FACULTY OF THE SOCIAL SCIENCES - University of Nigeria General Work Main.pdf · Acknowledgement iv...

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OZIOKO, DENNIS IFEANYICHUKWU

PG/ M.Sc./ 07/ 42863

INFLUENCE OF RELIGIOUS DEVOTION, SELF-EFFICACY AND

PRISONERS’ STATUS ON THE PRISON INMATES MANIFESTATION OF

PSYCHOLOGICAL DISTRESS

FACULTY OF THE SOCIAL SCIENCES

DEPARTMENT OF PSYCHOLOGY

Ameh Joseph Jnr

Digitally Signed by: Content manager’s Name

DN : CN = Webmaster’s name

O= University of Nigeria, Nsukka

OU = Innovation Centre

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INFLUENCE OF RELIGIOUS DEVOTION, SELF-

EFFICACY AND PRISONERS’ STATUS ON THE

PRISON INMATES MANIFESTATION OF


BY


PG/ M.Sc./ 07/ 42863



UNIVERSITY OF NIGERIA, NSUKKA

FEBRUARY, 2014

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INFLUENCE OF RELIGIOUS DEVOTION, SELF-

EFFICACY AND PRISONERS’ STATUS ON THE

PRISON INMATES MANIFESTATION OF


PROJECT SUBMITTED IN PARTIAL FULFILLMENT

FOR THE AWARD OF A MASTER OF SCIENCE (M.Sc.)

DEGREE IN CLINICAL PSYCHOLOGY

BY


PG/ M.Sc./ 07/ 42863



UNIVERSITY OF NIGERIA, NSUKKA

SUPERVISOR: REV. FR. PROF. M.C. IFEAGWAZI

FEBRUARY, 2014

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CERTIFICATION

OZIOKO, DENNIS I., a postgraduate student in the Department of

Psychology and with Registration Number PG/M.Sc/07/42863 has

satisfactorily completed the requirements for course and research work for

the Degree of M.Sc in Clinical Psychology. The work embodied in this

thesis is original and has not been submitted in part or full for any other

diploma or degree of this or any other University.

_______________________ ___________________________

Rev. Fr. Prof. M. C. Ifeagwazi Prof. P. N. Ibeagha

SUPERVISOR HEAD, DEPARTMENT OF PSYCHOLOGY

__________________________ _____________________________

Prof. C. O. T. Ugwu EXTERNAL EXAMINER

DEAN, FACULTY OF THE

SOCIAL SCIENCES

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DEDICATION

This work is dedicated to my dear wife Mrs. Ann Oby Ozioko

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ACKNOWLEDGEMENTS

First and foremost, I acknowledged God Almighty for His protection,

wisdom, favour and provision throughout the duration of this programme. I also

acknowledge the efforts, encouragement, support and unqualified supervision of

my project supervisor Rev. Fr. Prof. M. C. Ifeagwazi whose humane treatment

and thoughtful observation helped facilitate the completion of this work. My

profound gratitude goes to the lecturers in the Department of Psychology,

University of Nigeria, Nsukka including: Prof. P. N. Ibeagha, (H.O.D), Rev. Sr.

Dr. M. B. Nwoke, Dr. I. Onyishi, Dr. J. E. Eze, Dr. P. Mefoh, Dr. V.C. Eze, Dr.

A. Agbo, late Rev. Sr. Dr. F.C. Enukorah, Dr. E. U. Onyeizugbo, Dr. L.I. Ugwu

and Miss. N. Obi as well as other members of non-academic staff of the

Department of Psychology for their dedicated and continued interest in students

welfare.

My special thanks also go to my wife Mrs. A. O. Ozioko for her moral

and social support. My appreciation also goes to my boss Dr. W. K. Akorede for

his financial and moral support and also to Victor Odo and many other well

wishers. I also acknowledge and appreciate the source of materials used, the

authors of the textbooks and journals whose work were consulted and cited in

this work.

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TABLE OF CONTENTS

Title Page i

Certification page ii

Dedication iii

Acknowledgement iv

Table of Contents v

List of tables vi

Abstract vii

CHAPTER ONE: INTRODUCTION

Introduction 1

Statement of the problem 16

Purpose of the study 17

Operational definition of terms 17

CHAPTER TWO: LITERATURE REVIEW

THEORITICAL REVIEW 19

Cognitive Theory 19

Medical Model 20

Psychodynamic Theory 22

Interpersonal Theory 23

Behavioural Theory 24

Social Model 26

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Stress Vulnerability Model 27

Bio-psychosocial Model 29

EMPIRICAL REVIEW 30

Religious devotion and psychological distress 30

Self-efficacy and psychological distress 40

Prisoners’ status and psychological distress 53

SUMMARY OF THE LITERATURE REVIEW 61

HYPOTHESES 63

CHAPTER THREE: METHOD 64

Participants 64

Instruments 64

Procedure 67

Design/Statistics 69

CHAPTER FOUR: RESULT 71

CHAPTER FIVE: DISCUSSION 76

Implications of the study 78

Limitations of the study 80

Suggestions for further studies 80

Summary and Conclusion 81

REFERENCES 83

APPENDICES

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LIST OF TABLES

1. Table 1: The mean scores used in categorizing participants on religious

devotion, self-efficacy and psychological distress

2. Table 2: Means (ẋ) and Standard Deviation (SD) of Religious devotion,

Self efficacy and Prisoners’ status on the prison inmates manifestation of

psychological distress.

3. Table 3: A 2 x 2 x 2 ANOVA Summary Table showing the influence of

Religious devotion, Self- efficacy and Prisoners status on the prison

inmates’ manifestation of psychological distress.

4. Figure 1: Graphical representation of religious devotion on prison inmates

in manifestation of psychological distress.

5. Figure 2: Graphical representation of self efficacy on prison inmates in

manifestation of psychological distress.

6. Figure 3: Graphical representation of prisoners’ status on prison inmates in


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ABSTRACT

The study investigated the Influence of religious devotion, self-efficacy and prisoners’

status on the prison inmates manifestation of psychological distress among three hundred

and ninety nine (399) prison inmates drawn from Medium Security Prison Kuje in Abuja

Federal Capital Territory. Three instruments were used for data collation in this study:

Religious Affiliation Scale, General Self-Efficacy Scale and General Health Questionnaire-

12. A 3-way analysis of variance was used for data analysis and the result showed that

religious devotion produced significant main effect on prison inmates manifestation of

psychological distress F (399 = 4.30, P < .05). The result also indicated that self-efficacy

produced significant main effects on the inmates manifestation of psychological distress F

(399 = 9.76, P <.05). Prisoners’ status also produced a significant influence on the inmates

manifestation of psychological distress F (399 = 24.17, P <.001). Further, self-efficacy and

prisoners’ status produced an interaction effect on the prison inmates manifestation of

psychological distress F (399 = 4.08, P <.05). The results of the study were discussed, the

implication of the study highlighted and suggestions were made for further study.

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CHAPTER ONE

INTRODUCTION

Prisoners’ characteristics are of considerable diversity, yet they share a

common experience of incarceration. Public Heath (2009) remarked that one of

the outstanding features of prisons in contemporary times is that they contain

people with more than one problem and from more than one culture. Prisons

environment can be harsh, psychologically depersonalizing and dehumanizing.

In addition, the social stigma associated with incarceration combined with the

depersonalizing effects of imprisonment may result in a sense of hopelessness

and powerlessness as well as deeply internalized shame and guilt.

Deprivation of liberty in imprisonment invariably results in deprivation of

choices usually taken for granted in the outside community. Blaauw and Van

Marle (2007) pointed out that once incarcerated, prisoners are no longer free to

decide where to live, with whom to associate and how to spend their time.

Communication with families and friends is limited and often without privacy.

In a developing nation like Nigeria, prison inmates are seldom seen by

their relatives due to distance, prohibitive travel cost and impression that the

inmate has dragged the family name to the mud for being imprisoned. Those on

remand hardly get update on the state of their cases for lack of legal counsel, or

insufficient fund to pay for legal services. Moreover, the court processes are

very slow due to incessant adjournments of proceedings by judges. One of the

agonizing things is that in many instances their case files get lost at the office of

the Director of Public Prosecution (DPP), thus making the inmate to stay in the

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prison for years without going to the court for hearing. In addition to this,

inmate’s inability to support their kids and family among other things serves as

constant sources of anxiety and other related distress.

Prison conditions in Nigeria are generally poor, as food and water are

scarce. The prison cells are overcrowded and most prisons have poor ventilation

system. Prisoners are vulnerable to illness particularly psychological disorder

(Fraser, Gatherer & Haytron, 2009). Buttressing on the state of prisons, Hassan

(2010) pointed out that Nigerian prisons are very congested, and the

development has become a major concern to the prison authorities and other

components of the Criminal Justice System, - the judiciary and police. This is

because over the years, inmates have outnumbered the capacity of prison cells

and facilities at the prison are being overstretched.

Fink (2010) observed that imprisonment is one of the most stressful

human experience and figures high in all comparisons of negative life events.

Holmes and Rahe (1967) stated that a positive correlation was found to exist

between stressful live event and illness. Imprisonment was rated as 4th after

death of spouse, divorce and marital separation in the list of 43 stressful life

events that can contribute to illness.

Traditionally, incarceration was based on punishing those who wronged

society by inflicting suffering of the body similar to “the pound of flesh”

depicted in Shakespeare’s Merchant of Venice. Every generation produces its

own share of persons who must act outside the law. When apprehended, they

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are made to go through the Criminal Justice System (CJS) and end up

institutionalized in prison if found guilty or they are placed on remand.

However, there is a global shift in the philosophy behind imprisonment.

It has shifted from the traditional punitive orientation to correctional orientation.

Ogunleye (2007) pointed out that a prison system that was designed to inflict

harsh punishment would not normally induce any effort at education or training.

Today’s imprisonment is no longer simply intended as an acute form of corporal

punishment, but a method by which to work on a person’s mind as well as his

body, through four exclusive areas which include safe custody, reformation,

rehabilitation and re-integration.

These four imitable areas when interlinked into a single process are

intended to allow society to remove criminals from a position where they may

continue their criminal behaviour, place them into an institution that satisfies the

masses who desire some form of retribution. This quarantine form of approach

will by extension persuade other potential criminals that such activities are not

beneficial. Thus, this in time will shape them into productive and law abiding

citizens through positive psychological conditioning of which they will later be

re-integrated back to the society (Orakwe, 2010). In theory, such idea fairs well,

but unfortunately in a developing nation like Nigeria, a large range of negative

psychological experiences encountered within prison do not have adequate

potentials to lead to this otherwise well thought out plan.

Nigerian Prisons Service Authority recognized that a significant number

of prisoners have psychological problems owing to congestion, over stay,

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inadequate food and medicare, among other things. This necessitated the

creation of a specialized unit called Psychological/Mental Health Care Services

(The Reformer, 2006). The unit is within the Health/Social welfare services

Directorate of the Nigerian Prisons Service. One of the major goals in the

interim is to compliment the prisons health care service delivery. Psychologists

in this unit work with other medical personnel in the assessment, diagnosis and

treatment procedures within an integrated health system.

