factors in Ethiopia.
Ethiopia
Methods: A number of databases such as Pub Med, Medline, HINARI, Cochrane library, the Web of Science, and
Google Scholar were searched for studies reported on depression among inmates in Ethiopia. Stata/SE V14 was
used for statistical analysis, and publication bias was assessed using the funnel plot and Egger’s test (P = 0.063).
Result: A total of 13 full-text articles were found, and 7 full articles were used for the analysis. The pooled
prevalence of depression among inmates in Ethiopia was 44.45% (95%CI: 40.28, 48.61). The factors that were
associated with depression among inmates were the age (AOR = 0.70, 95%CI: 0.59–0.82), presence of chronic
diseases (AOR = 1.70, 95%CI 1.42–2.05), and history of Khat chewing (AOR = 1.57, 95%CI 1.32–1.86), smoking
(AOR = 1.52, 95%CI 1.10–2.10), suicidal attempt (AOR = 1.66, 95%CI 1.43–1.93), and not having paid job in
the prison (AOR = 0.39, 95%CI 0.20–0.74).
Conclusion: There is a high prevalence of depression among prisoners in Ethiopia. Many of the modifiable
associated factors should be a target for intervention by stakeholders involved in prison healthcare service. This
service should be strengthened, with a focus on the identification of high-risk inmates towards more effective
prevention of depression.

1. Background
Mental disorders occur at high rates in all countries of the world. An
estimated 450 million people worldwide suffer from mental or behav­
ioral disorders. These disorders are especially prevalent in prison pop­
ulations (WHO, 2019). Though prison is used to punish those inmates
who committed a crime, it is also a place where mental illnesses like
depression are the most common (Rao, Manaf, & Minhat, 2018). Psy­
chiatric disorders are known to be common among inmates than in the
general population (Piwuna et al., 2019). The World Health Organiza­
tion estimated that, of the 9 million inmates worldwide, at least 1
million (11%) suffer from significant mental disorders, and the most
common mental health problems are depression and anxiety (Nseluke &
Siziya, 2011; Shrestha et al., 2017).
Depression is characterized by sadness, loss of interest or pleasure,
feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness,
and poor concentration. Individuals with depression may also have
multiple physical complaints with no apparent physical cause. Depres­
sion can be long lasting or recurrent, substantially impairing people’s
ability to function at work or school, and cope with daily life. At its most
severe, depression can lead to suicide (WHO, 2019)
In different parts of the world, the prevalence of depression among

Abbreviations: AOR, Adjusted odds ratio; CI, confidence interval; SNNP, Southern Nations, Nationalities and Peoples; WHO, World Health Organization.
* Corresponding author.
E-mail address: retatg@gmail.com (R. Tsegaye).

