The rates of mental illness are significantly higher in prison populations compared to the general community; however, little research has examined the rates of mental illness for cross‐cultural groups of prisoners in Australia. This omission is concerning given the increasingly diverse nature of the Australian prison population. To address this gap in knowledge, the present study aimed to identify rates of key mental health factors and associated psychological processes in a cohort of 191 men from culturally and linguistically diverse, Indigenous Australian and English‐speaking backgrounds who were incarcerated at a maximum‐security prison in Victoria, Australia. We also explored differences in both psychological distress levels and predictors of psychological distress. Although no significant mental health differences were identified cross‐culturally, the results revealed that several mental health factors predicted psychological distress for all prisoners, F(
Australia is among the most culturally diverse nations in the world: Nearly half of the population was either born overseas or has a parent who was born elsewhere (Australian Bureau of Statistics [ABS], 2016). This diversity is reflected in the Australian prison population, in which there is a growing number of culturally and linguistically diverse (CALD) inmates (Shepherd, 2016). The term CALD refers to heterogeneous groups of people who have various migration experiences and may differ across language, ethnic, religious, and socioeconomic factors (Queensland Government, 2010). The ABS (2014) defines the CALD population mainly by country of birth, language spoken at home, English proficiency or other characteristics (e.g., year of arrival in Australia), parents' country of birth, and religious affiliation. The exact number of CALD prisoners incarcerated in Australian prisons remains unknown due to deficiencies in the ways police and corrections agencies collect data on this group (Bartels, 2011). Nonetheless, at least 20% of the Australian prison population can be categorized as being from a CALD background, with those from Vietnamese, Chinese, Lebanese, Sudanese, Iraqi, Malaysian, and Samoan backgrounds disproportionately represented (ABS, 2017a). Indigenous Australians (i.e., Aboriginal and Torres Strait Islanders) are the most overrepresented cultural group in the Australian criminal justice system (ABS, 2017b). This group represents 28% of the total prison population of Australia yet comprises less than 3% of the general Australian population (ABS, 2017b).
It is well established in the literature that prison populations have significantly higher rates of mental health issues compared to general populations (Fazel & Danesh, 2002; Fazel & Seewald, 2012). Depression, anxiety, and posttraumatic stress disorder (PTSD) are prevalent in the Australian prison population (Butler, Allnutt, Cain, Owens, & Muller, 2005; Butler, Indig, Allnutt, & Mamoon, 2011; Egeressy, Butler, & Hunter, 2009; Fleming, Gately, & Kramer, 2012), as are high levels of psychological distress (Australian Institute of Health and Welfare [AIHW], 2019). Psychological distress is emotional suffering and discomfort that manifests in response to stressful experiences (Arvidsdotter, Marklund, Kylén, Taft, & Ekman, 2016). Increased levels of mental illness have been found to be positively associated with higher levels of psychological distress in prison populations (Baidawi, Trotter, & O'Connor, 2016; Indig, Gear, & Wilhelm, 2016), but no researchers have examined the association between mental illness and psychological distress cross‐culturally in the Australian prison population.
Engagement in psychological processes, such as coping and cognitive fusion, may also impact how prisoners manage the challenging and often stressful nature of prison. Coping processes are cognitive and behavioral techniques used to deal with stressors in the environment (Compas, Connor‐Smith, Saltzman, Thomsen, & Wadsworth, 2001). Previous research indicates that coping strategies may be either helpful or harmful in managing the stress accompanying imprisonment (Ireland, Brown, & Ballarini, 2006; Shulman & Cauffman, 2011; Van Harreveld, Van der Pligt, Claassen, & Van Dijk, 2007). Coping strategies found to reduce the intensity of mental health concerns and psychological distress for inmates include a focus on the positive aspects of prison, acceptance of being in prison, and speaking with others about issues in prison (Shulman & Cauffman, 2011; Van Harreveld et al., 2007). In contrast, avoidance‐focused coping and cognitive processes, such as cognitive fusion, which is a cognitive process by which individuals become intertwined with their own thoughts and perceive them to be unconditionally true (Gillanders et al., 2014), are processes associated with increased levels of psychological distress (Gillanders, Sinclair, MacLean, & Scott, 2015; Krafft, Haeger, & Levin, 2018). Furthermore, past research has identified an interaction effect between experiential avoidance and cognitive fusion in community samples, suggesting that individuals who engage in high levels of these psychological processes are prone to developing symptoms of mental illness (Bardeen & Fergus, 2016). At present, no research of which we are aware has investigated the effect of coping strategies and cognitive fusion on psychological distress levels in Australian cross‐cultural prison populations.