Progress has been made as one consultant psychiatrist, sixty (60)

psychologists and about 56 psychiatric nurses have been enlisted into the service

to attend to the psychological/mental health care needs of the ever increasing

prison inmates population which stood presently at 54,156 (Nigerian Prisons

Service, 2007, 2012; & Akorede, 2012). This is in line with Section 49 of United

Nations Standard Minimum Rule for the treatment of prisoners which stipulates

that prison personnel should include so far as possible sufficient number of

specialists like psychiatrists, psychologists, social workers, teachers and trade

instructors (United Nation Organization, 1977).

Furthermore, going by the numerous inadequacies in the prison, the

adaptation to imprisonment is almost always difficult and at times creates habits

of thinking and acting that can be dysfunctional in the periods of post-prison

adjustment. At the very least, prison is painful, and incarcerated persons often

suffer long term consequences from having been subjected to pain, deprivation,

and extremely a typical patterns and norms of living and interacting with others.

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However, the psychological effects of incarceration are likely to vary

from individual to individual. Not everyone who is incarcerated is disabled or

harmed psychologically. Some people are completely unchanged or unscathed

by the experience while the reverse is the case for others. Similarly, Agoha and

Ilobi (2010) pointed out that not every one who is exposed to high stress

becomes ill. According to them, this may be due to the modulatory influences of

other factors such as personality, gender, and the social network of the

individual. Similarly, De Viggiani (2007) argues that prisoners’ health is

influenced as much by structural determinants (institutional, environmental,

political, economic and social) as it is by the physical and mental constitution of

the prisoners themselves. A prisoner’s health may therefore be better understood

with greater insight into how people respond to imprisonment, the psychological

pressures of incarceration, the social world of prison, being dislocated from

society, and the impact of the institution itself with its regime and architecture.

Even researchers who are openly skeptical about whether the pains of

imprisonment generally translate into psychological harm concede that, for at

least some people, prison can produce negative, long lasting change (Bonta &

Gendrean, 1990). The more extreme, harsh, dangerous, or otherwise

psychologically tasking the nature of the confinement, the greater the number of

people that will suffer and the deeper the damage they will experience. This

automatically leads to manifestation of psychological distress at various levels.

The concept of psychological distress is elusive because it is poorly

defined, though it is a concept which is familiar to both layman and professional

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alike. Decker (1997), Burnette and Mui (1997) conceptualized psychological

distress as lack of enthusiasm, problems with sleep (trouble falling asleep or

staying asleep), feeling downhearted or blue, feeling hopeless about the future,

feeling emotional (for example crying easily or feeling like crying) and feeling

bored or loosing interest in things and thoughts of suicide. Lerutla (2000) also

defined psychological distress as the emotional condition that one feels when it

is necessary to cope with unsettling, frustrating or harmful situation.

From all these definitions, one can infer that psychological distress is the

deviation from some objectively healthy state of being. It implies maladaptive

patterns of coping. It is mild psychopathology with symptoms that are common

in the community. It is negative feelings of restlessness, depression, anger,

anxiety, loneliness, isolation and problematic interpersonal relationships.

The existence of psychological distress has been recognized for thousands

of years ago. Kovacs and Beck (1978) state that even a 3,900-year old Egyptian

manuscript provides a distressingly accurate picture of the suffers: pessimism,

his loss of faith in others, his inability to carry out the everyday tasks of life and

his serious consideration of suicide. These historical descriptions are congruent

with some of present accounts of the phenomenon of psychological distress.

Psychological distress which is as a result of incarceration may represent

significant impediments to the inmate’s reformation, rehabilitation and post

prison adjustment. Psychological distress may interfere with the transition from

the prison to home, impede an ex-convict’s successful re-integration into a social

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network and employment setting. It may also compromise an incarcerated

parent’s ability to resume his or her role with family and children.

It is therefore very difficult to quantify the impact of psychological

distress in emotional terms but the suffering it causes is undeniable, and affects

individuals, families and entire communities. In a community like prison yard,

the psychological distress which the prison inmates suffer usually make them to

reject their daily ration, avoid participating in the gang duties, and other

recreation activities in the yard. In addition to this, there is the cost of providing

care, the loss of productivity, and some legal problems including the potential

for violence associated with some mental disorder. Umeh (2008) pointed out that

psychological distress impairs individual well-being as well as social and

occupational functioning.

In the same vein, Rutherford and Duggan (2009) remarked that the impact

of prison upon prisoners is largely destructive. There are real dangers that prison

will cause mental and physical health to deteriorate further. They went further to

state that life and thinking skills will be eroded, and that prisoners will be

introduced, or have greater access to drugs. Petersilia (2003) also estimated that

one in six prison inmates have a mental illness; and that depression is the most

prominent among them.

One of the major variables that are of interest to the present study is

religious devotion. Religion has long been considered as an important force in

shaping social life. Faith is as old as humankind itself. For a considerable time,

psychiatrists, psychologists as well as other mental health team have largely

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neglected this important area of human experience. Sims (1994) in his

Presidential valedictory lecture criticized psychiatrists and other related

professionals for ignoring the spiritual dimension of their patients. He

emphasized the need for these professionals to understand their patients who

often take spiritual issues seriously. Connelly (1996) pointed out that religion

originates in an attempt to represent and order beliefs, feelings, imaging and

actions that arise in response to direct experience of the secret and the spiritual.

He went further to state that as this attempt expands in its formulation and

elaboration; it becomes a process that creates meaning for itself on a sustaining

basis, in terms of both its originating experiences and its own continuing

responses.

In the same vein, Williams and Sternthal (2007) postulated that religion

tends to refer to aspects of belief and behaviour, including spirituality that are

related to the sacred or supernatural and are grounded in a religious community

or tradition. Similarly, Kiernan (1995) described religion as a mode of

transcending everyday experience, a way of rising above the routine ways, a way

of communicating with an order of being at a remove from the limitations of

space and time. Through transcending experience, religion explains anomalies

and dilemmas out of experience, which are resistant to rational and empirical

resolution. In other words, it provides a problem-solving mechanism or

technique and it gives wisdom. Religion therefore, in the words of Adamu

(2006) is a response of human beings to the human conditions.

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Religion has both positive and negative effects on health (Ferraro &

Albrecht-Jense, 1991). Verghese (2008) pointed out that religion is important,

directly and indirectly in the etiology, diagnosis, sympomathology, treatment

and prognosis of psychiatric disturbances. Religion according to Freud (1961) is

a form of mass neurosis. It exists only as a response to deep emotional conflicts

and weakness. Freud pointed out that since religion is nothing but a by-product

of psychological distress, it should be possible to eliminate the illusion of

religion by alleviating that distress. Dawkins (2006) also argued that religious

belief often involves delusional behaviour. Similarly, Harris (2004) likened

religion to a form of mental illness. He stated that religion allows otherwise

normal human beings to reap what he called fruits of madness.

Koenig (2007) pointed out that some people may develop feelings of

excessive guilt and condemnation because of religion. For instance many parts

of religious writings describe God’s judgments for sin. Those who focus on

these writings may overlook the numerous scriptures that portray God’s

forgiveness. These religious adherents who do not feel they meet God’s

standards may experience distress associated with striving to be virtuous (Exline,

2002). In the same vein, Ellison, Burdette and Hill (2009) emphasized that

anxiety about judgment for sin, prophecies of future events, the rising of the anti

Christ, and other issues may trouble some religious adherents. Also, strong

beliefs in the pervasiveness of sin have been positively linked with anxiety and

other mental health problems.

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Jarvis and Northcolt (1987) also stated that religious involvement can

produce adverse effects on health through endogamous marriage customs or

ritual participation in unhealthy practices and ritual suicide. A typical example of

the ritual suicide is Jim Jones and the people’s temple in Jones town in Guyana,

USA were over 200 children were forcibly made to ingest cyanide by the elite

temple members. This incident in Guyana ranks among the largest mass suicides

in history. Similarly, Levin and Markides (1985) studying older Mexican-

Americans speculated that guilt from trying to follow strict religious norm may

have been the reason that those who were more religious showed a higher

prevalence of hypertension.

Yeung and Chan (2007) pointed out that the postulations of Freud and

other mental health scholars concerning the neurotic influences of religion have

had an enormous impact on the field of mental health in the 20th Century. Freud

had been skeptical, if not antagonistic towards religion. Freud (as cited by Ellis,

1980; 1988) suggested that the less religious people were more mentally healthy.

In the same vein, religious beliefs were responsible for the development of low

self-esteem, depression and even schizophrenia (Watters, 1992). During much

of the 20th Century, mental health professionals tended to either deny the

religious aspects of human life or consider religiousness as old-fashioned or

pathological. They anticipated that religious issues would disappear as mankind

matured and developed.

In the same vein, Ferraro and Albrecht-Jensen (1991) pointed out that

some religious groups such as Jehovah’s Witnesses may discourage blood

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transfusion or other types of medical treatment. Though, they went further to

state that most of these adverse effects of religion on health are not likely to

occur in the main stream line American denominations which the majority of the

populations identifies with.

Nevertheless, numerous studies have reported that religiosity has a

positive impact on mental health or psychological wellbeing of people

(Crawford, Paul, & Richard, 1989; Ellison, David, & Thomas, 1989). Research

has pointed out that many people who were not religious previously might turn

to religion for comfort when they experience great stress as a result of the

changes in life caused by adverse conditions they are undergoing (Koenig, 2001;

Koenig & Larson, 2001). This often involves in beliefs in a living and caring

God, private religious activities, reading scriptures for direction and

encouragement, or looking for support from religious leaders like pastors, Imam

or members of faith community. In fact, many studies commonly reported that

religiousness was powerful resources of help, meaning and purpose in life,

comfort and solace. These protective and beneficial effects are particularly

strong in people with illness and disability (Ehman, & Oh, 1999; King, 2000;

Koenig, George, & Titus, 2004).

Religion may provide a respite from the deprivation that pervades prison

life. By attending religious houses (Chapel or Mosque) inmates are able to leave

the monotony of their cell and enter the protective social cocoon of religion.

Religion therefore is seen as support structure that facilitates socialization. In

these religious houses, they can find other inmates who wish to avoid the

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dysfunction that plagues many prison relationships and associate with others

with similar values.

Another variable that is of great interest in this present study is self-

efficacy. Self-efficacy is conceptualized within the frame work of Bandura’s

(1977) social cognitive theory, as one’s capacity to mobilize the motivation,

cognitive responses and courses of action needed to meet given situational

demands. It is the degree to which a person believes that he or she can attain a

goal. People who regard themselves as highly efficacious act, think, and feel

differently from those who perceive themselves as inefficacious. They produce

their own future, rather than simply foretell it.