https://doi.org/10.1016/j.ijans.2021.100289
Received 22 June 2020; Received in revised form 17 January 2021; Accepted 25 January 2021
Available online 2 February 2021
2214-1391/© 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
R. Tsegaye et al.
Fig 1. PRISMA flow diagram of the included studies in the systematic review and meta-analysis of depressive disorder among inmates in Ethiopia.
inmates is varied by different factors. For instance; in Cameroon Buea
central prison, the prevalence of depression was 93.2% (Florence,
Atanga, Chu, & Abungwah, 2019). On the other hand, the magnitude of
depressive disorder was 29% among Egyptian inmates (Assadi et al.,
2006) while it was 29% among Nigerian inmates in Port Harcourt prison
respectively. Being a resident of an urban area was a strong correlate of
depressive disorder (Nwaopara and Stanley, 2015). Prison settings such
as overcrowding, lack of privacy, violence, social isolation, inadequate
mental health facilities, and the effects of the prison sentence may in­
crease the risk of mental disorders among inmates during imprisonment
(Shrestha et al., 2017). Moreover, the prison environment is character­
ized by overcrowding, lack of recreational activities, and a high level of
uncertainty could increase the risk of depression (Rao et al., 2018). The
need for effective mental health care services for inmates underscores
the importance of the epidemiological study to determine the contrib­
uting factors of depression. Although depression is common among in­
mates, there is varied evidence of factors significantly associated with
depressive disorder among inmates (Rao et al., 2018).
In Ethiopia, several prisons or correctional facilities are found and
large numbers of inmates are detained as well (ICPR, 2012). Several
studies were conducted on the magnitude of depression and associated
factors in Ethiopia. Those studies reported varying magnitudes of
depression which ranges from 29.7% to 57.4% and varying determinant
factors (Abdu, Kabeta, Dube, Tessema, & Abera, 2018; Alemayehu,
Ambaw, & Gutema, 2019; Bedaso, Kediro, & Yeneabat, 2018; Beyen,
Dadi, Dachew, Muluneh, & Bisetegn, 2017; Dadi, Dachew, Tariku,
Habitu, & Demissie, 2019; Reta et al., 2020; Shibre et al., 2014). Though
limited studies exist, the question addressing what is the extent of
depressive disorder and its determinants among inmates in Ethiopia? is
studied in the country. Therefore, this systematic review and meta-
analysis was intended to draw the pooled magnitude of depressive
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International Journal of Africa Nursing Sciences 14 (2021) 100289
disorder and associated factors in Ethiopia to provide evidence for
policy-makers in designing and intervening depressive disorder among
prisoners and to forward input for further research.
2. Methods
2.1. Search strategy
In this review two reviewers (RT and BW) independently searched
electronic engine databases including Medline, Pub Med, the Web of
Science, Africa Index Medicus, EMBASE and Google Scholar. Key terms
used for the search were “depression”, “ depressive disorder”, “ psy­
chiatric disorders” combined with “prisoners“, “inmates” and
”Ethiopia“. The key terms were used individually and in combination
through “AND” and “OR” Boolean operators. MeSH words applied with
an asterisk were used to get relevant articles on the title of the study.
Addis Ababa University Digital Library was searched to find unpub­
lished papers. Articles were downloaded to Endnote (version X7.2) to
manage citation and facilitate the review process. The presence of
similar systematic reviews and meta-analysis was checked by using the
Cochrane library to avoid duplication. The search was conducted from
December 20, 2019 to January 30, 2020. We searched for articles
published between 2005 and 2019. Preferred Reporting Items of Sys­
tematic Reviews and Meta-Analysis (PRISMA) checklist guideline was
used to ensure scientific consistency in reporting searched articles
(David Moher, 2009) (Fig. 1)
2.2. Selection and eligibility criteria
2.2.1. Inclusion criteria
The review included published and unpublished articles conducted
R. Tsegaye et al. International Journal of Africa Nursing Sciences 14 (2021) 100289

Table 1
Summary of included Studies and magnitude of depressive disorder among inmates in Ethiopia, 2020.
Author Year of publication Town Region Study design Sample size Prevalence 95%CI

Dadi et al. (2019) 2019 Northwest Amhara Amhara Cross-sectional 662 42.90(39.13,46.67)
Reta et al. (2020) 2019 Debre Berhan town Amhara Cross-sectional 345 42.90(37.68,48.12)
Beyen et al. (2017) 2017 Northwest Amhara Amhara Cross-sectional 727 39.06(35.52,42.65)
Bedaso et al. (2018) 2018 Hawassa city SNNP Cross-sectional 335 56.42(51.11,61.73)
Alemayehu et al. (2019) 2019 Bahir Dar city Amhara Cross-sectional 422 43.36(38.64,48.09)
Abdu et al. (2018) 2018 Jimma town Oromia Cross-sectional 336 41.37(36.1,46.64)
Terefe (2007) 2007 Debremarkos town Amhara Cross-sectional 104 47.12(37.52,56.71)
Overall Weight from random effect analysis 44.45(40.28,48.61)