Research examining the rates of mental illness symptoms and psychological distress across cross‐cultural prison populations in Australia is also limited. This is despite CALD and Indigenous Australian prisoners possessing unique backgrounds and cultural factors that can increase their vulnerability to developing mental health issues. A number of CALD groups are subjected to traumatic and distressing situations before migrating and during settlement in Australia (Shepherd, 2016). Additionally, CALD groups born in Australia can be adversely impacted by acculturation, discrimination, and language and socioeconomic challenges (Shepherd, 2016). These pre‐ and postmigration factors may intensify the risk of CALD groups developing a range of mental health issues (Nickerson, Bryant, Steel, Silove, & Brooks, 2010; Schweitzer, Brough, Vromans, & Asic‐Kobe, 2011; Schweitzer, Melville, Steel, & Lacherez, 2006).
For Indigenous Australians, mental health is often conceptualized as a component of a more holistic sense of social and emotional well‐being, encompassing factors that contribute to the well‐being of an individual and their community with a co‐occurring spiritual dimension (Dudgeon, Walker, Scrine, Shepherd, Calma, & Ring, 2014; Victorian Government, 2017). Compared to non‐Indigenous Australian populations, Indigenous Australians experience a range of factors associated with increased rates of mental health issues, including socioeconomic disadvantage, exposure to trauma, marginalization, and racism (Dudgeon et al., 2014; Victorian Government, 2012). Approximately 30% of Indigenous Australian adults experience high rates of psychological distress, which is nearly three times higher than rates reported in the non‐Indigenous Australian population (ABS, 2013). Indigenous Australians also have higher rates of depression and anxiety disorders (34.8%) compared to non–Indigenous Australians (19.6%; Victorian Government, 2012). In the prison environment, high numbers of Indigenous Australian inmates also suffer from mental illness and elevated levels of psychological distress (Heffernan, Andersen, & Kinner, 2009). For instance, 68% of male and 76% of female Indigenous Australian prisoners report being diagnosed with a mental illness during their lifetime (Ogloff, Pfeifer, Shepherd, & Ciorciari, 2017). Most research of prisoners in Australia, however, has not compared the mental health of Indigenous Australian and non–Indigenous Australian prisoners (Heffernan et al., 2009). Further research with Indigenous Australian custodial populations is warranted given the overrepresentation of this group in prison and their exposure to significant mental health issues.
To our knowledge, only two Australian studies have explicitly compared the rates of mental health concerns across CALD, Indigenous Australian, and English‐speaking–background (ESB; i.e., those predominately from Anglo‐Australian heritage) prisoners. Kenny and Lennings (2007) found no significant differences in psychological distress levels between CALD, Indigenous Australian, and ESB young people in custody. Rose and colleagues (2019) reported that whereas 63% of prisoners reported high levels of psychological distress, Indigenous Australian prisoners reported significantly higher psychological distress levels than both CALD and ESB prisoners and significantly higher depressive and anxiety‐related symptoms than CALD prisoners.
Limited and inconsistent previous literature means that key mental health factors, such as mental illness symptoms, psychological distress, and coping, have not been adequately examined for cross‐cultural groups of Australian prisoners. Furthermore, although previous studies have found links between mental illness symptoms, psychological distress, and psychological processes such as coping and cognitive fusion, it is unclear whether factors predicting psychological distress differ for cross‐cultural groups of prisoners. To address this gap in the literature, the aims of the present study were to (a) assess levels of psychological distress, mental illness symptoms, and psychological processes in CALD, Indigenous Australian, and ESB prisoner groups and (b) identify which factors predict psychological distress for CALD, Indigenous Australian, and ESB prisoner groups and whether these identified factors differ cross‐culturally.
A total of 194 participants were recruited from Port Phillip Prison (PPP); this represents approximately 20% of this facility's total prison population. Port Phillip Prison is a maximum‐security prison that houses remand and sentenced male inmates in Victoria, Australia.
