Spirituality and Religion Among French Prisoners

Abstract

The aim of this study was to describe the role of spirituality and religiousness (SR) among detainees. Thirty detainees from a French short-stay prison were assessed with the World Health Organization Quality of Life–Spirituality Religion and Personal Beliefs questionnaire (WHOQOL-SRPB) and with open questions about SR. Forty percent of detainees described SR as an important way of coping with incarceration and stressful events, as a means of finding inner peace, showing altruism, and gaining the respect of others. SR involvement was associated with reports of decreased suicide risk and of the prevention of future offences. SR appears to be an important coping mechanism and may help the transition to the community following incarceration. This study endorses the view that SR should be considered when treating this population.

Keywords

spirituality religiousness French detainees prison

Introduction

About 9 million people are imprisoned worldwide including more than 2 million in the United States, 70,000 in the United Kingdom, and 75,200 in France in 191 establishments for the deprivation of liberty (CEMKA-EVAL, 2004; Fazel & Danesh, 2002). Several studies have shown that prisoners are in poor general health and have high rates of mental disorders compared with the general population (Fazel & Danesh, 2002; Fazel & Lubbe, 2005; Singleton, Bumpstead, O’Brien, Lee, & Meltzer, 2000). Detention is a stressful situation which can trigger adaptation disorders or lead to relapses of preexisting psychiatric disorders. The suicide rate in prisons has increased dramatically since 1980s and now represents the third leading cause of death in U.S. prisons (Anasseril, 2006). The most important risk factors for suicide are mental illness, hopelessness, drug misuse, and the prison environment itself (Anasseril, 2006; Fernander, Wilson, Staton, & Leukefeld, 2004).

Many studies have shown that the prevalence of mental disorders is higher among inmates than in the general population (Shaw, Baker, Hunt, Moloney, & Appleby, 2004). A systematic review of psychiatric surveys of prison populations (including 23,000 prisoners) in 12 Western countries (Fazel & Danesh, 2002) found that about one in seven prisoners suffered from psychotic disorders or major depression and about one in two male prisoners had antisocial personality disorder. Age-standardized suicide rates among male prisoners are between 5 and 8 times higher than in the general population (Blaauw, Kerkhof, & Hayes, 2005). France has the highest suicide rate in Europe, with 37 suicides for 10,000 prisoners between 2006 and 2008 (Dammer, 2002). The most recent study conducted in 2004 found that 24% of prisoners suffered from a psychotic disorder (including 8% who had schizophrenia), 39% suffered from depression, mania, or another mood disorder, and 32% had a personality disorder (CEMKA-EVAL, 2004).

Religion, in its broadest sense, encompasses spirituality (concern with the transcendent, the significance and meaning of life, etc.) and religiousness (specific behavioral, social, and doctrinal practices and denominational characteristics). It has been suggested that spirituality may provide a sense of meaning in life which may help people to cope more effectively with the important coping resource for facing stressful life events. Spirituality and religiousness (SR) have a protective effect on suicide (Koenig, 2003, 2009; Wortzel, Binswanger, Anderson, &Adler, 2009) and together play a key role in recovering from substance abuse and dependence (Galanter, 2006; Miller, 1996; Miller, 1998; Miller, Davies, & Greenwald, 2000). Pargament (1997) suggested that religious coping potentially serves several purposes: spiritual (meaning, purpose, hope), self-development, resolve (self-efficacy), sharing (closeness, community connectedness), and restraint (keeping emotion and behavior under control). SR coping can be positive (e.g., praying for relieving anxiety, stop drinking alcohol due to religious considerations, etc.) or negative (e.g., thinking to be abandoned by God, feeling anxious after reading scriptures, etc.). Studies have been conducted on spiritual coping in various populations. Tepper, Rogers, Coleman, and Malony (2001) showed that 80% of patients with persistent mental illness, particularly those who were experiencing more severe symptoms, used religious beliefs or activities to cope with daily difficulties or frustrations.

Little is known about the potential role of SR in mental health and suicide prevention in detained individuals. Yet, being in jail is obviously a stressful situation likely to require coping strategies such as those involving religion, as described earlier. In a recent meta-analysis on the issue of SR coping of detainees, Eytan (2011) concluded that SR was associated with lower frequency and severity of depressive episodes, but did not obtain any concrete evidence that SR may reduce suicide rate. The aim of this study is to describe the role of SR coping among detainees in a French short-stay prison, from both quantitative and qualitative perspectives. We have also assessed the changes, as reported by detainees, in their beliefs and practices since incarceration, to test the hypothesis that the stress associated with incarceration increases religiousness and hence SR coping.