in the English language in Ethiopia with the aim of determining the
prevalence of depression among prisoners and its determinants. This
review included observational study designs mainly cross-sectional
studies. Duplicate reports and inconsistent outcome measures were
excluded. This systematic review and meta-analysis used the COCOPOP
(Condition, Context, and Population) framework to assess the eligibility
of the articles included. The study Population (POP) was prisoners, the
Condition (CO) was the prevalence of depression and its determinants,
and the context (CO) was only studies conducted in Ethiopia.
2.3. Outcome measurement
2.3.1. Study outcome
The outcome of this systematic review and meta-analysis was the
pooled prevalence and determinants of depression among prisoners.
Depression among prisoners was assessed by Patient health question­
naire (PHQ-9) which contained nine questions each measuring a prob­
lem that the prisoners bothered in the last 15 days were used to measure
depression with scale measurement ranging from zero (not at all) to
three (nearly every day) (Kroenke, Spitzer, & Williams, 2001). HQ-9 is
also found to be a reliable and valid tool in different countries, including
Ethiopia (Gelayea et al., 2013; Kohrt, Luitel1, Acharya, & Jordans, 2016;
Manea, Gilbody, & McMillan, 2012; Woldetensay et al., 2018)
The second outcome of this study was the determinants of depression
among prisoners. Data for this outcome was extracted in a format of two-
by-two tables on the Microsoft Excel spreadsheet, and then the odds
ratio for each factor was calculated. Determinant factors included in this
review were the age of prisoners (34 and fewer versus greater than 34),
Marital status (married versus unmarried), Educational status (formal
education versus No formal education), current sentence in years (five
and less years versus greater than five years), chronic illness (chronic
illness versus No chronic illness), previous history of khat chewing
(Previous chewing versus no previous chewing), cigarette smoking his­
tory (has smoking history versus has no smoking history), suicidal
attempt history (suicidal attempted versus suicidal not attempted)and
Having worked in prison (have job in prison versus have no job in
prison).
2.3.2. Quality assessment and data extraction
Initially, the citation manager (Endnote version X7.2) was used to
manage citation and to remove duplicate articles. Then, the titles and
abstracts of the studies were exhaustively screened based on the rele­
vance of the outcome. Full-texts of the remaining articles were evaluated
for eligibility based on pre-set inclusion and exclusion criteria. The
Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Re­
view Instrument (JBI-MAStARI) was used for a critical appraisal (JBI,
2017). The checklist for data extraction contains the name of authors,
publication year, region (the area where the study was conducted),

Fig. 2. (a) Forest plot of the pooled magnitude of depressive disorder among inmates in Ethiopia, 2020. (b) Sub-group analysis of studies included in the meta-
analysis on the magnitude of depressive disorder among inmates in Ethiopia, 2020.

3
R. Tsegaye et al.
Fig. 3. Funnel plot with 95% confidence limit of the pooled Prevalence of depressive disorder among inmates in Ethiopia, 2020.
study design, the setting of the study, sample size, response rate, and
participants with the outcome (Table 1). Two reviewers (RT and BW)
extracted data using a standardized data extraction checklist on a
Microsoft Excel spreadsheet. Incongruities between two independent
reviewers were resolved by a third reviewer (DM).
2.4. Statistical analysis and data synthesis
Extracted data on a Microsoft Excel spreadsheet format were im­
ported to STATA version 14 for analysis. The logarithm and standard
error of the odds ratio (OR) for each included study were generated
using the “generate” command on STATA. The pooled prevalence of
depression among prisoners and its determinants was presented in the
form of a forest plot. The presence of heterogeneity among the included
studies was checked by Cochran’s Q test (reported as the p-value) and
inverse variance index (I2). A random-effect model was computed to
estimate the pooled prevalence of depression among prisoners as a high
degree of heterogeneity was observed.