Victoria is a state in southeastern Australia with a population of 6.5 million people. The study was advertised on message boards in prisoners' units and across the prison. Participants were excluded from the study if they were identified as having a traumatic or acquired brain injury, intellectual disability, or an acute mental health condition, as the focus of this study was on the mainstream prison population (i.e., the group representing the largest proportion of individuals in custody). Participants provided informed written consent prior to taking part in the study, in accordance with approved ethical requirements. Of the 194 participants recruited, three participants were excluded due to providing largely incomplete surveys. The final sample of 191 comprised CALD (n = 57, 29.8%), Indigenous Australian (n = 49, 25.7%), and ESB (n = 85, 44.5%) individuals in custody. The research team oversampled CALD and Indigenous Australian participants to ensure that sufficiently sized subgroup samples were collected.
Ethical approval was sought by the Justice Human Research Ethics Committee and the Swinburne University Human Research Ethics Committee (CF/16/23380). All procedures were conducted in line with this ethical clearance. The data collection for this study was part of a larger controlled trial examining the feasibility and outcomes of a coping enhancement and well‐being program (CopE‐Well). As such, only participants who were able to speak English were recruited for the study. The present study used a cross‐sectional design, with all demographic information and clinical measures completed prior to participation in the program or placement on the waitlist. Before they began the survey, participants were provided with an explanatory statement outlining the voluntary and confidential nature of the study. Following the provision of written informed consent, participants completed the self‐report surveys in small groups in their units or the programs building. The surveys took approximately 50 min to complete.
Demographic items related to cultural background, country of birth, and languages spoken at home were included in the survey. Responses to these items were used to allocate participants to cultural subgroups for the purposes of analysis. Age and legal status in prison (i.e., remand or sentenced) were also obtained.
The Kessler Psychological Distress Scale (K‐10; Kessler et al., 2002) was used to assess general psychological distress over the past 4 weeks (Kessler et al., 2002). The K‐10 comprises 10 items related to symptoms commonly associated with psychological distress, which are measured on a 5‐point Likert scale ranging from 1 (none of the time) to 5 (all of the time). Scores are aggregated to create a total score that ranges from 0 to 50. Total scores between 22 and 29 indicate high levels of psychological distress, and scores between 30 and 50 indicate very high levels of psychological distress (ABS, 2017c). Previous research has supported the psychometric properties of the K‐10 in measuring psychological distress (Furukawa, Kessler, Slade, & Andrews, 2003; Kessler et al., 2002). In the present sample, Cronbach's alpha for the total scale was.95.
The General Health Questionnaire‐28 (GHQ‐28; Goldberg, 1978) was used to assess recent symptoms of mental illness (Goldberg, 1978). The GHQ‐28 includes 28 items across four subscales: Somatic, Anxiety/Insomnia, Social Dysfunction, and Severe Depression symptoms. We used the two most common scoring methods for the GHQ‐28 (Sterling, 2011). For the multiple one‐way analyses of variance (ANOVAs), items were rated on a 4‐point Likert scale that included the options: 0 (not at all), 0 (no more than usual), 1 (rather more than usual) and 1 (much more than usual). There is no threshold for subscale scores on the GHQ‐28, but total scores above 4 suggest the likely presence of elevated mental illness symptoms (Sterling, 2011). For the multiple regression analysis in the study, items were scored from 0 (not at all) to 3 (much more than usual) to meet the necessary assumptions. Only the Anxiety/Insomnia and Depression subscales were used in the multiple regression analysis. For the ANOVA analysis, the Anxiety/insomnia and Depression subscales were assessed, as well as the overall GHQ‐28 score (containing all four subscales). Previous research has supported the psychometric properties of the GHQ‐28 as a screening tool for mental illness symptoms (Failde, Ramos, & Fernandez‐Palacin, 2000). In the present sample, Cronbach's alpha was.96 for the total scale.
The PTSD Checklist–Civilian Version (PCL‐C; Blanchard, Jones‐Alexander, Buckley, & Forneris, 1996) was used to assess past‐month PTSD symptoms. The PCL‐C comprises 17 items that assess symptoms associated with PTSD. These are measured on a 5‐point Likert scale that ranges from 1 (not at all) to 5 (extremely). Scores are aggregated to create a total score (range: 17–85), with higher scores reflecting elevated PTSD symptom levels. There is no cutoff score for the PCL‐C, but scores above 35 suggest problematic levels of PTSD symptoms (U.S. Department of Veteran Affairs, 2012). Previous research has supported the psychometric properties of the PCL‐C in measuring PTSD symptoms (Blanchard et al., 1996; Conybeare, Behar, Solomon, Newman, & Borkovec, 2012). In the present sample, Cronbach's alpha was.73.