Subjects and Method

Study Design and Procedure

The study was conducted at the short-stay prison of Bois d’Arcy in France. It is a prison for males, where a regional medical psychological service (RMPS) related to the regional psychiatric hospital (Charcot Hospital) is provided. Detainees can consult psychiatrists or psychologists at the center at their own request or are referred by general practitioners, prison warders, or by lieutenants when they observe psychological symptoms (about 20% of all detainees consult at least once).

The study was conducted between January and August 2011. Thirty patients were included in the study. One of the authors (O.M.), who worked as a psychiatrist in the RMPS at that time, collected the data and met all detainees selected. We invited all consecutive detainees, who were our patients, arriving before blocking movements and circulation (the end or beginning of the exercise periods) to participate in the study, to control for selection bias, for example, to avoid patient selection according to religious characteristics. Participants had to choose between walking and remaining with the researcher. Those who accepted to participate (only 2 detainees refused to participate and choose to go walking) had to read and answer all questions in the presence of the researcher who checked for missing answers. All patients accepting the study completed the whole survey. Patients who did not understand French sufficiently well were excluded, as were those who had an acute mental illness, a diagnosis of schizophrenia, or other nonaffective psychoses.

The research protocol was approved by the ethics committee of Cochin Hospital. All patients gave their informed consent after receiving detailed information about the study.

General Assessment

Sociodemographic data as well as information on type of crime and number of previous incarcerations were collected. Clinical and substance use history was collected from medical records. Current psychiatric disorders were diagnosed by the Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) Axis I and the Structured Clinical Interview (SCID-II) for DSM-IV Axis II for personality disorders (First, Gibbon, Spitzer, Williams, & Benjamin, 1997).

Assessment of SR

Participants were asked about their SR practice. If they did not have religious practices, they were asked if they had any sense of religious belonging. Participants were asked about the religious affiliation they felt closest to (Catholicism, Protestantism, Judaism, Islam, Buddhism, Agnosticism, or Atheism), and if they had participated in religious practices in childhood, adolescence, and adulthood, and during incarceration.

Because of the secular culture and high prevalence of agnosticism and atheism in France, investigators chose to assess spirituality using the World Health Organization Quality of Life–Spirituality Religion and Personal Beliefs questionnaire (WHOQOL-SRPB). The SRPB is a chapter of the WHOQOL, which is a subjective, cross-cultural quality-of-life questionnaire and one of the few such instruments that include an existential component. Growing research on spiritual health had led the World Health Assembly in 1998 to incorporate spiritual well-being into the WHO definition of health (WHOQOL Group, 1998). The WHOQOL Group considers that those with agnostic or atheist views may also have a rich spiritual life, and developed the WHOQOL-SRPB which could be used for multicultural and multifaith communities. It can be used for clinical and nonclinical populations. It was validated on 5,087 participants in 18 countries around the world (WHOQOL Group, 1998; WHOQOL-SRPB Group, 2006).

WHOQOL-SRPB covers eight facets (spiritual connectedness, meaning of life, awe, wholeness and integration, spiritual strength, inner peace, hope and optimism, and faith) and contains 32 items (four questions per facet) answered on a 5-point Likert-type scale ranging from “not at all” to “an extreme amount.” The scores obtained by detainees for dimensions covered by the WHOQOL-SRPB were compared with those obtained in a sample from the general French population in which WHOQOL-SRPB was validated in 561 French-speaking participants from France and Switzerland who completed the questionnaire online at http://www.stoptabac.ch/cgi-bin/spiritu.pl?language= (Mandhouj, Etter, Courvoisier, & Aubin, 2012).

In addition, we asked detainees if their beliefs and practices helped them to cope with their current difficulties, if they were important in their daily life and in preventing future offences and protecting them from suicide, and if they gave them meaning in life or induced guilt. We also asked if the representative of their religion could help them to face current difficulties and to prevent future offences. All these items were auto-evaluated by means of a visual analogue scale with 10 anchored points. They were also asked to give definitions of the following words: meaning of life, spirituality, religion, faith, and representation of God.