2.5. Heterogeneity and publication bias
I2-test statistics was used to check heterogeneity across studies by
determining its p-values that inverse variance test statistics values of 0,
25, 50, and 75% were considered as no, low, moderate, and high degrees
of heterogeneity, respectively (Higgins & Thompson, 2002). Due to
heterogeneity among studies, we performed a subgroup analysis based
on region. A funnel plot was used to check publication bias. Besides,
Egger’s weighted regression test and Begg’s test were also used to check
the presence of statistically significant publication bias (Colin B. Begg,
Madhuchh, & Mazumdar, 1994). A p-value of less than 0.05 was used to
declare the statistical significance of publication bias.
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International Journal of Africa Nursing Sciences 14 (2021) 100289
3. Results
A total of 89 published articles were accessed from databases. Three
unpublished articles were also accessed from google scholar and google.
From those first searched, 71 were removed due to duplication, and the
remaining 21 articles were screened for eligibility. Accordingly, eight of
them were excluded by their title and abstract. Then, 13 studies were
screened for eligibility criteria based on the outcome variables related to
the magnitude of depressive disorders among prisoners of which six
articles were excluded because of non-relevance to the current review.
Finally, 7 articles fulfilled all the eligibility criteria and were included in
this analysis (Table 1).
From the included seven articles, a study conducted in Northwest
Amhara had the largest sample size while a study conducted in Debre
Markos, the Amhara region had the smallest sample size. There is high
heterogeneity in this study (I2 = 92.3%, P = 0.00), and due to this
random effect model was used to find the pooled depression among
inmates in Ethiopia. Accordingly, the pooled meta-regression indicated
that the depression among inmates in Ethiopia is 44.45(95%CI:
40.28,48.61) (Fig. 2)
We have performed the subgroup analysis based on the region where
studies were conducted. The subgroup analysis showed that the
magnitude of depressive disorder among inmates in the Amhara region
was 41.98% (95%CI: 39.83–44.13) while in SNNP and Oromia region it
was 56.42% (95%CI: 51.11–61.73) and 41.37% (95%CI: 36.10–46.64)
respectively (Fig. 2b). To assess the presence of publication bias, funnel
plot, and Egger test at 5% significant level were computed. The funnel
plot shows a shape of symmetry, and the Egger test also showed there is
no statistically significant publication bias with P = 0.303 (Fig. 3).
To identify single study influence on the overall meta-analysis, a
sensitivity analysis was performed using a random effects model and the
result showed that there was no strong evidence for the effect of single
study influence on the overall meta-analysis (Fig. 4)
R. Tsegaye et al.
Fig. 4. Sensitivity analysis for single study influence of the magnitude of depressive disorder among inmates in Ethiopia, 2020.
3.1. Factors associated with depression among inmates in Ethiopia
3.1.1. Association between age and depression among inmates
To identify the association between age and depression among in­
mates, two studies were included in this meta-analysis in which both of
them had a significant association between the occurrence of depression
and their age (Alemayehu et al., 2019; Reta et al., 2020). From this meta-
regression, the pooled analysis indicated that inmates whose age less
than or equal to thirty-four years were less likely to develop depression
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International Journal of Africa Nursing Sciences 14 (2021) 100289
compared to their counterparts (OR = 0.70, 95%, CI: 0.59–0.82). Fixed
effect model was used for this analysis because, the included studies
were not exhibited heterogeneity (I2 = 0.00%, p = 0.390) (Fig. 5).
3.1.2. Association between depression among inmates and chronic diseases
To identify the association between having chronic diseases and
depression among inmates, three articles were included in this meta-
analysis in which all of them were indicated a significant association
between having chronic diseases and depression (Abdu et al., 2018;
R. Tsegaye et al. International Journal of Africa Nursing Sciences 14 (2021) 100289