The key contentions as regards the role of self-efficacy beliefs in human

functioning are that peoples level of motivation, affective states, and actions are

based more on what they believe than on what is objectively true

(Bandura,1977). For this reason, how people behave can often be better

predicted by the beliefs they hold about their capabilities than by what they are

actually capable of accomplishing. The act of self-efficacy towards a specific

situation is different from self esteem, which is a general regard for one’s overall

worth. Someone with very high self-efficacy in a task is more likely to make

more of an effort, and persist longer than those with low efficacy. Bandura

(1977) also pointed out that the stronger the self-efficacy or mastery expectation,

the more active the effort. Recognizing self-efficacy as the degree to which one

feels he or she is capable of attaining his or her goals, Friestad, Lise and Hansen

(2005) noted that it is important to explore the issue of self-efficacy and mental

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health in an offender population because the relationship between these factors

has important ramifications for successful re-entry to the community.

The level of self-efficacy plays a great role in a person’s state of health.

Bandura, Ress and Adams (1982) pointed out that self-efficacy plays a vital role

in mediating the stress-induced immune suppression and physiological changes

such as blood pressure, heart rate and stress hormones. This was supported by

Ifeagwazi and Oguizu (2006) that people with low self-efficacy usually obtain

higher mean arterial blood pressure scores than people with high self-efficacy.

Health behaviours such as non-smoking, physical exercise, dieting,

condom use, dental hygiene, seat belt use, or breast self-examination are, among

others, dependent on one’s level of perceived self-efficacy (Conner & Norman,

2005). Self-efficacy beliefs are cognitions that determine whether health

behaviour change will be initiated, how much effort will be expended, and how

long it will be sustained in the face of obstacles and failures. Self-efficacy

influences the effort one puts forth to change risk behaviour and the persistence

to continue striving despite barriers and setbacks that may undermine

motivation.

The third variable that is of interest in this study is prisoners’ status. In

many countries like Nigeria, prison inmates are broadly classified into two

namely convicts (sentenced) and awaiting trial. A prisoner on remand (awaiting

trial) is someone who is imprisoned before the start of or during his or her trial.

WiseGeek (2011) pointed out that because awaiting trial inmate has not been

formally tried or convicted, he or she is presumed to be innocent under the

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principles of many legal systems, and therefore the prisoner is entitled to special

benefits and treatment which are not offered to regular prisoners. Being a

prisoner on remand can still be stressful and emotionally distressing. However,

as such prisoners may feel like they are being punished despite the fact that they

have not been convicted. A correctional publication, Justice and Prison (2011)

reported that pre-trial detainees represent over 75% of all prisoners. These

include Liberia (97%), Mali (89%), Haiti (84%), Bolivia (75%), Mozambique

(73%), India (70%), Peru (68%). The statistics is not different in Nigeria, where

70.82% prison inmates are on awaiting trials (Nigerian Prisons Service, 2012).

These high rates are particularly common in post conflict countries where

the Criminal Justice System (CJS) does not function effectively. Pre-trial

prisoners are not being held in detention as a punishment and international

regulations make a number of rules which protect their special status. The law

in many countries states that detainees who have not yet been convicted must

always be treated as innocent. Although paradoxically in practice, in many

countries pre-trial prisoners are kept in the worst conditions and do not have

access to the same services or contacts with the outside world as do convicted

prisoners.

The consequences of lengthy remand can be significant. Their detention

while on awaiting trial can be lengthy. Sometimes it ends up longer than the

sentence would have been if the accused were found guilty. Prisoners whether

convicted or on awaiting trial are removed from families, friends and work for a

considerable amount of time. They may lose their jobs and perhaps their

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families. They may contract an infectious disease while in prison and spread it

to their families on return. All prisoners are vulnerable to a certain degree.

When the liberty of a group of individual is restricted and they are placed under

the authority of another group of people, and when this takes place in an

environment which is to a large extent closed to public scrutiny, the abuse of

power has proven to be widespread (United Nation Office on Drug and Crime,

2009).

Akinnawo (1993) reported that more than 20% of prison inmates in

Nigeria manifest high level of psychopathological symptoms, which he

attributed to the effects of incarceration on their mental health. The prevalence

ranges from 20.86% for depression, to 35.29% for general mood disorder,

32.62% for intellectual disorder, while head disorder is 31.03%. This statistics is

not different from other African countries like in South Africa, where, Naidoo

and Mkize (2012) reported that 55.4% of prisoners had an Axis 1 disorder. The

commonest disorders being substance and alcohol use disorder (42.0%).

Even in some developed nations the situation is the same. One out of 10

prisoners in custody in Australia visited the clinic for a psychological or mental

health issue, and 1 in 5 prisoners in custody was taking mental health related

medications (Australian Institute of Health and Welfare, 2011). When looking

at the type of medications, 18% of all repeat medication was for

depression/mood stabilizers, 9% for anti psychotic, 2% for anti-anxiety

medication and 1% for sleep disturbance. It equally reported that almost 3 in 10

prisoners had high or very high level of distress.

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In the same vein, a publication by the United Kingdom based Institute of

psychiatry, Research Review (1998) reported that from a prison population of

approximately 65,000 (in England and Wales), an estimated 66% of the remand

population are thought to have some form of mental health problem compared

with 39% of the sentenced population.

STATEMENT OF THE PROBLEM

Nigerian prisons service exists for the safe custody, reformation,

rehabilitation and reintegration of inmates back to the society. For adequate

implementation of these core mandates, the plan is for every prison in Nigeria to

operate with the full complement of legal, vocational, educational, religious,

health and social services but the situation has remained pathetic. In the Nigerian

prison system, prisoners are faced with problems of poor chaplaincy

programmes, low self efficacy and self worth as a result of stigma associated

with imprisonment. There are also problems of congestion, poor medicare, long

remand, over-stay and deplorable prison condition to mention but a few.

As a result of this, the researcher wish to seek answers to the following

problems:

1. Will religious devotion influence prison inmates’ manifestation of

psychological distress?

2. Will self-efficacy influence prison inmates’ manifestation of


3. Will there be status difference in the prison inmates’ manifestation of


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PURPOSE OF THE STUDY

The researcher intends to investigate the influence of religious devotion, self-

efficacy and prisoners’ status on prison inmates’ manifestation of psychological

distress. Specifically, the study is designed to find out whether:

1. Religious devotion will significantly influence manifestation of psychological

distress among prisoners.

2. Self-efficacy will significantly influence the manifestation of psychological

distress among prisoners.

3. Prisoners’ status will significantly influence prisoners’ manifestation of


OPERATIONAL DEFINITION OF TERMS

Religious devotion: Religious devotion in this study refers to the level of ones

involvement/commitment or attachment to his or her religion as indexed by;

frequency of attendance and participation in religious activities, religious

conviction and how it guides one’s action. This is measured using Religious

Affiliation Scale (Omoluabi, 1995).

Self-efficacy: Self-efficacy in this study refers to the believe in ones capabilities

to achieve a goal or outcome. This is measured using General Self Efficacy

Scale (Schwarzer & Jerusalem, 1995).

Prison inmates: This refers to all persons legally interned at Kuje prison, Abuja.

Prisoners’ status: This refers to convicts and awaiting trial prison inmates.

Psychological distress: Psychological distress in this study refers to

psychopathology that mark an individual’s deviation from objectively healthy

28

state as measured by General Health Questionnaire (GHQ-12) (Goldberg &

Williams, 1988) with higher scores indicating higher psychological distress.

29

CHAPTER TWO

LITERATURE REVIEW

Theoretical Review

This is discussed under eight theoretical perspectives:

Cognitive Theory

Medical (or Disease) Model

Psychodynamic Theory

Interpersonal Theory

Behavioural Theory

Social Model

Stress vulnerability Model

Bio-psychosocial Model

Cognitive Theory: (Albert Ellis, 1962)

According to this model, abnormal behaviour is caused by abnormal

thinking processes. Ellis (1962) proposed that humans develop irrational

beliefs/ goals about the world; and therefore, create disorders in cognitive

abilities. We interact with the world through our mental representation of it. If

our mental representations are inaccurate or our way of reasoning is inadequate

then our emotions and behaviour may become disordered (McLeod, 2008,

Barlow & Durand, 1999). Put simply, the cognitive model posits that people

interpret their thoughts, which in turn are the main determinants of behaviour

(Tyrer & Steinberg, 1998). Therefore, negative and unrealistic thoughts can

cause us distress and result in problems. When a person suffers with

30

psychological distress, the way in which they interpret situations becomes

skewed, which in turn has a negative impact on the action they take (McLeod,

2008). The essence of this model is that emotional difficulties begin when the

way we see events gets exaggerated beyond the available evidence, this manner

of seeing things tend to have a negative influence on feelings and behaviour in a

vicious cycle (Mabitsela, 2003).

For the cognitive therapist primacy is given to errors or biases in thinking

and it is these dysfunctional thought patterns that create mental disorders. An

important framework used by many cognitive therapists is the ABC model first

described by Ellis (1962). In this model ‘A’ stands for ‘’activating events”, ‘B’

stands for ‘beliefs’ about the ‘activating events’, and ‘C’ stands for the

emotional or behavioural ‘consequences’ that follows ‘B’, given ‘A’.

Medical (or Disease) Model

The medical model is a prevailing view of pathology in the world

(Novello, 1999; Kaplan & Sadock, 1998). Kendall (1975) reviewed disease

definitions in mental health, which ranged from the purely subjective (for

example, personal suffering) to the purely objective (for example, the presence

of an identifiable pathogen). Scadding (1967) described disease as the presence

of abnormal phenomena displayed by a group within a species, which sets the

group apart from its species in so far as the disease places them at a biological

disadvantage. Therefore, a disease is only present if it harms the individual or

reduces his or her capacity to produce (Tyrer & Steinberg, 1998).

31

Disease theorists attribute mental disorders, to physiological and chemical

changes in the individual, particularly in the brain but also in other parts of the

body (Tyrer & Steinberg, 1998). This helps us to understand clearly the basis for

disorders of perception and cognition among some people, for example people

with dementia or those who have suffered brain injuries. Observable

physiological changes in brain structure have correlates in human behaviour.

The disease model extends beyond these organic conditions to explain disorders

such as depression, which can be attributed to changes in serotonin levels or to

some other chemical fluctuation. Similarly, schizophrenia can be attributed to

chemical abnormalities, and more recently to physiological differences such as

the size of the temporal lope in the human brain (Gournay, 1996). Psychological

distress is regarded as a disease in the same category as any other physical

illness, this model uses similar model in defining psychological distress as that

used by medical practitioners. In other word, psychological distress is some

form of neurological defect responsible for the disordered thinking and

behaviour and requires medical treatment and care. (Carson, Butcher, &

Mineka, 1996).

The disease model, following traditional medicine, endeavours to identify

through scientific objectivity the presence of a stable phenomenon called

“mental illness’’. Clinical syndromes become refined into diagnoses, which are

essentially codes for heterogeneous, and often unstable collection of symptoms

(Craig, 2000). The treatment armoury of the disease theorist is elitist, being

available only to the qualified practitioner. Medicines are prescribed to balance

32

chemical imbalances, electroconvulsive therapy is administered to shunt neural

pathways into shape, position emission tomography may be requested to check

those temporal lobes and, in the most extreme of cases pieces of the brain may

be removed.