Finally, we asked subjects with open questions if any beliefs or practices had changed since incarceration.

Statistical Analysis

Analyses were conducted with SPSS, version 14.0. We used t tests to compare the means of two samples and the Pearson test to compare continuous variables. An alpha level of .05 was used as the threshold of significance.

Results

Characteristics of the Sample

Table 1 describes the characteristics of the patients included in the sample. Thirty detainees were recruited. Their mean age was 31.5 (SD = 9.6) years. The majority was of low socioeconomic background (76.7%) or unemployed (23.3%), and most did not have an educational diploma giving potential access to university (83.3%). The mean number of incarcerations was 3.23 (SD = 3.57). The main offences were theft, drug trafficking, driving under the influence of alcohol, and interpersonal violence. Ten detainees suffered from a mood disorder (33.3%), 3 (10%) had an adaptation disorder (i.e., trauma related to the incarceration), 3 (10%) a sleep disorder, and 2 (6.7%) pathological gambling. Drug misuse was quite frequent: only 7 (23.3%) subjects had never misused drugs, 10 (33.3%) had alcohol dependency at the time of the incarceration, 12 (40%) used marihuana, and 23 (76.7%) were current smokers.

Table 1.

Characteristics of the Study Population (n = 30).

Age years, mean (SD)	31.5 (SD = 9.6)
Possession of a diploma giving access to university	5 (16.7%)
Professional status
Employee	23 (76.7%)
No professional activity	7 (23.3 %)
Mean number of incarcerations, mean (SD)	3.23 (SD = 3.57)
Offence
Theft	10 (33.3%)
Drug trafficking	4 (13.3%)
Driving under the influence	4 (13.3%)
Violence	7 (23.3%)
Others	5 (16.7%)
Religious practices
Regular	11 (36.7%)
Occasional	7 (23.3%)
None, but feeling of belonging	8 (26.7%)
None, and no feeling of belonging	4 (13.3%)
Religious affiliation
Catholic	7 (23.3%)
Jewish	1 (3.3%)
Islam	15 (50%)
Buddhist	1 (3.3%)
Agnostic	3 (10%)
Atheist	3 (10%)
Religious practices
Religious practices during childhood	16 (53.3%)
Religious practices during adolescence	12 (40%)
Religious practices during adulthood	15 (50%)
Religious practices during incarceration	15 (50%)
Psychiatric disorders
Mood disorder	10 (33.3%)
Adaptation disorder	3 (10%)
Sleep disorder	3 (10%)
Pathological gambling	2 (6.7%)
Personality disorder	16 (53.3%)
Antisocial personality disorder	12 (40%)
Substance abuse
Alcohol dependency	10 (33.3%)
Marihuana	12 (40%)
Tobacco	23 (76.7%)

SR

The majority of subjects were Muslims (50%), while 23.3% were Catholics, 3.3% Jewish, 10% Agnostics, 10% Atheists, and 3.3% Buddhists. More than half of the detainees described had observed religious practices during childhood (53.3%). Only 40% of the latter continued these practices during adolescence. Fifty-percent stated that they had observed religious practices in prison.

Scores of the WHOQOL-SRPB were compared with the general population, in which the instrument was validated in French. This population of 561 French-language persons featured a mean of age 42.2 (SD = 11.6) years. Most respondents were female, most (71%) had an educational diploma that would give access to university, most (76%) had no religious practice, and 37% were either agnostics or atheists.

Scores for the faith dimension were higher for the sampled detainees than scores obtained in the general population whereas scores for meaning of life, hope and optimism, and inner peace were significantly lower (Table 2).

Table 2.

SRPB Scores: A Comparison Between Detainees and the General Population.

	Detainees	General population^a
Spiritual dimensions	n = 30 M (SD)	n = 561 M (SD)	p
Spiritual connectedness	11.80 (6.08)	10.08 (5.39)	.09
Meaning of life	5.18 (4.01)	13.26 (4.10)	<.000001
Awe	12.67 (3.06)	15.30 (3.22)	.00001
Wholeness and integration	10.37 (3.82)	12.25 (3.89)	.01
Spiritual strength	11.77 (4.82)	11.78 (4.85)	.989
Inner peace	10.33 (3.11)	12.12 (3.78)	.011
Hope and optimism	11.20 (3.23)	13.33 (3.10)	.0003
Faith	12.23 (5.25)	9.70 (5.57)	.015
Total SRPB score	11.16 (3.13)	12.15 (3.24)	.107

Note: t tests were used to compare the means of the two groups. SRPB = Spirituality Religion and Personal Beliefs.