Fig. 5. Forest plot of the association between depressive disorder among inmates and their age in Ethiopia, 2020.

Fig. 6. Forest plot of the association between depressive disorder among inmates and chronic diseases in Ethiopia, 2020.

Bedaso et al., 2018; Reta et al., 2020). The pooled analysis indicated that fixed-effect model was used (I2 = 0.53.3%, p = 0.117) (Fig. 6)
those inmates who have chronic diseases were 1.70 times more likely to
develop depression compared to those who don’t have (OR = 1.70, 95%
CI 1.42, 2.05). Since there is no heterogeneity in the included studies, a

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R. Tsegaye et al. International Journal of Africa Nursing Sciences 14 (2021) 100289

Fig. 7. Forest plot of the association between depressive disorder among inmates and history of khat chewing in Ethiopia, 2020.

Fig. 8. Forest plot of the association between depressive disorder among inmates and history of smoking in Ethiopia, 2020.

7
R. Tsegaye et al.
Fig. 9. Forest plot of the association between depressive disorder among inmates and history of sucidal attempt in Ethiopia, 2020.
3.1.3. Association between depression among inmates and history of khat
chewing
To identify the association between inmates’ depression and the
history of khat chewing; two articles were included in this meta-analysis
in which both were found to have a significant association with
depression among inmates (Abdu et al., 2018; Bedaso et al., 2018). The
pooled effect from this meta-analysis also indicated that there was a
positive and significant association between the occurrence of depres­
sion among inmates and having a history of khat chewing. Those in­
mates who were having a history of khat chewing have a chance of
developing depression 1.57 times higher compared to their counterparts
(OR = 1.57, 95% CI 1.32, 1.86). Since there is no heterogeneity in the
included studies, a fixed-effect model was used (I2 = 36.2%, p = 0.210)
(Fig. 7)
3.1.4. Association between depression among inmates and a history of
smoking
Again to identify the association between the occurrence of depres­
sion among inmates and the history of smoking; two articles were
included in this meta-analysis in which both of them were indicated
significant association (Abdu et al., 2018; Bedaso et al., 2018). The
pooled finding from this meta-analysis also shown that there is a positive
significant association between the occurrence of depression among
inmates and having a history of smoking. Inmates who were having a
history of smoking were 52% higher chance of developing depression
than those who had no history of smoking (OR = 1.52, 95% CI 1.10,
2.10). Since there is heterogeneity in the included studies, a random-
effect model was used (I2 = 72.1%, p = 0.058) (Fig. 8)
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International Journal of Africa Nursing Sciences 14 (2021) 100289
3.1.5. Association between depression among inmates and history of
suicidal attempt
To identify the association between the occurrence of depression
among inmates and the history of suicidal attempt; two articles were
included in this meta-analysis in which both of them have shown a
significant association between the occurrence of depression among
inmates and history of suicidal attempt (Beyen et al., 2017; Reta et al.,
2020). The pooled meta analysis also showed that there is a positive
significant association between the occurrence of depression among
inmates and having a history of suicidal attempts. Inmates who were
having a history of suicidal attempts in their life have 1.66 times higher
chance of developing depression than those who were not having a
history of suicidal attempt (OR = 1.66, 95% CI 1.43, 1.93). Since there is
no heterogeneity in the included studies, a fixed-effect model was used
(I2 = 0.000%, p = 0.536) (Fig. 9)
3.1.6. Association between depression among inmates and having worked
in a prison
In this meta-regression; two articles were included to show whether
there is an association between having worked in the jail and the
occurrence of depression among inmates both articles showed negative
significant finding between the occurrence of depression and having
paid job in prison (Abdu et al., 2018; Bedaso et al., 2018). The pooled
meta-analysis similarly indicated that inmates who have paid job in jail
have 61% lesser chance of developing depression than those who have
no job (OR = 0.39, 95% CI 0.20, 0.74). Since there is heterogeneity in
the included studies, a random-effect model was used (I2 = 61.5%, p =
0.107) (Fig. 10)
On the other hand, marital status, educational status and current
R. Tsegaye et al.
Fig. 10. Forest plot of the association between depressive disorder among inmates and having work in jail in Ethiopia, 2020.
sentence in year were not associated with the occurrence of depressive
disorder among inmates in this meta-analysis.
4. Discussion
This review and meta-analysis was the first of its kind targeting in­
mates with depressive disorder in Ethiopia. There is a relatively small
number of available and eligible studies for review, especially when
compared to several potentially eligible studies in Western/more
developed countries. Those available are inconsistent in magnitude and
determinant factors. Thus, this systematic review and meta-analysis was
mainly intended to find out the pooled magnitude of depression and
associated factors among inmates in Ethiopia.
In the present systematic review and meta-analysis, the pooled
magnitude of depression among inmates in Ethiopia was 42.59%. This is
nearly similar to a study conducted among Norwegian inmates (46.1%),
and Nepalese prisoners (35.3%) (Shrestha et al., 2017; Værøy, 2011).
However, this finding is lower than the magnitude of depression among
older adult prisoners in Nigeria (59%) (Piwuna et al., 2019) and inmates
in Cameroon (93.2%) (Florence et al., 2019) but higher than the prev­
alence of depression among inmates in Iran (29%) (Assadi et al., 2006).
This difference could be attributed to the difference in the socioeco­
nomic status of countries, differences in prisoner handling, and variation
in scales of measurement of depression between these studies. Besides
this, in the current study, the magnitude of depressive disorder is higher
among studies having a larger sample size. Generally, the magnitude of