The Brief Cope Inventory (Brief COPE; Carver, 1997) was used to assess past‐month coping strategies (Carver, 1997). The Brief COPE includes 28 items that assess 14 different coping processes. These items are measured on a 4‐point Likert scale that ranges from 1 (I haven't been doing this at all) to 4 (I've been doing this a lot). Previous research has supported the psychometric properties of the Brief COPE in measuring coping in diverse populations (Carver, 1997; Monzani et al., 2015). For the present study, the measure's 14 subscales were divided into four factors: Seeking Social Support, Problem Solving, Avoidance, and Positive Thinking in the study (Baumstarck et al., 2017). In the present sample, Cronbach's alpha ranged from.79–.81 for each of the four factors.
The Cognitive Fusion Questionnaire (CFQ; Gillanders et al., 2014) was used to assess levels of cognitive fusion (Gillanders et al., 2014). The CFQ comprises seven items related to patterns of thinking commonly associated with cognitive fusion. These items are measured on a 7‐point Likert scale that ranges from 1 (never true) to 7 (always true). Scores are aggregated to create a total score (range: 7–49). There is no cutoff score for the CFQ, but higher scores reflect higher levels of cognitive fusion. Previous research has supported the psychometric properties of the CFQ as a measure of cognitive fusion (Costa, Marôco, & Pinto‐Gouveia, 2017; Gillanders et al., 2014). In the present sample, Cronbach's alpha was.96.
Analyses were conducted using SPSS (Version 22) and AMOS. Data screening revealed that 71 participants (37.2%) did not answer all survey items, resulting in the culmination of missing data. To retain the 71 cases, this missing data were managed using the expectation‐maximization (EM) algorithm, in line with recommendations from Dong and Peng (2013). The EM algorithm finds the maximum‐likelihood approximations for model parameters (when data points are missing) using the complete data log‐likelihood function (Dong & Peng, 2013). Multiple one‐way ANOVAs were used to assess differences between CALD, Indigenous Australian, and ESB prisoners on the K‐10, PCL‐C, GHQ‐28, Brief COPE, and CFQ. The assumptions necessary to run one‐way ANOVAs were met (Field, 2013). The one‐way ANOVA analyses required a minimum sample size of 159 to detect moderate effect sizes (i.e., f =.25) with 80% power and an alpha level of.05 for significance.
We also used multiple regression analyses to assess which factors predicted psychological distress in the population. Mental illness symptoms (PCL‐C, GHQ‐28 Depression and Anxiety subscales), status in prison (remand or sentenced), cultural background (CALD, Indigenous Australian, ESB), and psychological processes (Brief COPE, CFQ) were the independent variables. A square root transformation was performed on the K‐10 to account for a nonlinear association between the dependent and independent variables (Field, 2013). The multiple regression analysis required a minimum sample size of 123 to detect a moderate effect size (f
In the final sample (N = 191), the mean participant age was 30.95 years (SD = 8.81, range: 18–60). There were no significant differences in age across the three cultural groups. The sample included both remand (59.2%) and sentenced (40.8%) prisoners from various units at PPP. Means and standard deviations for the K‐10, PCL‐C, Brief COPE, GHQ‐28, and CFQ scales for CALD, Indigenous Australians, and ESB prisoners are presented (see Table 1). No significant differences were found between groups of prisoners on these measures. On the K‐10, 17.7% of participants reported high levels of psychological distress, and 27.3% of participants reported very high levels of psychological distress. On the PCL‐C, 49.7% of participants reported problematic levels of PTSD symptoms. Additionally, 54.1% of participants reported elevated levels of mental illness symptoms on the GHQ‐28.