Data from Mandhouj, Etter, Courvoisier, and Aubin (2012).

The Role of Prisoners’ Beliefs

Beliefs were reported to play an important role in coping with current difficulties, preventing suicide and further offences and in giving meaning to life (Table 3). WHOQOL-SRPB scores correlated significantly with the scores obtained for the question “Do your beliefs protect you from suicide?” (r = .51, p = .003). The majority of WHOQOL-SRPB dimensions seemed to be associated with the idea that spiritual beliefs could protect one from suicide: meaning of life, r = .66, p = .0001; spiritual connectedness, r = .58, p = .0008; inner peace, r = .39, p = .03; spiritual strength, r = .40, p = .02); and faith, r = .70, p < .00001. Spiritual dimensions that appeared to be associated with the idea that spiritual beliefs could prevent future offences were meaning of life (r = .39, p = .03), spiritual connectedness (r = .46, p = .01), and faith (r = .53, p = .002).

Table 3.

Importance of Religion and Beliefs in Prison.

	M (SD)	Median
Do your beliefs help you to face current difficulties?	5.17 ( 3.80 )	5.00
Do your beliefs cause a sense of guilt in you?	4.21 (3.68)	5.00
Do you think that your beliefs could prevent future offences?	5.48 (4.14)	7.00
How much importance do your beliefs have in your daily life?	4.41 (2.33)	4.00
Do your beliefs protect you from suicide?	6.21 (4.06 )	7.00
To what extent do your beliefs give meaning to your life?	5.17 (4.05)	6.00
To what extent do representatives of your religion help you to face current difficulties?	0.69 (2.14)	0.00
To what extent do representatives of your religion help you to prevent future offences?	0.34 (1.85)	0.00

Perception of Religion

Table 4 reports answers to open questions about the role of religion. Twelve detainees (40%) described SR as an important way of coping. It could help them tolerate incarceration and stressful events, achieve inner peace, show altruism, and gain the respect of others. Conversely, 7 (23.3%) detainees had a negative view of religion, arguing that it can be the cause of wars and violence or a frightening experience or a force that demands their submission against their will. Eleven detainees (36.7%) had a neutral opinion (or no opinion at all) and viewed religion as a simple issue of membership.

Table 4.

Representations of Religion.

Positive representation n = 12 (40%)	Neutral representation n = 11 (36.7%)	Negative representation n = 7 (23.3%)
Religion is the most important thing in my life	Religion is simply an issue of membership	Religion is the principal cause of wars on earth
Religion implies helping others	Religion is a free choice	Religion is frightening
Religion leads to altruism and to respect for others	Religion is a personal relationship between God and individuals	I avoid thinking about such disturbing topics
Religion helps me to find inner peace	I never asked myself such questions	Religion is submission
Religion helps me to cope with stressful events	There is only one God, all the rest is not important	Religion is a bad heritage
Religion helps me to cope with incarceration	Beliefs are beneficial for some and harmful for others	Religion is used by some against humanity
Religion defines my limits	I did not have any religious education	Reconciling different religions is the most complicated thing on earth
Religion makes me optimistic

Note: Some detainees gave more than an answer in the same category.

Changes Since Incarceration

Eleven subjects (36.7%) reported that their beliefs and practices did not change in prison. A few (6.6%) detainees reported that they had lost their trust in God or feared his vengeance. Others (10%) reported that they felt guilty and were seeking forgiveness. While some detainees (43.3%) found it easy to practice in prison (because of more free time and lack of alcohol/drugs abuse) and planned to undertake an in-depth reading of the Holy Bible, a few (6.6%) had stopped their religious practices, reportedly as a result of depressive mood. Three detainees said they had converted to Islam (2 detainees) or Buddhism (1 detainee) during their incarceration. Some detainees (6.6%) were trying to convert others and reported that they found meaning in their incarceration in this way. For many detainees (43.3%), religion was the most important topic they discussed during exercise periods, even though some found it difficult to reconcile different religions (they felt that other detainees or warders discriminated against them because of their beliefs).