Psychodynamic Theory: (Sigmund Freud, 1856-1939)

Different theories have been put forward within the psychodynamic

tradition to explain different human experiences, but the founding father of the

psychodynamic school was Sigmund Freud (1856-1939). Traditional

Psychoanalytic models look at pathology (psychological distress) from an

intrapsychic view. They emphasize the role of unconscious processes and

defense mechanism in the determination of both normal and abnormal

behaviour. Tyrer and Steinberg (1998) pointed out that the psychodynamic

model is more accurately described as a style of human interaction and

understanding that draws on a broad philosophy, which includes clinical,

biological and evolutionary theory as well as religion and arts. Psychodynamic

practice may conjure an image of the psychoanalyst listening to their patient’s

stream of consciousness as patient lies on a couch at their side.

Common to all psychodynamic approaches, this delineates them from

other psychotherapeutic perspectives (for example, behaviour therapy), is their

primary focus on the ideas and feelings behind the words and actions that

constitute human behaviour. Psychological distresses are not viewed as illnesses

with disease-based aetiologies but as conflicts between different levels of mental

functioning (Ryrie & Norman, 2004). Of critical importance in this model are

33

the conscious and unconscious levels. Substantial amounts of mental activity

that occur beyond our awareness are believed to determine much of our

behaviour.

Ryrie and Norman (2004) remarked that human development is very

crucial in this respect since a person’s early experiences can produce a particular

gestalt or view of the person and their world, which they will take with them into

adult life. This gestalt will include mental tricks and mechanisms to protect the

person’s sense of self. Problems may arise if our gestalt, that we necessarily

cling to, is at odd with the real circumstances we find ourselves in as adult. Box

(1998) and Clair, (1996) also emphasized that early childhood experiences are

imperative in later personality adjustment. In other words, they understand the

expression of a symptom in the present as an extension of past conflicts.

The crux of this model is that psychological distress in a person’s life

may be described as his attempt to cope with present difficulties using past

childhood defense mechanisms, which may seem maladaptive and socially

inappropriate for the present situation.

Interpersonal Theory: (Harry Stack Sullivan, 1892-1949)

According to this theory, a healthy personality is the result of healthy

relationships. Personality develops according to people’s perception of how

others view them. ‘Others’ for Sullivan included personifications, like the

government, as well as imaginary and idealized figures (Sullivan, 1953).

Interpersonal theories attribute difficulties to dysfunctional patterns of

interaction (Carson, Butcher & Mineka, 1996). They emphasize that we are

34

social being, and much of what we are, is a product of our relationship with

others. Psychological distress is described as the maladaptive behaviour

observed in relationships, which is caused by unsatisfactory relationships of the

past or present. Psychological distress is identified when examining the

distressed person’s different patterns of interpersonal relationships (Mabitsela,

2003)

According to this perspective, distress is alleviated through interpersonal

therapy, which focuses on alleviating problems existing within relationships and

on helping people achieve more satisfactory relationships through learning of

new interpersonal skills.

Behavioural Model

The behavioural model has a scientific basis in Learning Theory.

Symptoms are considered to be learned habits from the interaction between

external events or stressors and an individual’s personality. Persistent,

distressing symptoms are considered maladaptive responses rather than being

markers for some underlying disease or illness. For the behaviour therapist the

symptoms and their associated behaviours are the disorder (Tyrer & Steinberg,

1998). Learning theory posits that forms of conditioning are responsible for the

formation of symptoms such as classical and operant conditioning.

Classical conditioning refers to a neutral stimulus that becomes associated

with an unrelated but established stimulus response sequence. Seminal

experimental work in this area was conducted by the Russian physiologist

Pavlov (1927) who conditioned dogs to salivate in response to a bell rather than

35

to the established stimulus of food. Operant conditioning on the other hand,

results from behaviour rather than as the consequence of a stimulus. Skinner

(1972) conducted seminal work in this field with a box in which one or more

levers could be pressed. Rats would be placed in the box and through natural

curiosity they would eventually press one or all the levers. When appropriate

lever was pressed food would be deposited in the box.

But how do these theories relate to the development of human

behavioural problems? Ryrie and Norman (2004), pointed a simple example

involving a phobia or fear of spiders in a parent of a family with children. When

the parents encounter a spider their response may be at odd with threat that

spider poses. They may appear to panic, perhaps scream and will certainly try to

avoid the spider. It is possible that the children in this family will also develop a

similar response since they have been subject to the classical conditioning of the

parents. Thus they may learn to fear and avoid spiders, which can become self-

perpetuating as their fear confirms the danger spiders pose, and their avoidance

obviates any opportunity to realize that spiders pose no threat.

The behaviour therapist is interested in replacing maladaptive responses

with adaptive behaviour patterns. This is usually done by gradually removing the

fear through such techniques as graded exposure and systematic desensitization.

An important principle of behaviour therapy is a collaborative working

partnership between client and therapist. A person’s behaviour is part of their

own responsibility and not something that can be handed over to a doctor to sort

out (Tyrer & Steinberg, 1998). The therapist does not view the person as being

36

abnormal or ill, but regards them as an equal partner in an unlearning or new

learning process. In addition to this, behaviour therapists see this partnership as

critical if the individual is to maintain and develop their new adaptive behaviours

once therapy has finished (Ryrie & Norman, 2004).

Social Model

The social model is concerned with the influence of social forces as the

causes or precipitants of mental disorder. While the psychodynamic model is

principally concerned with the individual and their personal relations, the social

model focuses on the person in the context of their society as a whole (Tyrer &

Steinberg, 1998). Evidence that social forces are central to the aetiology of

mental disorder can be traced to the work of Durkheim (1897) who demonstrated

that social factors, particularly isolation and the loss of social bond, were

predictive of suicide.

At the heart of this model is the premise that we are all prone to mental

disturbance when unpleasant events strike us without warning. This fact led

Holmes and Rahe (1967) to develop the Social Readjustment Rating Scale,

which attributes a severity score to 42 life events according to the degree of

change or adaptation they produce in people. Perhaps not surprisingly,

bereavement, divorce, a new job and imprisonment are high on the list. The

social model provides also a rationale for the origin of other types of

psychological distress in which delusions, hallucinations and an apparent loss of

contact with reality occur. For example, it is known that unexpected life events

are associated with the onset of schizophrenia (Brown & Birely, 1968).

37

Furthermore, the levels of critical ‘expressed emotion’ experienced by a person

with schizophrenia from family members are predictive of the severity of the

person’s condition and, in particular, the likelihood of relapse (Fallon, 1995).

Proponents of the social model do not have fixed ideas about what

constitutes a psychiatric illness. Indeed, the model is concerned that labeling

people with a psychiatric illness may create a disorder itself (Tyrer & Steinberg,

1998). All symptoms and behaviour have to be understood in the context of the

society from which they emanate. There are no independent, objective criteria

for mental disorder according to the social model, only a boundary line between

normal and abnormal that has been set by society. Supporters of the model aim

to help people take up an acceptable role in society once more, rather than

correct a chemical imbalance or recondition specific behaviours (Tyrer &

Steinberg, 1998). This may involve social skills training (Liberman, Wallance &

Blackwell, 1993), some systematic family therapies (Barker, 1981) and more

general family interventions involving education on the influence of critical

“critical expressed emotions” (Brooker & Butterworth, 1991; Fallon, 1995).

Stress Vulnerability Model: (Zubin & Spring,1977)

This is an integrated model developed by Zubin and Spring (1977) to

specifically explain the aetiology of schizophrenia. Incorporating all other

models, it has as its common denominator the relationship between stress and

vulnerability. Stress is the variable that influences the manifestation of

symptoms and a person’s vulnerability represents their predisposition to such

manifestations (Ryrie & Norman, 2004). Two types of stress are at play here.

38

One is known as ambient stress and reflects the general concerns and pressures

that we all face in our everyday lives, while the second one refers to stress that

arises from life events as listed by Holmes and Rahe’s (1967) Social

Readjustment Rating Scale.

Similarly, there are two types of vulnerability. The first is inborn and will

include genetic loading and the neurophysiology of the person. The second is

acquired and will be specific to an individual’s life experiences but may include

prenatal complications, maladaptive learned behaviours or thought patterns, and

adolescent peer interactions (Zubin and Spring, 1977). Their central hypothesis

is that the interface between an individual’s vulnerability and the stress they

experience in the course of their lives is the basis for the development or

otherwise or schizophrenic symptomatology. There will, of course, be a range of

vulnerabilities in any population, with some people being extremely prone to

illness even when experiencing relatively mild levels of stress, to those whose

vulnerability is so low that they are able to tolerate high levels of stress for

significant periods without any trace of psychiatric symptoms (Zubin & Spring,

1977). This model had considerable impact in the field of mental health care, as

it offers hope to those who experience mental disorders because it suggests that

coping mechanisms can be acquired to counter the effects of stress and thus

reduce the risk of continued illness or relapse (Ryrie & Norman, 2004).

39

Bio-psychosocial Model (Engel George, 1977)

This is an interdisciplinary model which posits that biological,

psychological and social factors all play a significant role in human functioning

in the context of disease and illness. Indeed, health is best understood in terms of

a combination of biological, psychological and social factors rather than purely

in biological terms (Santrock, 2007). This is contrast to the traditional,

reductionist biomedical model of medicine that suggests every disease process

can be explained in terms of an underlying deviation from normal function such

as a pathogen, genetic or developmental abnormality or injury (Engel, 1977).

The biological component of the bio-psychosocial model seeks to

understand how the cause of the illness stems from the functioning of the

individual’s body. The psychological component of the bio-psychosocial model

looks for potential psychological causes of health problem such as lack of self-

control, emotional turmoil, and negative thinking. The social part of the model

investigates how different social factors such as socio-economic status, culture,

poverty, technology, and religion can influence health.

The bio-psychosocial model presumes that it is important to handle the

three together as a growing body of empirical literature suggests that patients

perceptions of health and threat of disease, as well as barriers in a patient’s

social or cultural environment, appear to influence the likelihood that a patient

will engage in health-promoting or treatment behavior, such as medication

taking, proper diet or nutrition and engaging in physical activity (Di Matteo,

40

Haskard & Williams, 2007). Psychological factors can cause a biological effect

by predisposing the patient to risk factors. A typical example is that depression

by itself may not cause liver problems but a depressed person may be more

likely to have alcohol problem, and therefore liver damage. Perhaps, it is this

increased risk-taking that leads to an increased likelihood of disease.

EMPIRICAL REVIEW

Relevant empirical works were reviewed under three sections: Religious

devotion and Psychological distress; self-efficacy and psychological distress;

prisoners’ status and psychological distress.

Religious devotion and Psychological Distress

Ferraro and Albrecht-Jensen (1991) examined the effect of religion on

health status. In this study, particular attentions were given to assessing the

effects of religious affiliation and religiosity (especially practice) on subjective

health status. The population sampled included all English- speaking, non

institutionalized adults who are 18 years old and above in the United States of

America. Respondents were asked for their religious affiliation during

childhood. A dummy variable for a stable religious affiliation was then created

to determine if lifelong affiliation were associated with better health. Factor

analysis of the religiosity items available revealed that three dimensions –

practice, experience and ideology – were considered in the work.

