Measuring Depression, and Its Association with Substance Use, during an Adherence Study of Patients Treated for Tuberculosis in Haitian Prisons

Purpose Diagnosed depression is prevalent in prisons of affluent countries; literature on depression screening in prisons of low-resource nations is sparse. Haiti has experienced multiple recent disasters, which could have both somatic and mental health consequences. To surveil its prisons for depression, ethnoculturally appropriate scales could be helpful. Design/methodology/approach We performed a cross-sectional analysis of symptoms of depression and its associations among participants in a 2019-2020 tuberculosis treatment adherence project across 6 Haitian prisons. To measure depression, we piloted the use of the Zanmi-Lasante Depression Symptom Inventory (ZLDSI) scale in a carceral setting. We calculated its Cronbach alpha in this setting and generated binary logistic models to study the associations of depression with basic demographic variables; use of cigarettes, marijuana, and alcohol; and incarceration history. We then performed a multivariate logistic regression to determine if substance use and education predicted depression, after adjusting for age. Findings Fifty subjects were recruited; age ranged from 18 to 59 years. Adherence to TB medication was recorded as above 99% in all subjects. The Cronbach alpha score for the ZLDSI scale in this population was 0.77, signifying the good fit of the scale for this population. A ZLDSI score ≥13.0 has been associated with depression; 66% of participants had scores of 13.0 or greater, mean 13.9 (S.D. 8.2). Multivariate analysis showed significant associations between depression, alcohol consumption, age, and income. Originality/Conclusion We believe this study represents the first measurement of depressive symptoms in a Haitian prison population; it found symptoms common. ### Competing Interest Statement Anne Spaulding has received subcontracts and grants through her institution from Health through Walls/TB Reach, Gilead Sciences, and the Bill and Melinda Gates Foundation. She has received support for travel from the Infectious Disease Society of America. ### Funding Statement This work was funded under a subcontract from Health through Walls, to Emory University. Health through Walls was funded for this work by TB Reach. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of Emory University, Atlanta GA, gave ethical approval for this work. The National Bioethics Committee of the Ministry of Health, Republic of Haiti gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript. * DOT : direct observed therapy TB : tuberculosis VDOT : video direct observed therapy ZLDSI : Zanmi-Lasante Depression Symptom Inventory