Meaning of Life

When asked how they would define the meaning of life, 36.7% of detainees reported a lack of meaning in their life. More than the half (53.3%) stated that having a family, and educating and loving their children would be the most important purpose of their life. Finding inner peace, helping others, and finding a job were the principal answers given by detainees (26.6%). A few of them (10%) thought that human beings should spend their life protecting the earth.

Spirituality, Faith, and Representation of God

When asked to give a definition of spirituality, 21 (70%) detainees were unable to define this term, or reported that they had never heard the word. Others (30%) said that they saw no difference between spirituality and religion. God did not exist for 16.7% of the detainees interviewed. The others viewed God as the creator of the world. God was described as loving, caring, and forgiving by 53.3% of detainees, while 6.6% stated that He had punished or abandoned them. Eleven (36.6%) detainees reported having a strong faith defined as a strong inner feeling. The others (63.4%) had no definition or feeling related to faith.

Discussion

This study described the SR of detainees in the short-stay prison of Bois d’Arcy (France). We assessed the coping role of SR and the changes in beliefs and practices during incarceration, as reported by detainees. The main findings were that some religious dimensions (as measured by the WHOQOL-SRPB) differed from those of the general population: the faith dimension was higher for detainees while scores for meaning of life, hope and optimism, and inner peace were significantly lower. The reports made by detainees suggested that SR involvement could be associated with decreased suicide risk and the prevention of future offences. Moreover, SR appeared to be a significant and positive way of coping for 40% of detainees, while 23% viewed it as a negative force.

Religious communities promote moral and ethical teaching that discourages illegal conduct (Koenig, McCullough, & Larson, 2001). In France, religious congregations have played a crucial role in prisons and confinement institutions since the 17th century trying to implement and promote the Christian ethic and education (Foucault, 1998). Religion has been considered as a deterrent to crime because it encourages the development of moral character and conformity to societal norms and values. To date, however, studies remain inconclusive about the association between religiousness and delinquency. Most studies showed less juvenile delinquency and less adult criminality among the more religious (Koenig et al., 2001). In addition, many studies have suggested that SR may reduce the incidence of prison deviance (Clear & Sumter, 2002; Koenig, 1995). Hence, our results give some indications as to how religion may interact with the criminality and mental suffering of detainees, as described in more detail below. This study was conducted in France, characterized by a secular culture with a high prevalence of agnosticism and atheism (more than 30% of population). Other studies generally took place in North America where subjects feature higher religiosity. This underscores the need for conducting such studies in various environments.

Eighty percent of the study sample had a religious affiliation and 50% were currently practicing a religion. These rates are higher than those found in the general French population, where 27% to 29% state that they have no religion (Atlas of Religions, 2007). This may be explained by the characteristics of prisoners in France, 20% of whom do not originate from France but from abroad, particularly North Africa (Baux, 2010). “Meaning of life” scores were found to be lower, as were the scores for awe, hope, optimism, and inner peace, although detainees scored more highly for faith. Furthermore, SR and personal beliefs seemed to play an important role in coping with current difficulties and in preventing suicide and further offence for the majority of participants. Koenig (1995) found that 64% of detainees indicated that religion was very important for them. For one out of three, it was the most important coping mechanism. It has been shown that religious involvement may serve to mitigate the psychological and physical deprivations created by imprisonment (Dammer, 2002; Fernander et al., 2004) and to contribute to a better adjustment to prison and a reduction in episodes of confinement (Clear & Sumter, 2002; Eytan, 2011; Kerley, Matthews, & Blanchard, 2005; Kerley & Copes, 2009). SR may also reduce aggression, hostility, acting out, and harming self or others (Scarnati, 1991).