An addictive index of 4 items was created for religious practice. It had an

alpha reliability coefficient of .77. Single-item indicators were used for the

experiential and ideological dimensions of religiosity which are: closeness to

41

God and life after death. On the other hand, health status was measured with

three self-reported items. Two of the items were fairly subjective rating of

health, while the third measured the recency of a hospitalization or disability

episode. Addictive index of these items had a reliability of .70. In order to

consider other sources of social participation, this study used secular group

membership as a control for the social support offered by a membership in any

group. Controlling for this extra social support allowed the researcher to see the

effect religion has on health. They included a control variable for life trauma in

the study because of the negative effect stress may have on physical and mental

health assessment. The analysis began by examining differences in the

dependent variables between the two surveys. Multiple regressions of the

dependent variables on the relevant predictors and a dummy variable

distinguishing the 2 years revealed no significant differences over time.

Result of the study revealed that regardless of one’s religious affiliation

and the intensity of one’s beliefs, higher levels of practice are related to better

self-reported health status (the degree to which they pray and practice service –

were significantly related to better health status, regardless of age). They also

pointed out that there is a significant negative effect of conservative religious

affiliation on health (poorer health).

In another related study, Glenn (1997) examined the question of whether

or not commitment to religious beliefs is associated with better mental health.

The research was conducted at Johnson County, a rural valley in Tennessee. The

county has only one incorporated town named Mountain city with a population

42

of 2,139 (in 1990). A systematic sample of households was taken from a list of

addresses. The county was divided into seven sub-regions and every person in

30 to 50 households in each sub region was interviewed. Residents that were 15

years of age or younger were interviewed by proxy through an adult living in the

household.

Though 541 residents were initially selected for the research but 367

residents were finally used after some dropped voluntarily while others failed to

respond to quite number of questions. The interviews were conducted by

researchers, teachers, students and staff as part of an inter disciplinary rural

health care curriculum conducted on site in Johnson county. The students and

teachers were from the medical, nursing and public health schools of the East

Tennessee State University. Both the students and staff were trained on

interviewing technique and were equally familiarized with the survey. The

interview was conducted using a 48-item survey, which included the Duke

Health Profile (DHP) and selected items from the National Health Interview

(NHI). The result of the analyses indicated among other things that there is a

definite relation between religiosity and mental health in the study population

with mental health improving as the personal importance of religion increases.

Similarly, Chatters, Bullard, Taylor, Woodward, Neighbors and Jackson

(2008) examined the religious correlates of psychiatric disorders of 837 African

- American aged 55 years and above. Religious correlates of selected measures

of life time DSM-IV psychiatric disorders (i.e. panic disorder, agoraphobia,

social phobia, generalized anxiety disorder, obsessive compulsive disorder, Post

43

Traumatic Stress Disorder (PTSD), major depressive disorder, dysthymia,

bipolar I and II disorders, alcohol abuse/ dependence, and drug abuse) were

examined. The DSM-IV World Mental Health Composite International

Diagnostic Interview (WMH-CIDI) was used to assess mental disorders.

Measures of functional status (mobility and self-care) were assessed using the

World Health Organization Disability Assessment Scheduled-second version

(WHODAS-II). Measures of organizational, non-organizational and subjective

religious involvement, number of people doctors diagnosed of physical health

conditions and demographic factors were assessed. The interviews were face-to-

face and conducted within respondents’ homes. The overall response rate was

72.3%. Multivariate analysis found that religious service attendance was

significantly and inversely associated with the odds of having a life time mood

disorder.

Ayeni (2011) in a related study investigated religious correlates of some

selected psychological distress (depression, anxiety, somatization, paranoid

ideation and psychotic disorder). The researcher also examined the gender

differences in the level of selected psychological distress and religiosity. A total

of 50 participants comprising of (25 males and 25 females) aged 19 to 48 years

(mean=36.30, SD=8.36), who were psychiatric outpatients from Lagos State

University Teaching Hospital (LASUTH) were used for the study. The

convenience and purposive random sampling techniques were used in selecting

the participants.

44

The following instruments were used by the researcher, Biographic

Information Questionnaire (BIQ), Religious Affiliation Scale (RAS), Religious

Trust Scale (RTS), Religious measures scale (RMS) and Symptom Check List-

90 (SCL-90). All the patients’ case files in the Psychiatric Unit were given to the

investigator for identification and separation of those patients suffering from the

targeted disorders (i.e. anxiety, depression, paranoid ideation and psychoticism).

The participants were randomly selected and the assessment was conducted in

groups. Statistical package for the Social Sciences (SPSS) was used for analysis

of the data after collection and scoring. He equally employed the following

statistics for the analysis: t- independent test, Pearson product moment

correlation, one – way ANOVA, apart from computing mean scores, standard

deviation and age ranges. The result showed that the low religious group had the

highest mean scores in all the measures of Symptom Check List-90 (SCL- 90)

except in measure of somatization indicating that the low religious group has

more level of depression, anxiety, paranoid ideation and psychoticism than high

religious group.

These findings is consistent with the study done by McGloshen and

O’Bryant (1988); McCure and Loden (1982); Koeing, 2001; Magana and Clark

(1995); Coke (1992); Koenig , George, Meador, (1994); Ho, Woo, and Lau,

(1995), which indicated that the more time spent on religious activities, the

higher life satisfaction/ happiness. These findings demonstrated that religiosity

has a protective effect against the development of psychological distress.

45

Ahrens, Abeling, Ahmad and Hinman (2010) examined the relationship

between religious coping and mental health outcomes among survivors of sexual

assault. A total of 103 female rape survivors were recruited from Long Beach,

California and were interviewed about their post assault experiences.

Recruitment procedures involved a modified form of adaptive sampling

(Campbell, Sefl, Wasco, & Ahrens, 2004) that involved systematic sampling

from locations frequent by women during their daily lives (e.g. churches,

Laundromats, coffee shops). The distribution of posters, brochures, and in-

person presentations was tracked on a zip code map to ensure breadth of

coverage. Depth of coverage was achieved by engaging in intensive recruitment

efforts in areas with high concentrations of traditionally overlooked populations

(e.g. women of colour, low-income neighbours). Interested participants called

the phone number listed on the posters and brochures. Screening procedures

involved identifying rape survivors who were at least years old and whose most

recent rape occurred after age 14. Interviews lasted an average of 2.64 hours

(SD=50.45), and participants received $30 for their time. The interview was

designed to cover a range of topics about rape survivors’ experiences of

violence, post assault help seeking, use of coping strategies, and health

outcomes. Instruments used in the study include, Religious coping Activities

Scale (RCOPE), Centre for Epidemiologic Studies -Depression Scale (CES-D),

Post Traumatic Diagnostic Scale (PTDS), the Positive Affect Subscale of

Kammer and Flett’s (1983) Affectometer 11 was used to measure psychological

46

well-being while the Post Traumatic Growth Inventory (Tedeschi & Calhoun

(1996) was used to measure post traumatic growth.

To determine whether ethnic differences in the use of religious coping

exist, a multivariate analysis of variance (MANOVA) was used to examine mean

differences in each of the six types of religious coping. They equally employed

hierarchical linear regression to determine the impact of religious coping on

mental health. The result of the analysis shows among other things that sexual

assault survivors engage in fairly high levels of religious coping. They also

observed that sexual survivors who use greater amounts of positive religious

coping experience higher levels of psychological well-being. They concluded

that viewing God as a source of protection may provide solace following an

assault.

Similarly, Ramirez, Macedo, Sales, Figueiredo, Daher, Arujo, Pargament,

Hyphantis and Carvalho (2012) in a cross-sectional study evaluated the

relationship among religious coping, psychological distress and health related

quality of life (HRQoL) in patients with End stage renal disease (ESRD). They

assessed whether positive religious coping or religious struggle was

independently associated with psychological distress and health-related quality

of life (HRQoL) in hemodialysis patients. They recruited a random sample of

170 patients who had End stage renal disease (ESRD) from three outpatient

hemodialysis units. Socio-demographic and clinical data were collected. Patients

completed the Brief RCOPE, the Hospital Anxiety and Depression Scale

47

(HADS) and the World Health Organization’s Quality of Life instrument-

Abbreviated version (WHOQOL- Brief).

Result of their analysis revealed that positive or negative religious coping

strategies were frequently adopted by hemodialysis patients to deal with ESRD.

Religious struggle correlated with both depressive (r=0.43: P<0001) and anxiety

(r=0.32: P<0001) symptoms. These associations remained significant following

multivariate adjustment to clinical and socio-demographic data. Positive

religious coping was associated with better overall, mental and social relations.

These associations were independent from psychological distress symptoms,

socio-demographic and clinical variables.

These findings supported the findings of Manfredi and Picket (1987);

Meyer, Altmaier, & Burns, 1992; Manusov, Carr, Rowane, Beatty & Nadeau,

(1995) and Paragament, Magyar, Benore & Mahoney, 2005) which

demonstrated that people who reappraise the situation they find themselves as

part of God’s plan may fare better than others who interpret the situation as a

form of desecration. It equally demonstrated that people’s religious orientation

influences their coping process in their time of difficulties.

However, there is some evidence against the idea that religious devotion

and other forms of religiosity is associated with an improved mental health.

Ellison and Lee (2010) conducted a study titled “Spiritual struggles and

psychological distress: Is there a dark side of religion?” They examined the

correlates and sequelae of spiritual struggles. Particular attention was focused on

three specific types of such struggles namely: (a) divine or troubled relationships

48

with God (b) Interpersonal, or negative social encounters in religious settings

and (c) intra-psychic or chronic religious doubting. They examined these issues

by analyzing data from the 1998 General Social Survey (GSS), a nationally

representative cross-section survey of adults residing in the contiguous (lower

48) United States conducted by the National Opinion Research Centre (NORC).

Although the 1998 General Social Survey (GSS) interviewed a total of

2,832 respondents, the survey implemented a split-ballot design, in which only a

limited number of core (mostly socio demographic) items are asked of all

respondents. The mini-module on religion, spirituality, and health, from which a

number of their study items were taken was included on approximately one-half

of the 1998 interviews (n=1,445). Psychological distress which is the dependent

variable was measured with an index developed for this purpose by Kessler,

Andrews, Colpe, Hiripi, Mroczek and Normand (2002). The three aspects of

spiritual struggle constituted the independent variables namely: (a) divine

struggle indicating a strained or troubled relationship with God was assessed

with two items drawn from Pargament’s Brief RCOPE (Pargament, Koenig &

Perez, 2000). (b) interpersonal struggles i.e., negative interactions in religious

settings, were gauged via responses to two items, which have been employed in

prior work in this area (Idler, Musick, Ellison & George, 2003). (c) intra-psychic

spiritual struggles or chronic religious doubting were measured using two items

drawn from the previous work of Galek, Krause, Ellison, Kudler, & Flannelly

(2007).

49

The result of the multivariate analysis reveals among other things that at

the zero-order level each of the spiritual struggle variables is positively

associated with psychological distress with zero-order correlations ranging from

.10 to .36. Thus, reporting on the potential “dark side” of the religions-health

connection.

