Most Iranian Inmates Drug Addicted, But Few Get Treatment

While Western countries have been trying to contain Iran's nuclear capabilities, some Iranian psychiatrists have been waging a different kind of battle—determining the prevalence of mental illness among Iranian prisoners.

Their study was conducted in one of the largest men's prisons in Iran. It included a random sample of 351 prisoners and was based on interviews using the clinical version of the Structured Clinical Interview for DSM-IV Axis I Disorders and the Psychopathy Checklist: Screening Version. A troubling finding emerged from the study: Some three-fourths of the prisoners interviewed were either currently dependent on opioids or had been at some time in their lives.

“This is one of the strongest associations between crime and drug addiction reported thus far,” the principal investigator of the study told Psychiatric News. He is Seyed Mohammad Assadi, M.D., an assistant professor of psychiatry at Tehran University of Medical Sciences.

The study was funded by the Iran University of Medical Sciences. Results were published in the February British Journal of Psychiatry.

As Assadi and his colleagues pointed out in their report, only 25 percent to 50 percent of prisoners in Western countries have been found to have had a lifetime substance abuse diagnosis.

The reason why so many Iranian criminals appear to abuse opioids, Assadi speculated, might be because “Iran is the main route of opiate trafficking between Afghanistan and Europe. According to the United Nations Office on Drugs and Crime, Iran is among the countries with the highest prevalence of opioid abuse.”

Another noteworthy finding to emerge from their study was that 29 percent of the inmates studied were currently suffering from a major depression. In contrast, only 10 percent of male prisoners in Western countries have been found to have a major depression, Assadi and his group stated in their study report.

Moreover, 4 percent of the prisoners were found to have a lifetime diagnosis of psychosis. This rate is comparable to that reported for male prisoners in Western countries. A lifetime diagnosis of psychopathy was found in 24 percent of the prisoners. This rate is comparable to that found in North American prisoners (25 percent to 30 percent), but higher than that reported in European prisoners.

Also of interest, when the Iranian prisoners in this study were grouped according to offense, their prevalence of mental illness was discovered to vary considerably.

For example, all of the subjects imprisoned because of drug-related offenses had a lifetime diagnosis of an Axis I disorder, compared with only 54 percent of those imprisoned because of financial crimes. The latter “are usually individuals whose financial forecasts have proved wrong during economic fluctuations,” Assadi and his colleagues explained in their study report.

Further, whereas 31 percent of the drug-offense group had a lifetime diagnosis of psychopathy, only 16 percent of those incarcerated for murder, robbery, or other violent crimes did, and only 15 percent of those imprisoned for immoral acts did. Immoral acts in Iran, Assadi and his group explained, include “fornication, prostitution, and alcohol use or trading.”

Finally, according to the data collected in the overview section of the clinical version of the Structured Clinical Interview for DSM-IV Axis I Disorders, only 11 percent of prisoners with current Axis I diagnoses were receiving psychiatric treatment. So when Psychiatric News asked Assadi whether their study results might lead to better treatment of Iranian prisoners' mental illnesses, he replied: “We hope. We think this report and a few other smaller studies have drawn attention to the substantial burden of psychiatric problems in Iranian prisoners.”

An abstract of “Psychiatric Morbidity Among Sentenced Prisoners: Prevalence Study in Iran” is posted at<http:bjp.rcpsych.org/cgi/content/abstract/188/2/159>.▪

Br J Psychiatry 2005 188 159