Suicide is an omnipresent preoccupation in detention. In France, there were 37 suicides for 10,000 detainees between 2006 and 2008. This rate is the highest in European countries (Duthé, Hazard, Kensey, & Pan Ké Shon, 2009). Spiritual beliefs appear to be a protective factor for suicide in our sample. Indeed the majority of WHOQOL-SRPB dimensions were correlated with the scores for the question, “Do your beliefs protect you from suicide?” Most studies examining the relationship between religion and suicide found fewer suicides or a more negative attitude toward suicide among the more religious people (Colucci & Martin, 2008; Koenig et al., 2001; Wortzel et al., 2009). Yet, in his recent review, Eytan (2011) concluded that there was no evidence that SR may reduce the suicide rate in prison. Bearing in mind that SR is associated with lower frequency and severity of depression, this finding could be due to a lack of specific studies addressing this issue. Our findings support the view that, for some detainees at least, SR may play a role in reducing suicidal risk. Hence, this issue should not be neglected by either clinicians or by researchers. SR should be assessed and explored, in particular, in patients with risk factors for suicide or suicidal ideation and for whom lack of meaning in their life is at the core of their suffering.

With regard to the crucial issue of meaning, more than one third of detainees stated that they found no meaning in life. Having a family, educating and loving their children, finding inner peace, helping others, and finding a job were the principal wishes cited by detainees. Meaning in life is often related to a person’s life goals or values. Some investigators reported that a sense of meaning in life helps people cope more effectively with the deleterious effects of stress (Krause, 2004). Several authors have proposed that it is a primary component of spirituality (Mental Health Foundation, 2006) which can be useful in a religious context (Miller, 1999). It has also been a core concept for several phenomenological philosophers and existential scholars. One of the most influential was Victor Frankl, who developed a therapeutic approach (logotherapy) which focuses on the meaning of life (Frankl, 1963).

A minority of detainees stated that God did not exist. For the others, He was described as the creator of the world. God was most often considered as loving, caring, and forgiving, although a small minority felt that he had punished and abandoned them. Allen, Phillips, Cavanaugh, and Day (2008) found that older male inmates who experienced a higher number of daily spiritual experiences and felt that they had not been abandoned by God reported less desire for hastened death and fewer symptoms of depression. Owing to the sample size, it was impossible to look for differences between those who conceive God as loving and forgiving and those who conceive Him as vengeful and wrathful. Flannelly, Galek, Ellison, and Koenig (2010) showed that those who considered God as a loving, caring, forgiving, and approving figure were more likely to report positive mood and life satisfaction, whereas people who considered that God had punished or abandoned them tended to experience more negative moods and lower quality of life.

We found that only few detainees experienced a religious conversion during their incarceration. It should be noted that two detainees were trying to convert others and reported that this gave meaning to their incarceration. This phenomenon has been previously reported, especially by Dix-Richardson (2002), who showed that it has been a common practice for African American male inmates to convert to Islam as part of the prison experience. The annual number of prison converts is estimated at 30,000. This observation did not apply to African American women who view Islam as a religion that subjugates women.

We found that higher scores for meaning of life, spiritual connectedness, and faith were associated in detainees with the conviction that spiritual beliefs could prevent future offences. Parsons and Warner-Robbins (2002) studied the factors that support women’s successful transition to the community following incarceration. They found that the dominant factor was spiritual beliefs and practices. Although no questions were asked about SR, 96% of women described the important role that God played in their lives. Enache (2009) asked female detainees about the foundations of hope for a better future after release. Results showed that the development of moral, family, social, and spiritual values was beneficial and increased hopes of social reintegration.

Limitations

To the best of our knowledge, this is the first study to explore spirituality and religiosity in a French prison from both quantitative and qualitative perspectives. Its first limitation is its small sample size, at least for the quantitative part. In addition, the results are based on a single site, which involves mostly immigrants, precluding generalization to other areas with a different religious and judiciary background. Our results should be replicated, therefore, before definitive conclusions can be drawn. Moreover, as our data were not collected over time, we are not able to draw firm conclusions about causalities. Hence, the changes observed in SR coping due to incarceration should be taken with caution, keeping in mind the qualitative and retrospective nature of these data.

Conclusion

Little research has been conducted on SR among detainees. Longitudinal or case control studies could assess whether SR may play a specific role in preventing suicide and in achieving a successful transition to the community following incarceration, hence potentially preventing repeated offences. Yet our results suggest that SR could be an important coping resource for some detainees. They underscore the need for collaboration between custodial administration, clinical staff, and religious representatives so as to overcome problems with reconciling different religions and to help detainees sustain the help they get from SR. In this regard, suicide prevention and mental health promotion programs among detainees should involve a comprehensive approach, which takes the spiritual dimension into account.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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