Similarly, Ellison, Bradshaw, Storch, Marcum, and Hill (2011) carried

out a study titled “Religious doubts and sleep quality: Findings from a National

study of Presbyterians”. They examined the correlates and sequelae of spiritual

struggles, such as religious doubts. The data was analyzed from a national panel

survey conducted among representative samples of two populations affiliated

with the Presbyterian Church in United States of American: active elders (i.e.

active members who have been ordained as an elder in a Presbyterian

congregation and who are currently serving on the session, or governing board,

of a Presbyterian congregation and other active members (i.e., all other active

members minus the subset of active elders). They used random sampling to

select 1,471 elders and 1,892 active members. The individuals in each sample

were mailed a questionnaire in the fall of 2005. A total of 1,163 elders (79% of

samples) and 1,099 active members (58% of samples) returned this screening

survey.

Three items from Pittsburgh Sleep Quality Inventory (Buysse, Reynolds,

Monk, Berman, & Kupfer, 1989) were used to measure sleep quality/problems

which is the dependent variables. While the religious doubts which is the

independent variable was measured by asking respondents: How often have

50

these problems caused doubts about your religious faith: (a) evil in the world, (b)

conflict of faith and science and (c) feeling that life really has no meaning.

Answers range from 1 (never) to 3 (often), and their measure was based on the

mean score on these items.

The descriptive statistics for all the variables reveal among other things

that there are moderate correlations between each of the sleep quality outcomes

(r’s range from .234 to -.475. Religious doubts bear modest, yet statistically

significant, corrections with each of the aspects of sleep quality examined in the

study (r’s range from .090 to .155). Psychological distress is moderately

correlated with each of the measures of sleep quality (r’s range from .174 to -

.369), as well as religious doubts (r=.231). They concluded that their results

confirm several robust associations between religious doubts and poor sleep

quality.

These findings coincide with the result of the study done by (Pargament,

Koenig, Tarakeshwar & Hahn, 2001; 2004; Musick, 2000;), which links divine

struggle or troubled relationship with God, to negative mental and physical

health outcomes, even including mortality risk. It associated interpersonal

struggle (i.e., negative interactions in religious settings) with undesirable health

sequelae.

Self-Efficacy and Psychological Distress

Cheung and Sun (2000) examined the effects of self-efficacy and social

support on the mental health conditions. They examined 65 members of Mutual-

aid organization of Hong Kong. Participants had anxiety and depressive

51

problems and had received cognitive behaviour therapy before they joined the

organization. A three-wave design was adopted and participants filled in

measures including the General Health Questionnaire (GHQ), State Anxiety

Inventory (SAI), the Centre of Epidemiologic Studies Depression Scale, the

General Self-Efficacy Scale (GSES) and the Medical Outcome Study Social

Support Survey. Regression analyses showed that residualized self-efficacy was

a strong predictor of the mental health variables. Effects of social support, both

functional and structural were mainly mediated by self-efficacy.

Similarly, Tabassum and Rehman (2005) carried out a descriptive study

to determine the relationship between self-efficacy and depression in physically

handicapped children. The study was conducted at different institutes of

physically handicapped children of twin cities of Rawalpindi and Islamabad. All

the children who presented themselves on the dates of testing were included in

the study. The mentally retarded children were excluded. Samples includes 42

physically handicapped children of age range between 13 to 17 years (M=14.17,

SD= 2.70). These included boys and girls (in equal numbers). The two

instruments used include: the Urdu translation of Generalized Self-efficacy Scale

(GESS) and Becks Depression Inventory (BDI).

Participants were approached in their institutes individually after formal

permission from principals of the institutes. Respective school teachers helped in

selecting the sample. The booklet along with demographic information sheet was

individually administered to the physically handicapped children by the

researchers, who read out each item themselves. The results show that score of

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Generalized Self-efficacy Scale (GSES) are inversely correlated with scores of

Becks Depression Inventory (BDI); indicating an inverse correlation between

self-efficacy and depression. Results further indicated that scores of Generalized

Self-efficacy Scale (GSES) are significantly inversely correlated with the scores

of Becks Depression Inventory (BDI) on items measuring emotional and

cognitive symptoms of depression. This finding suggests that impact of low self-

efficacy is more upon emotional and cognitive symptoms of depression

compared to the motivational and somatic symptoms of depression.

Friestad, Lise and Hansen (2005) investigated how the accumulation of

welfare deficiencies affected Norwegian inmates’ symptoms of mental distress,

and if this relationship was influenced by perceived self-efficacy. A mental

survey of 360 male inmates was conducted in Norway where data were collected

through structured personal interviews. Findings from the survey indicated

among other things that inmates’ situations are marked by serious deficiencies

when it comes to important welfare dimensions such as education, employment,

income, housing and so on. Result also indicated that persons experiencing the

heaviest symptoms of mental problems also suffer from heavy load of poor

living conditions, concluding that mental health problems are an important part

of inmates generally disadvantaged living conditions. It equally supported

previous findings indicating that self-efficacy plays an important independent

role in the prediction of inmates’ mental distress.

These findings are in line with results of some earlier studies

(Davis,1988; 1990; Bandura, Pastorelli, Barbaranelli & Caprara, 1999;

53

Makaremi, 2000) indicating that high generalized self-efficacy may serve as a

protective factor against depression, where as, low self-efficacy can lead to

depression or any other mental health problems.

Grembowki, Patrick, Diehr, Durham, Beresford, Kay and Hecht (1993)

pointed out that self-efficacy has a well-established, beneficial effect on health

behaviour and health status in young and middle-aged adults, but little is known

about these relationships in older populations. They examined this issue as part

of a randomized trial to determine the cost savings and changes in health-related

quality of life associated with the provision and reimbursement of a preventive

services package of 2,524 medicare beneficiaries enrolled in Group Health Co-

operative of Puget Sound. They collected the base line self-efficacy data for all

participants in five behavioural areas: exercise, dietary fat intake, weight control,

alcohol intake and smoking.

Result showed that older adults with high self-efficacy had lower health

risk in all behaviour and better health. Regression analyses detected a positive

association between socio-economic status and health related quality of life (P <

.02) but the strength of the association declined (P < .11) after the self-efficacy

measures entered the model, indicating that self-efficacy explains part of the

association between socio-economic status and health status. They concluded

that intervention aimed at improving self-efficacy may also improve health

status.

Karimi and Niknami (2011) carried out a cross-sectional study in 2009

aimed to determine the self-efficacy and perceived benefits/ barriers of AIDS

54

preventive behaviours in opiate dependency. The study population was 86 drug

user men at Re-birth Association in Zarandieh City. The data were collected

using self-administered questionnaires including demographic characteristics,

perceived benefits/ barriers of self-efficacy and AIDS preventive behaviours.

Data was analyzed with ANOVA, Regression and correlation coefficients.

Regression analysis showed that age, educational level, knowledge and

perceived benefits/ barriers, self-efficacy, all together explain 28% of AIDS

preventive behaviour variance. Perceived barrier and self-efficacy were the most

important predicting factor. Sixty three percent (63%) of the samples believed

that they have ability of HIV- preventive behaviours. They suggested that the

findings of this study may be used as a basis for designing interventions to

improve better performance in the concerned area.

In the same vein, Ogunyemi and Mabekoje (2007) sought to determine

the combined and relative efficacy of self-efficacy, risk-taking behaviour and

mental health on personal growth initiative of university undergraduates. The

expo-facto research design was used to conduct the study. Stratified random

sampling technique was used to select 425 participants (Males= 175 and

females=250) from 6 faculities of the Olabisi Onabanjo University, Ago Iwoye,

in Ogun State, Nigeria. The selected faculties include, Arts, Social sciences,

Management sciences, Education, Law and Pure sciences. The age range of the

participants was between 19 and 29 years. The mean age and standard deviation

of participants were 22.40 and 4.56 respectively. Four validated instruments

were used in collecting data namely, the General Perceived Self-efficacy Scale

55

(GPSS) to measure the self-efficacy. Personal Growth Initiative Scale (PGIS)

was used in measuring the personal growth initiative. International Personality

Item Pool Scale (IPIPS) was used in assessing risk taking. While, Mental Health

Inventory (MHI-5) was used in measuring mental health.

Multiple regression analysis (step wise) and t-test statistical measures

were utilized to analyze data. The result indicated that risk –taking behaviour

and self-efficacy together predicted 8.7% of the variation in personal growth

initiative of university undergraduate. Mental health was not a good predictor of

personal growth initiative. However, risk-taking behaviour, self-efficacy, and

mental health positively correlated with one another, and also with personal

growth initiative. Based on this finding, it was suggested that enhancing risk-

taking and self-efficacy behaviour of university undergraduates would boost

personal growth initiative that is desired for the social transformation of the

developing countries.

These findings supported the earlier studies (Henealy & Herrick, 1990;

Nicholas, 2002) which affirm that risk is important to achieving programme

objective and personal growth. Positive risk taking experience makes people to

continue seeking challenge and resolute in giving direction to goal achievement.

Moeini, Shaffi, Hidarnia, Babaii, Birashk and Allahverdipour (2008)

investigated the relationship between perceived stress, general self-efficacy and

mental health status among Iranian male adolescents recruited from Midtown

high schools in Tehran who studied in 12th grade (N=148). Pupils completed

three questionnaires namely Perceived Stress Scale (PSS-14), General Self-

56

efficacy Scale (GSS), and General Health Questionnaire (GHQ-28). Statistical

analyses revealed that greater stress was associated with lower general self-

efficacy and lower mental health status. A significant inverse relationship

between self-efficacy and general health was found among these students.

Clark, Martin and Martin (2009), examined the relationship of self-

efficacy and perceived stress for differences between employees of close

security and medium security level institutions. A convenience sample of 118

correctional employees was selected from volunteers who currently work in the

state correctional institute in Ohio. Two instruments Perceived Stress Scale

(PSS) and the General Perceived Self-efficacy Scale (GPSS) were used to

examined predictive relationships. A multiple regression analysis and analysis

of covariance were used to analyze the data. They hypothesized that after

controlling for length of time, there would be no significant difference between

security levels, perceived stress, self-efficacy and gender.

Finding indicated among other things that there was a negative

relationship between stress, security level and self-efficacy. As stress increases,

reported self-efficacy decreases and vice versa. Most importantly, individuals

who reported higher self-efficacy viewed their environment as less stressful. The

higher the self-efficacy scores, the lower the reported stress.

Song (2003) examined the effects of self-efficacy promoting cardiac

rehabilitation program on self-efficacy, health behaviour, and quality of life of

patients with ischemic heart disease. The study was conducted using a non-

equivalent control group non-synchronized design. Patients in the control group

57

were recruited first and after completing data collection in the control group,

recruitment and data collection in the experimental group was done. Patients

were enrolled from the Coronary care unit between May and October, 2000. A

total of 50 patients were enrolled in the study at the beginning. Five (5) patients

could not complete the study and therefore were excluded, yielding 23 for the

control group and 22 for the experimental group.

