1.1 Statement of the problem
The prison population is more than 10.35 million worldwide. Since the year 2000 the number of prisoners has grown by 20%. According to world prison population list report 2015, In Ethiopia about 111,050 peoples are in prison,(1).Since the prison population growing rapidly worldwide the health and behavior of prisoners have become urgent social concerns,(2). Number of prisoners in Africa is increasing from time to time due to many reasons,(3). Among the common health and behavioral problems facing by prisoners mental illness is the most common. Study shows that 29% of prisoners had current mental illness,(4). About 4 in 10 prisoners with mental condition are unemployed and 44% are recidivist.(5)
Personality disorder define as an enduring pattern of behavior and inner experiences that deviates significantly from the individual’s cultural standards. The vital feature of antisocial personality disorder is a persistent pattern of disrespect for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. For this diagnosis to be given, the individual must be at least age 18 years. Individuals with anti-social personality disorder fail to conform to social norms. They may frequently perform acts that are grounds for arrest, such as destroying property, harassing others, stealing, or charging illegal occupations,(6)
Antisocial personality disorder (ASPD) is the most reliably diagnosed and most prevalent among all personality disorders ,(7). The highest prevalence of antisocial personality disorder is found among men with alcohol use disorder and in prison populations, (8). Antisocial personality has been linked to a variety of executive functioning deficits, including poor cognitive control, (9). Despite criminality and ASPDs are not the same there is high prevalence of ASPD in prisoners(10)
ASPD in prison population has high comorbidity with other mental disorders. prisoners with personality disorder were charged with violent crimes such as murder, assault, armed robbery and kidnapping, non- violent crimes like fraud, theft, and housebreaking, sex crimes e.g. rape and indecent assault and drug related offences e.g. possession of or dealing in illegal substances as a result they repeatedly imprisoned,(3). It is common that up to 50% of the trial subjects diagnosed with ASPD, and many participants report behavior or symptoms associated with the ASPD,(7). Personality disorders are common and it takes decades to be expressed , they presents 10 to 20 % in the general population,(8).
Among peoples with ASPD there is 21.7 % of recidivism rate. This makes nonproductive due to spending of their time in prison,(3). According a study conducted in the United States ofAmerica (USA) on mental health of prisoners 55 % of the prisoners didn’t have mental health service.Individuals with ASPD high tendency to abuse substance, being offenders, disturb their family and the community and have high rate of have treatment dropout,(11,12).
A meta-analysis study reports that fourteen studies showed there is high risk violent behavior among individuals with personality disorder there was increased violent out comes in studies with personality disorder.The Couse of ASPD remains unclear but same study shows the risk of developing ASPD increases hereditary and being male,(13).
Antisocial personality disorder associated with a substantial impairment of the individual. Moreover, the problem is not limited to the individual it has negative impact on the people surrounding them, such as spouse,childeren and at large the community,(14).
1.2 Literature review
1.2.1 Magnitude of antisocial personality disorder
Epidemiological survey rates the prevalence 2 to 3% in community sample it increased to 60% in male prisoners. it has an association with multiple problems , social and medical such as substance abuse, crime and deliberate self-harm,(15). A research from Germany conducted only on female inmates by using PCL-R and with the cut point of score of 25 the prevalence rate of psychopathy was 17%,(16).
Another research from USA on a sample of 288 men and 183 women by using structured interview for personality disorder (SIPD-IV) mentioned that from cluster B personality disorders among prison population the most prevalent one was ASPD with the prevalence of 57% among men and 36% women prisoners,(17).
Another sectional study conducted in UK on pre-sentence prison population with a total sample size of 283 by using IPDE-SQ the prevalence of ASPD was 25.8%,(18).
A cohort research conducted on randomly selected 191 prisoners who are consecutively admitted to prison in Netherlands reported that the incidence rate of ASPD was 37%,(19).
Antisocial personality disorder (ASPD) is highly prevalent in prison populations and likely to be present in 63% of sentenced male prisoners and 31% of female offenders, (20). A cross sectional study conducted in Italy shows that among the common mental disorders which are highly prevalent among prisoners antisocial personality disorder was the first with the prevalence of 20%,(21).