depressive disorder in the current meta-analysis was relatively high
which denotes prison health needs due focus on Ethiopia.
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International Journal of Africa Nursing Sciences 14 (2021) 100289
This analysis had also identified the associated factors for depressive
disorders among inmates. Age was one of the significant predictors for
depressive disorder. Inmates whose age less than or equal to thirty-four
years were 30% less likely to develop depression than their counterparts
(OR = 0.70, 95%, CI: 0.59–0.82). This finding is consistent with a lon­
gitudinal cohort study in the Netherlands, in which older age was
significantly associated with a worse 2-year major depressive disorder
(Schaakxs, Comjis, kok, & Penninx, 2018). This may be attributed to
older ages are prone to chronic diseases which perhaps lead to ultimate
despair and depression (Majekodunmi, Obadeji, Oluwole, & Oyelami,
2017). This finding is different from a study conducted in Port Harcourt
Prison and another study done on older adults. Both studies had found
out that depression was less prevalent among older adults than among
younger adults but can have serious consequences (Fiske, Wetherell, &
Gatz, 2009; Nwaopara and Stanley, 2015). The possible difference could
be due to the nature of studies as this study is a systematic review while
those studies were cross-sectional studies.
Having chronic disease during imprisonment was found to be a sig­
nificant predictor of depression among inmates in Ethiopia. Inmates
who have chronic diseases were 1.70 times more likely to develop
depression compared to those who do not have (OR = 1.70, 95% CI 1.42,
2.05). Two study findings in Nigeria similarly found that known chronic
medical condition(s) was a risk factor in developing depression among
inmates (Majekodunmi et al., 2017; Piwuna et al., 2019). This could be
because patients having chronic diseases have an additional burden of
stress due to their health condition that may affect a person’s mobility,
change the way a person lives. These changes can be stressful and cause
a certain amount of despair which may lead to the development of
R. Tsegaye et al.
depression among inmates (Simon, 2001). This implies that inmates
with known chronic illnesses should be emphasized by providing regular
follow-up at the prison center to minimize the development of
depression.
According to this systematic review and meta-analysis, inmates who
have a history of khat chewing and cigarette smoking were more prone
to the development of depression. Those inmates who were having a
history of khat chewing have a chance of developing depression 1.57
times higher than their counterparts (OR = 1.57, 95% CI 1.32, 1.86)
whereas inmates who were having a history of smoking were 52%
higher chance of developing depression than those who had no history
of smoking (OR = 1.52, 95% CI 1.10, 2.10). This finding is consistent
with a study conducted among Norwegian inmates in which almost 70%
of all inmates had a history of drug abuse including chewing khat
(Værøy, 2011). The reason for the development of depression among
smokers and khat chewers could be due to the withdrawal effects of
these substances. This implies that inmates who had a history of sub­
stance use should be treated differently. On the other hand, no associ­
ation was found between the level of depression and substance use
characteristics according to a study on depression among female in­
mates in Kathmandu, Nepal (Regmi, Shrestha, Gaihre, & Thagunna,
2019). This difference might be due to a single area study that included
only female inmates compared to the current meta-analysis.
Not having a paid job while in prison was also a significant factor in
the occurrence of depression among inmates. Inmates who have paid
work in jail have a 61% lesser chance of developing depression than
those who have no work (OR = 0.39, 95% CI 0.20, 0.74). A similar
finding was being reported in an Egyptian national study which revealed
a prevalence of depression was lower among prisoners who worked in
income-generating activities (El-Gilany, Khater, Gomaa, Hussein, &
Hamdy, 2016). This may be because having a paid job within a prison
may be considered as a source of income which in turn relief them from
stress and depression. This denotes that creating a job opportunity for
prisoners at the detention center especially after providing vocational
training would increase the efficiency and productivity of inmates and
assures a career after release which in turn reduces the occurrence of
depression
Having a history of suicidal attempts was also identified as a pre­
dictor of depressive disorder among inmates. In this meta-analysis, in­
mates who were having a history of suicidal attempts in their life have a
1.66 times higher chance of developing depression than those who were
not having a history of suicidal attempts (OR = 1.66, 95% CI 1.43, 1.93).
This finding is similar to finding in Nepal and the U.S.A (Baillargeon
et al., 2009; Shrestha et al., 2017) in which suicidal attempts or ideation
were predictors of depression among prisoners.
4.1. Strength and limitation of the study
The strength of the study was using various databases to search for
published articles. Moreover, this study used a PRISMA checklist and
JBI-MASTARI for data extraction and appraisal that increases the quality
of the study. But, since only studies published in English were included
in the study, studies reported in other languages might be overlooked.
Causality cannot be asserted since most studies were cross-sectional
studies
5. Conclusion
In the current review and meta-analysis, the magnitude of depressive
disorder among inmates in Ethiopia was generally high. Health policy­
makers should consider interventions that target modifiable factors such
as chronic diseases, substance use, and not having paid jobs within the
prison. Prison health should also be strengthened by stakeholders hav­
ing a due focus on those inmates who are prone to the problem.
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International Journal of Africa Nursing Sciences 14 (2021) 100289
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
Acknowledgments
We would like to acknowledge Wollega University for its support to
conduct this study.
Funding
No funding was received to conduct this study.
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