Physiologic risk factor scores were calculated according to the

Frammingham Heart Study Global Risk Assessment (Grundy, Pasternak,

Greenland, Smith, & Fuster, 1999). Self-efficacy was measured with the self-

efficacy questionnaire which was modified from Becker and Levine’s (1987)

Life Style Assessment Tool for patients with Hypercholesterolemia. Health

behaviour was recorded using the health behaviour questionnaire which was

modified from Han’s (1998). The quality of life was measured using the health

related quality of life tool (Shinn, Shinn, Lee, Kim, Won, Sunwoo & Park,

1999).

Data was analyzed using SPSS WIN 9.0 program. To describe

demographic and clinical characteristics, descriptive statistics were used. Chi-

square test and t-test were conducted to identify the homogeneity of the control

and experimental group. Four weeks after discharge, the increment of total self-

efficacy score was significantly higher in the experimental group than in the

control group (P < .01). There was also a significant difference in the total

quality of life scores increments between the two groups (P < .01). However, no

significant changes were noted in the increments of total health behaviour scores

58

between the two groups. He concluded that a cardiac rehabilitation programme

focusing on promoting self-efficacy was effective in improving self-efficacy,

and quality of life of patients with Ischemic heart disease.

Wu, Tang and Kwok (2004) carried out a study with the aim to determine

the associations among health locus of control, self-efficacy, and psychological

distress in elderly Chinese women who have chronic physical illnesses. The

study adopted a convenience sampling design in recruiting elderly Chinese

women. Using the Directory of Social Services in Hong Kong, of the listed

community centers for elderly people every tenth centre was selected and

contacted. Eleven of the fifteen selected elderly community centers consented to

refer their female members to participate in the study. A majority of these

elderly members belonged to the middle or lower social classes with junior high

educational attainment. The inclusion criteria for this study were that

participants had to be ethnic Chinese women, aged at or above 60 years old,

which is the official retirement age in Hong Kong, and had at least one chronic

physical illness at the time of the study. At the end, a sample of 159 elderly

Chinese women aged between 60 and 89 years old were selected. Their mean

age was 74 (SD=6.80), with 68% of them aged between 70-85 years old.

They used demographics to elicit information about their age, gender,

marital status, working status, monthly income before their retirement, and the

type of chronic physical illnesses that they had. The 10-item Generalized Self-

Efficacy Scale (Schwarzer, 1993) was used to measure participants perceived

self-efficacy. Participants’ perception about ‘who’ controls their health outcomes

59

(Health locus of control) was assessed by the Multidimensional Health Locus of

Control Scale (Wallston, Wallston & DeVellis, 1978). The 28-item General

Health Questionnaire (Goldberg, 1978) was used to measure participants’


The measurement scales showed satisfactory internal consistency

reliabilities (K-R 20), with alpha values ranging from 0.60 to 0.85. Hierarchical

regression analysis was performed to determine the respective predictive powers

of these variables on the participants’ psychological distress. Result showed

among other things that general self-efficacy was found to be a significant

predictor, accounting for an additional 9.6% variance (R2 = 0.12, B =-0.323,

F=7.01, p<0.05). Internal health locus of control did not contribute to the

prediction of psychological distress after considering the effect of general self-

efficacy (p > 0.05). External health locus of control was found to be a significant

predictor, accounting for an additional 1.2% of the variance of psychological

distress (R2 = 0.155, B = 0.209, F = 5.63, P < 0.05). These results indicated that

participants’ psychological distress was best predicted by a low level of self-

efficacy and high level of external health locus of control.

In order to determine whether or not health control beliefs interacted with

general self-efficacy in influencing participants’ psychological functioning, a

similar regression analysis was conducted with the addition of two interaction

terms, i.e., internal health control beliefs x general self-efficacy. Results showed

that both interaction terms were non-significant (p > 0.05). In other words,

health control beliefs and general self-efficacy did not interact with each other,

60

but each exerted their main effects on participants’ level of psychological

distress. This study shows that general self-efficacy and health control beliefs are

salient predictors of psychological functioning. Thus, health promotion programs

that aim to enhance competence in performing various desirable health

behaviours or to modify health control beliefs may mitigate elderly Chinese

women’s negative adjustment to chronic health conditions.

This finding is in line with previous studies that indicated that elderly

people’s competence in performing behaviours are predictive of their adjustment

to chronic pain, nursing home placement, and other stressful life events

(Johnson, Stone, Altmaier & Berdahl, 1988; Holahan & Holahan,1987; Melding,

1995). Thus, general self-efficacy is the most salient predictor in determining

people’s manifestation of psychological distress.

Mizutani, Ekuni, Furuta, Tomofuji, Irie, Azuma, Kojima, Nagase,

Iwasaki, and Morita (2012) examined the relationship between gingivitis, oral

health behaviours and self-efficacy in university students in Okayama, Japan. A

total of 2,111 students (1,197 males, 914 females) aged 18 and 19 years were

examined. The degree of gingivitis was expressed as the percentage of bleeding

on probing (%BOP). Additional information was collected via a questionnaire

regarding oral health behaviours (daily frequency of tooth-brushing, use of

dental floss and regular check-up). Self-efficacy was assessed using the Self-

efficacy Scale for Self-care (SESS). Path analysis was used to test pathways

from self-efficacy to oral health behaviour and %BOP.

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In the final structural model, self-efficacies were related to each other,

and they affected oral health behaviours. Good oral health behaviours reduced

dental plaque and calculus, and lower levels of dental plaque and calculus

resulted in lower % BOP. It was concluded that higher self-efficacy correlated

with better oral health behaviours and gingival health in university students.

They further suggested that improving self-efficacy may be beneficial for

maintaining good gingival health in university students. To prevent gingivitis,

the approach of enhancing self-efficacy in university students would be useful.

Semiatin and O’connor (2012) examined the relationship between self-

efficacy and positive aspects of caregiving in Alzheimer’s disease caregivers.

Participants were 57 caregivers (39 spouses, 15 adult children, 3 siblings/

friends) of patients diagnosed with Alzheimer’s disease enrolled in a randomized

controlled trial of a caregiver intervention. Caregivers were recruited from

several referral sites with independent Institutional Review Board approval

received from each participating institution. Recruitment sites included hospitals

and clinics located at the Boston University School of medicine, Boston

Veterans Administration Health care system, and Bedford Veterans

Administration Hospital. Instruments used include RIS Eldercare self-efficacy

scale, Centre for Epidemiological Studies Depression (CES-D), the

Neuropsychiatric symptom inventory. The result revealed that self-efficacy

accounted for a significant percentage of the variance in positive aspects of

caregiving after controlling for other factors commonly associated with positive

aspects of caregiving including caregiver demographics, care recipient

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neuropsychiatric symptoms and care giver depression. They suggested that high

self-efficacy relates to caregivers’ perception of positive aspects of the

caregiving experience.

This is consistent with previous researches which demonstrate that

caregivers with low self-efficacy are more focused on negative aspects of the

care giving experience (Steffen, McKibbin, Zeiss, Gallagher-Thompson, &

Bandura, 2002). While caregivers with higher self-efficacy are more likely to

identify positive aspects of even negative caregiving situations (Farran,

Loukissa, Perraud, & Paun, 2004; Kramar, 1997). This is because self-efficacy

influences the development of affective filters that influences whether life events

are cognitively construed, represented and in an affectively benign or distressing

manner (Bandura, 1977).

However, some studies have shown negative consequences of high self-

efficacy on performance, risk taking and by extension health related matters.

Lorente (2009) carried out a field study to investigate whether there are

significant difference between high and low self- efficacious people in safety

performance. A total of 228 employees (100%) men from 10 different Spanish

construction compares were used for the study. Age ranged from 16 to 64 years

old (mean age = 39.62, SD = 11. 89), 18% were foreigners and 35% had a

temporary contract. Interview guide designed by the researcher was used to

assess the work conditions in the construction industry. The guide included open

question as well as a questionnaire with the study variables, which was handed

out during the face-to-face interview with each construction worker.

63

ANOVA was used to test whether there are significant differences in

safety performance in terms of the self-efficacy levels. They selected the first

participants with high and low levels of self-efficacy from the data set using the -

/+ ISD criteria. High and low self-efficacy is the factor used for the ANOVA

test, and safety performance is the dependent variable. The ANOVA test results

show significant difference between high and low self efficacy groups in safety

performance (F = 3.13, P < 05). This study shows that construction workers who

display the highest levels of self- efficacy present less safety performance i.e

more risky behaviour) than those with the lowest levels of self- efficacy.

This findings is in harmony with previous studies that indicated

that feeling “over confident” can motivate people to set unrealistic goals. For

this reason, overconfident people present less safety performance or

inappropriate behaviors as less dangerous; consequently their responses to a

given threat are usually minimal.

Highly self efficacious people reached the moment on which they felt

confident about thinking through the received feedback quicker than those with

low self-efficacy, resulting in over confidence and more errors. (Whyte, Saks &

Hook, 1997; Wood, Bandura & Bailey, 1990; Seo, & Ilies, 2009; Stone, 1994).

Prisoners’ Status and Psychological Distress

Birmingham, Mason and Grubin (1996) carried out a consecutive case

study of prevalence of mental disorder in remand prisoners. This study was

carried out at a large remand prison for men (HMP Durham) which has a

capacity of 640. Five hundred and sixty nine men aged 21 years and above that

64

are on remand were used for the study. These inmates were received from courts

in Tyneside, Northumber Land, Cumbria and County Durham between 1st

October,1995 and 30th April, 1996. Instruments used include a semi structured

psychiatric interview designed specifically for the study, Schedule for Affective

and Schizophrenia (Life time version) to detect and classify current life time

mental disorders, the CAGE questionnaire to assess problem drinking, the

Severity of Dependency Questionnaire to quantify levels of drug abuse and

dependence, Self Reported levels of alcohol and drug consumption, Quick test to

measure intelligence quotient (IQ).

Result showed that 148 (26%) men had one or more current mental

disorders (excluding substance misuse) including 24 who were acutely

psychotic. The prison reception screening identified 34 of the men with mental

disorder and 6 of those with acute psychosis. One hundred and sixty eight (168)

men required psychiatric treatment, 50 of whom required urgent intervention.

While 16 required immediate transfers to psychiatric hospital. They concluded

that not only is the prevalence of mental disorder (in particular severe mental

illness), high in this population, but the numbers identified at the reception are

low and subsequent management in the prison is poor.

In the same vein, Eytan, Haller, Wolff, Cerutti, Sebo, Bertrand and

Niveau (2010) carried out a study to determine the prevalence of psychiatric

symptoms and complaints among remand prisoners and to analyze the

relationship between psychiatric symptoms, physical health and substance abuse

problems in this population. The study took place in the remand prison of the

65

Geneva District, situated in the French speaking part of Switzerland. The

medical files of all detainees attending the prison health service in year 2007

were reviewed and coded using the French version of the International

Classification of Primary Care, second edition (ICPC-2). In addition to this,

Alcohol Use Disorder Identification Test (AUDIT) was used for assessing

alcohol use.