A literature review from Australia reveals that in community sample there is a real difference between male and female sex by using various assessment instruments and diagnostic manuals, that there is a difference in prevalence between male and female it reports 27.2% were males and 7.5% were females. Two to five-fold rats of ASPD is found in men but the difference becomes less in prison sample, (22). a Swedish study conducted on forensic psychiatric patient samples 441 men and 123 women using the PCL-R 31% of men and 11% of women had ASPD,(23) .
A survey study on a sample on 496 sample in England and Wales using the schedules for clinical interview in neuropsychiatry, psychopathy checklist-revised and structured clinical interview for diagnostic statistical manual of mental disorder, fourth edition axis 2 personality disorders. Among 470, 211 (44.9%) diagnosed with ASPD out of them only 67 (31%) diagnosed with psychopathy score 25 and above of the psychopathy checklist-revised. Even though there is no separate diagnosis between psychopathy and ASPD psychopathy is sever form of ASPD with a greater risk of violence,(24). a study conducted in us the reports that there is association between ASPD and chronic cigarettes using, alcohol and marijuana,(25). a cross sectional study from a random sample of 495 prisoners sentenced inmates completed an interview the diagnostic schedule 56% of them were with ASPD,(26). Other study done in UK indicated that the prevalence of ASPD was62 % which was a cross sectional study by using PCL-R among 53 prisoners,(27).
A systemic review conducted in UK on 62 surveys from 12 countries which included 22790 prisoners the prevalence of ASPD was 47%, (28).
A study done by using PCL-R among Dutch prisoners indicate that ASPD was 34%and some of them were diminished responsibility especially those who have comorbid other mental disorders(19). A meta-analysis study from Canada revealed that the prevalence of ASPD was 50% in male offenders and treatment reduce recidivism.(29).
A cross sectional study from Spain among individuals who are prisoners and started chronic hepatitis C treatment in 25 Spanish prisons by using personality diagnostic questioner-4 the prevalence of cluster B personality disorder was 55.4%,(30). A research conducted on sample of 495 male prisoners in Greece by using cross sectional method and personality disorder questionnaire 4 personality disorders was 15.98%,(31).
An institutional based cross sectional study among prisoner in Egypt a randomly selected sample of 1350 prevalence of personality disorder was13.6% among them ASPD was the most common,(32). A cross sectional research done in south Africa on 193 sample of prisoners by using mini neuro- psychiatric interview tool the prevalence of ASPD was 46.1%,(3).
A study done in Nigeria on 300 participants by using Antisocial personality Disorder self- test the prevalence of ASPD was 47 %in male and 21% females prisoners,(33).
Cross sectional study from Zambia with a sample size of 206 inmates by using self-reported questionnaire (SRQ 20 ) 63.1% had current mental disorder including personality disorders,(34).
1.2.2 Determinants of anti-social personality disorders among prisoners
Socio demographic factors DSM 5 indicated that ASPD is more frequently diagnosed in males than females,(6). A study from Atlanta in USA there is a difference in the prevalence of ASPD in male and female inmates. The research was done using PCL-R with a cut -off score of 29 and 15% of women and 30% of male inmates were psychopathic,(35) .
An epidemiological catchment area study shows that socio demographic factors like being male, younger age and poorly educated have higher prevalence rat of ASPD. Being male have a prevalence of as high as 6-8 times more ASPD than female sex, and being young age (25-44) for both sex has high prevalence of ASPD than the older age individuals. The odds of ASPD was high for those who leaves school at the age of 11 ,it was 5 times higher than from those who remain at school,(15).
Substance related factors; A research from south Dakota of USA reported that there is association between alcohol use and prevalence of ASPD,(36), Another study from the US indicates that most people from the community sample with ASPD are chronic cigarette smokers, alcohol and marijuana users,(25).
The study conducted in Egypt among prisoners mentioned that the prevalence of ASPD in substance users was three times higher than non-users and the prevalence of ASPD is two times more common in those who have repeated admission to prison, (32).
Clinical factors having other psychiatric disorder has 2.5 times increasing the prevalence of ASPD among prisoners than those without mental disorders,(32).