1 TableMeans and Standard Deviations Across Measures
CALD group Indigenous group ESB group Measure ηp2 K‐10 21.67 9.86 23.68 11.74 24.03 10.60 F(2, 184) = 0.88 .009 PCL‐C 34.09 17.22 40.71 18.86 40.46 18.65 F(2, 182) = 2.47 .028 COPE Social Support 15.80 5.49 16.12 5.60 15.16 5.08 F(2, 182) = 0.54 .006 COPE Problem Solving 10.32 3.41 10.33 3.49 10.36 3.35 F(2, 175) = 0.01 .001 COPE Avoidance 18.88 5.87 21.33 6.97 19.52 6.20 F(2,183) = 2.12 .019 COPE Positive Thinking 13.54 4.38 13.23 4.43 14.18 4.15 F(2,181) = 0.80 .009 CFQ 22.95 12.90 25.55 13.77 26.54 12.52 F(2, 181) = 1.30 .016 GHQ: Anxiety 2.42 2.53 2.73 2.69 3.04 2.54 F(2, 188) = 0.98 .018 GHQ: Depression 1.60 2.36 2.17 2.50 2.04 2.38 F(2, 182) = 0.83 .005 GHQ Total 8.06 8.52 8.50 8.14 9.36 8.01 F(2, 178) = 0.44 .006
1 Note. N = 191. CALD = culturally and linguistically diverse; ESB = English‐speaking background; K‐10 = Kessler Psychological Distress Scale; PCL‐C = PTSD Checklist–Civilian Version; CFQ = Cognitive Fusion Questionnaire; GHQ = General Health Questionnaire.
The multiple regression analysis significantly predicted psychological distress F(
2 TableMultiple Regression predicting Kessler Psychological Distress Scale (K‐10) Scores From Legal Status, Cultural Background, Psychological Processes, and Mental Illness symptoms
Variable Unstandardized coefficient Standardized coefficient Square part correlation percentages Constant 3.13 Legal Status 0.04 .02 0.004 Indigenous −0.15 −.06 0.025 CALD 0.06 .03 0.004 PCL‐C 0.020002 .250002 2.560 COPE Social support −0.004 −.02 0.004 COPE Problem solving 0.01 −.03 0.053 COPE Avoidance 0.030002 .160002 1.000 COPE Positive thinking −0.040002 −.130002 0.090 CFQ 0.010002 .150002 1.080 Anxiety/insomnia 0.060002 .340002 3.920 Depression 0.040002 .190002 1.500
- 2 Note. N = 159. p values are two‐tailed. CALD = culturally and linguistically diverse; ESB = English‐speaking background; PCL‐C = Posttraumatic Stress Disorder Checklist–Civilian Version; CFQ = Cognitive Fusion Questionnaire.
- 3
* p <.05.** p <.001. - 3 TableSummary of Pearson's Correlation Coefficients for the Kessler Psychological Distress Scale (K‐10) and Independent Variables
1 2 3 4 5 6 7 8 9 10 11 12 1. K‐10 – .170002 −.04 −.09 .670002 .260002 .180002 .590002 .12 .640002 .760002 .680002 2. Legal satus – .09 −.10 .13 −.09 −.002 .10 .03 .07 .220002 .150002 3. Indigenous – −.410002 .13 .07 .001 .16 −.05 .04 .06 .08 4. CALD – −.180002 .02 −.01 −.10 −.02 −.140002 −.12 −.09 5. PCL‐C – .310002 .300002 .650002 .310002 .630002 .610002 .460002 6. COPE Social support − .530002 .510002 .470002 .360002 .300002 .240002 7. COPE Problem Solving – .480002 .640002 .250002 .270002 .140002 8. COPE Avoidance – .440002 .590002 .550002 .490002 9. COPE Positive Thinking – .300002 .190002 .11 10. CFQ – .590002 .540002 11. GHQ: Anxiety – .740002 12. GHQ: Depression –
- 4 Note. N = 159. p values are two‐tailed. CALD = culturally and linguistically diverse; PCL‐C = Posttraumatic Stress Disorder Checklistt–Civilian Version; CFQ = Cognitive Fusion Questionnaire; GHQ = General Health Questionnaire.
- 5
* p <.05.** p <.001.
In the present study, we aimed to identify key mental health differences between CALD, Indigenous Australian, and ESB groups of prisoners. It was the first study to explore the association between cultural background and psychological distress in the Australian prison population. We found no significant differences cross‐culturally on measures of mental health measures, but the findings highlighted the significant levels of mental health issues experienced by the Australian prison population. The results also identified several mental health factors predictive of psychological distress for all prisoners and found that factors predicting psychological distress do not differ cross‐culturally in this population.
A large percentage of prisoners exhibited high or very high levels of psychological distress as well as high levels of mental illness–related symptoms. These findings are consistent with research that has found rates of mental illness to be significantly higher in prison populations compared to general populations (Fazel & Danesh, 2002; Fazel & Seewald, 2012). Rates of mental health issues are thought to be high in these settings because large numbers of inmates enter prison with preexisting mental illnesses due to their disadvantaged backgrounds and exposure to cumulative adverse life experiences and high levels of trauma (AIHW, 2015; 2019).
The results of the present study did not demonstrate significant differences across cultural groups concerning levels of psychological distress, mental illness symptoms, coping processes, or cognitive fusion. This differs from previous findings from studies conducted within similar populations. For example, in a cohort of 530 adult male prisoners, Rose et al. (2019) identified significantly higher rates of psychological distress and PTSD symptoms and marginally higher rates of other mental illness symptoms (including symptoms of depression and anxiety) compared to participants in the current study. These differences may be attributed, at least in part, to the self‐selection of prisoners: The Rose et al. (2019) study recruited participants for one‐off surveys, whereas the current study recruited participants to complete surveys as part of a 3‐week intervention program. In the present study, participants may have presented with less severe psychopathology as they volunteered to be involved in a well‐being program, resulting, perhaps, in a sample of more well‐adjusted and agentic participants. Further research is required to explore these issues in broader samples of prisoners.
The CALD and Indigenous Australian populations in general society have been found to possess significantly higher rates of mental health issues than the ESB population (ABS, 2013; Ferdinand, Paradies, & Kelaher, 2015; Shepherd, 2016; Victorian Government, 2012), yet we did not find this discrepancy in the current study. One explanation is that prisoners may experience comparable levels of disadvantage and exposure to stressors regardless of their cultural background, resulting in few significant differences in the mental health profiles of cross‐cultural groups of prisoners. It is also likely that high numbers of prisoners from cross‐cultural backgrounds experienced mental health issues prior to their incarceration (AIHW, 2019). More severe symptoms of mental illness have also been found to intensify the risk of criminal offense and recidivism (Forsythe & Gaffney, 2012; Smith & Trimboli, 2010).
Prisoners' cultural background was not found to predict psychological distress in the present study. There is no existing forensic literature in Australia that has examined whether being a prisoner from a CALD, Indigenous Australian, or ESB background predicts higher levels of psychological distress. The current finding may be due to socioeconomic and lifestyle factors that result in high numbers of individuals entering prison with already‐elevated levels of psychological distress (AIHW, 2015). Individuals in custody have also been found to have higher levels of psychological distress if they have been imprisoned on more than one occasion (AIHW, 2015). The similar levels of psychological distress across cultural groups may also be based on the prison environment itself and the challenge of being incarcerated, which can be highly stressful for prisoners (Cooper & Berwick, 2001; Rose et al., 2019).
We did not find significant differences cross‐culturally for factors predicting psychological distress, which suggests that the same mental health factors predict psychological distress for CALD, Indigenous Australian, and ESB prisoners. Increased rates of mental illness symptoms predicted higher levels of psychological distress in the prison population as a whole, reflecting past research that has found inmates with a mental illness to be likely to have higher levels of psychological distress during incarceration (Baidawi et al., 2016; Indig et al., 2016). The anxiety and sleep disturbance–related symptoms most strongly predicted psychological distress in the study. Past research has found strong associations between anxiety disorders and higher levels of psychological distress in prisoners (Indig et al., 2016). Factors related to PTSD and depressive symptoms also significantly predicted increased psychological distress, mirroring research that has found associations between these symptoms and elevated psychological distress in prison populations (Indig et al., 2016; Hochstetler, Murphy, & Simons, 2004).
Regarding psychological processes, avoidance coping predicted increased levels of psychological distress. Past studies have suggested that avoidance coping is maladaptive and associated with increased levels of psychological distress (Deasy, Coughlan, Pironom, Jourdan, & Mannix‐McNamara, 2014; Eisenbarth, 2012). Cognitive fusion also predicted an increase in psychological distress levels, reflecting research that has found a strong association between these factors (Gillanders et al., 2014; Krafft et al., 2018). Past research has found that, when combined, experiential avoidance and cognitive fusion intensify psychological distress (Bardeen & Fergus, 2016). The study results also showed that the use of positive thinking as a coping strategy predicted a decrease in psychological distress levels. Previous research has indicated that positive thinking helps individuals deal with stressful circumstances and improves psychological functioning (Shulman & Cauffman, 2011; Van Harreveld, et al., 2007). Positive thinking may have assisted participants in reducing their levels of psychological distress by helping them manage their emotional response to being in prison (Lazarus & Folkman, 1984).
The present findings support past research that has demonstrated the significant overrepresentation of mental health issues in the Australian prison population, indicating the need for prisoners to have more access to services that can help reduce their psychological distress and mental illness symptoms and increase their coping ability. Treatment that addresses the unique needs of justice‐involved individuals is needed. The study findings also highlight the point that the same mental illness symptoms predict higher levels of psychological distress irrespective of cultural grouping. The fact that no significant differences were found across cross‐cultural groups suggests that the experience or lifestyle of justice‐involved individuals appears to have more bearing on mental health than cultural idiosyncrasies. These findings underpin the need for the prison system to view cross‐cultural prisoners as vulnerable to having mental health problems and provide services that alleviate these issues while they are incarcerated.
The inability to find significant cross‐cultural differences in levels of mental health issues does not diminish the need for prisoners to have access to specialized culturally appropriate mental health services. Past research has pointed to the need for these services to be made available for Indigenous Australian prison populations (Shepherd & Phillips, 2016). There are likely mental health benefits for both CALD and Indigenous Australian prisoners to be able to access culturally appropriate mental health services given that these groups exhibit high rates of mental health issues and have distinct cultural practices and values that affect their mental health. There is also a need for mental health services to evaluate whether the programs they provide are culturally appropriate and able to assist prisoners from cross‐cultural backgrounds to better manage their mental health. The use of these services may also help in initiating a more trusting relationship between clinicians and groups of prisoners.
Another implication of the study was that preexisting levels of psychological distress and mental illness symptoms experienced by prisoners perhaps influenced whether they self‐selected to take part in the study as a participant. Accordingly, the prison system needs to be aware that relying exclusively on prisoners who self‐select to take part in mental health services could result in numerous prisoners with severe mental health issues missing out on access to these services. Researchers working within the prison system also need to be aware of this self‐selection trend and take appropriate steps to ensure their research is reflective of the general prison population.
Finally, the findings that identified psychological processes such as coping and cognitive fusion to be predictive of psychological distress for cross‐cultural prison populations suggest these processes may be potential treatment targets for psychological interventions. Future intervention research within prisons should assess cognitive fusion and avoidance coping as potential mechanisms for change and seek to counteract these processes as a means of reducing psychological distress levels and giving individuals more autonomy to make positive value‐based choices (Gillanders et al., 2015; Hayes, Luoma, Bond, Masuda, & Lillis, 2006).
The study findings should be considered in light of its limitations. One such limitation was the heterogeneous nature of the term CALD, as it represents groups of people with wide‐ranging cultural practices. To attain a more accurate understanding of the mental health of this group, future research needs to divide CALD prisoners into more specific groupings. Moreover, the PCL‐C assessment measure used to assess PTSD symptoms in the study was keyed to criteria from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and does not correspond to the fifth edition of the DSM, which is the latest version of this manual. Additionally, mental health factors investigated in the study only made relatively minor independent contributions to predicting psychological distress in the model, suggesting overlap among predictors. The number of factors used to predict psychological distress was also limited by the sample size. It is advisable that future researchers obtain larger, more representative samples of participants to allow for the inclusion of more study predictors.
The representativeness of the sample may have also been restricted by the fact that only participants who were able to speak English were recruited for the study. It is likely, however, that only a small proportion of potential participants were excluded from the study due to this exclusion criterion as English is the primary language spoken at home for more than 90% of people entering into prison in Australia, and only 4% of prisoners in Australia speak a foreign language (AIHW, 2019).
The present study was among the first, to our knowledge, to compare the mental health of CALD, Indigenous Australian, and ESB individuals in custody. The study provided insight into key mental health factors in the Australian cross‐cultural prison population and the relation between a prisoner's cultural background and their level of psychological distress. The findings demonstrated that justice involvement is perhaps a more useful indicator of the mental health of prisoners than is their cultural background. The results also indicated that high rates of mental health issues and psychological distress are an ongoing concern for prisoners in Australia regardless of their cultural background, highlighting the need for individuals in custody to have more access to mental health services.
By Arran Rose; Justin S. Trounson; Stephanie Louise; Stephane Shepherd and James R. P. Ogloff
Reported by Author; Author; Author; Author; Author