The methodology and instrument were pretested over a 3-months period

(October 2006 to December, 2006). Approximately 400 files were analyzed

during the pretest while a total of 1510 files during the main study. It informed

improvements to be made to the technical procedure and helped harmonize the

use of the ICPC-2 within the research team. All ICPC-2 sheets correctly

completed by a physician over a one year period (January 2007 to December

2007) were analyzed. All data were recorded anonymously. The AUDIT and

drug related questions were administered by the usual caregiver during a

consultation. This was in fact a formalization of routinely asked questions. The

result of the study revealed that smoking was highly prevalent in this sample

(68.9%). Alcohol, cannabis, benzodiazepine and cocaine abuse were also

frequent (41.2%, 35.9%, 31.1% and 26.6% respectively). Apart from heroine, all

substance abuse problems were more frequent among men than women.

Goyal, Singh, Gargi, Goval and Garg (2011) examined the socio-

demographic profile of convicted prisoners and also to evaluate the prevalence

of psychiatric disorders in convicted prisoners. Inclusion criteria include subjects

in the age range of 18 to 60 years and informed verbal consent of prisoners.

66

While exclusion criteria include prisoners not consenting, uncooperative

prisoners and prisoners in prison psychiatric unit. Five hundred (500) convicts

(20 females, 480 males) were assessed for psychiatric morbidity with the help of

four instruments. Socio-demographic proforma was used to inquire various

socio-demographic variables. Pareek Udai and Trivedi G’s socio-economic

status scale (rural) (household schedule) was used to calculate socio-economic

status of rural prisons. Kuppuswamy’s economic status scale (urban) was used to

calculate the socio-economic status of urban prisoners. While Present State

Examination (PSE), was used to assess objectively the present mental state of

adult patients suffering from neurotic and functional psychotic disorder. The

result of the finding revealed that 23.8% of the convicted prisoners were

suffering from psychiatric illness excluding substance abuse, while 56.4% of the

prisoners had history of substance abuse/ dependence prior to incarceration.

Singleton, Meltzer, Gatward, Cold, and Deasy (1998) collected baseline

data on the mental health of male and female, remand and sentenced prisoners in

order to inform general policy decision. The survey was aimed specifically to

estimate the prevalence of psychiatric morbidity according to diagnostic

category among the prison population of England and Wales. A total of 131

prisons that were open at the start of the field work period participated in the

survey. A total of 3563 prisoners were selected to take part and 3142 (88%) were

interviewed. Personality disorder was assessed using the Structured Clinical

Interview for DSM-IV (SCID-II). The result of their finding revealed that the

prevalence of personality disorder is: male remand 78%, male sentenced 64%

67

and female prisoners 50%. They also pointed out that antisocial personality

disorder had the highest prevalence of any category of personality disorder.

They assessed psychosis by clinical interview using the Schedules for the

Clinical Assessment of Neuropsychiatry (SCAN). Result showed those males

sentenced are 7%, male remand are 10%, while 14% are for female prisoners.

They further pointed out that schizophrenia or delusional disorders were more

common than affective disorders. Singleton et al., (1998) went further to assess

neurotic symptoms using revised version of the Clinical Interview Schedule

(CIS-R). Result showed that remand prisoners both male and female were

generally more likely to report each neurotic symptoms than their sentenced

counterparts. The differences were particularly marked for depression,

depressive ideas, and among women, sleep problems.

Remand prisoners had higher total CIS-R scores than their sentenced

counterparts: 58% of the male and 75% of the female remand prisoners in the

sample had scores on or above the threshold compared with 39% of the male and

62% of the female sentenced prisoners. It is interesting to note that for all six

neurotic disorders (depressive episode, generalized anxiety disorder, mixed

anxiety and depressive disorder, phobia, obsessive compulsive disorder and

panic disorder), the prevalence rates for male remand prisoners were higher than

those for their sentenced counterparts, although, the differences for generalized

anxiety and obsessive compulsive disorder were not significant.

Singleton et al. (1998) used a question based ICD-10 diagnostic criteria to

assess the Post- Traumatic Stress Disorder (PTSD) among the prison inmates.

68

Result revealed that 5% of male remand, 3% male sentenced, 9% female remand

and 5% of female sentenced prisoners had Post Traumatic Stress Disorder

(PTSD). They pointed out that remand prisoners both male and female were

significantly more likely to report recurrent symptoms indicative of Post

Traumatic Stress Disorder (PTSD) following such an event than their sentenced

counterparts. In the same vein, the proportion of respondent who had thought of

committing suicide at some time was very high. Forty six percent (46%) of male

remand prisoners had thought of suicide in their life time, 35% in the past year,

and 12% in the week prior to interview. The rates for female remand prisoners

were even higher than their sentenced counterparts.

The rates of suicide attempts were also very high. Twenty seven percent

(27%) of male remand prisoners reported that they had attempted suicide at

some time in their life, 15% in the year before interview and 2% in the previous

week. Women both sentenced and remand reported higher rates of suicidal

thoughts and suicide attempts than their male counterparts.

Singleton et al., (1998), went further to use the Alcohol Use Disorder

Identification Test (AUDIT) to assess alcohol misuse (hazardous or harmful

drinking) among prisoners in the year before coming to prison. A score of 8 or

above was regarded as indicative of hazardous drinking. They defined hazardous

drinking as an established pattern of alcohol consumption which confers a risk of

physical and/ or psychological harm. The result of their finding revealed that the

prevalence of hazardous drinking in the year before coming to prison was higher

among men than women. Over half the men in the sample, 58% of male remand

69

and 63% of male sentenced prisoners had an AUDIT score of 8 or more

compared with 36% of female remand prisoners and 39% of female sentenced

prisoners.

These findings are consistent with prior research documenting a link

between prisoners’ status and mental health (Hurley & Dunner, 1994; Pfohlet,

Stangl & Zimmerman, 1983; Turner & Tofler, 1986; Wing, Babor, Brugha,

Cooper, Giel, Jablensky, Regier & Sartorus, 1990). They indicated that

psychological distress was more severe on awaiting trial inmates than their

sentenced counterparts. Furthermore, antisocial personality disorder had the

highest prevalence of any category of personality disorder among prison

inmates.

However, some studies have shown that sentenced prisoners have high

psychiatric morbidity. Duffy, Linchan and Kennedy (2006) conducted a cross-

sectional study of psychiatric morbidity using diagnostic instruments in

sentenced prisoners in Ireland. Three hundred and forty (340) men serving a

fixed sentence (14.6% of total) and Ninety eight (98) men serving a life sentence

(82% of total) participated in the study. Prisoners were drawn from 15 different

prisons using a random stratified sampling method. Mental illness and

substances misuse was measured using the SADS- 1, SODP and a structured

interview to generate ICD- 10- DCR diagnosis.

Result showed a high prevalence of mental illness. Their six months

prevalence for psychosis (2.7%) was similar o an international Meta analysis.

They found a significantly higher prevalence of psychosis in life sentenced

70

prisoners (6.1%) compared to fixed sentenced prisoners (1.8%). Drugs and

alcohol problems were very prevalent. Using the six months prevalence figures

found for psychosis, they estimated that there were approximately 79 sentenced

male prisoners with severe mental illness who would require treatment in

hospital additional to current provision in the prison.

Similary, Assadi Noroozian, Pakravannejad, Yahyezadeh, Aghayan,

Shariat and Fazel (2006) investigated the prevalence of psychiatric disorders in

Iranian sentenced prisoners. Through stratified random sampling, 351 prisoners

were interviewed using the clinical version of the structured clinical interview

for DSM- IV Axis I Disorder and the psychopathy checklist: screening version.

Result of the study showed that majority (88%) of prisoner met DSM-IV

criteria for life time diagnosis of at least one Axis I disorder and 57% were

diagnosed with current Axis I disorders. Opioid dependence (73%) had the

highest prevalence among life time diagnoses, where as major depressive

disorder (29%) was the most common current diagnosis. Psychopathy was

recorded in 23%. Prevalence rates of psychiatric disorders were significantly

different among offence categories.

Results of these studies are in line with previous studies which

indicated that a substantial burden of psychiatric morbidity exists among the

convicted prisoners with various treatment challenges. (Fido & Al-Jabally, 1993;

Ghubash & El- Rufaie, 1997).

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SUMMARY OF LITERATURE REVIEW

Psychological distress theories which stipulate that distresses arise from the

broad spectrum of conscious and unconscious mental activity that might be

referred to simply as human experience were reviewed in this study. Such

theories include: Cognitive Theory, Medical Model, Psychodynamic Theory,

Interpersonal Theory, Behavioural Theory, Social Model, Stress Vulnerability

Model and Bio-psychosocial Model. Also the empirical studies reviewed in this

study were categorized into three sections: Religious devotion and psychological

distress, self-efficacy and psychological distress, prisoners’ status and


Some studies demonstrated that religiosity has a protective effect against

the development of psychological distress; the more time spent on religious

activities, the higher life satisfaction/happiness (Ferraro & Albrecht-Jensen,

1991; McGloshen & O’Bryant, 1988; McCure & Loden, 1982; Koeing, 2001;

Magana & Clark, 1995; Coke, 1992; Koenig, George & Meador, 1994; Ho, Woo

& Lau, 1995). However, some studies also demonstrated the dark side of

religiosity especially spiritual struggle and religious doubt on mental health.

(Ellison & Lee 2010; Elison et al. 2011; Musick, 2000).

Reviewed literature also demonstrated that high generalized self-efficacy

may serve as a protective factor against mental health problems, whereas low

self-efficacy can lead to depression or any other mental health challenges

(Grembowki, et. al, 1993; Moeini, et. al., 2008; Wu, et. al., 2004). Nevertheless,

72

there are evidence against high self-efficacy on heath. Highly self-efficacious

people may reach the moment on which they feel confident about thinking

through the received feedback quicker than those low self-efficacious

individuals, resulting in over confidence and more errors. (Lorente, 2009; Stone,

1994). With regards to prisoners’ status, it was indicated that psychological

distress was more severe on awaiting trial inmates than their sentenced

counterparts ((Hurley & Dunner, 1994; Pfohlet, Stangl & Zimmerman, 1983;

Turner & Tofler, 1986; Wing, et. al., 1990). However, some studies indicated

that substantial burden of psychiatric morbidity exist among convicted prisoners

with various treatment challenges. (Duffy, et al. 2006; Assadi, et al. 2006; Fido,

and Al-Jabalhy, 1993).

It was observed that reviewed literature as regarding this study indicated

that most of the studies done were carried out in America, Europe and Asian

continents. Also there is a dearth of literature as regards to psychological distress

as it relates to religious devotion, self efficacy and prisoners status, in Nigeria

particularly. Most literature reviewed did not provide more detailed information

as it may reflect or relate to African/Nigerian background. With regards to this

notion, the researcher wish to embark on this study in order to fill this gap in

knowledge by providing more insight and understanding as it may relate to

African setting in general and Nigeria in particular.

73

HYPOTHESES

Following the review of literature, the under listed hypotheses were tested.

1. There will be no statistically significant difference between prison

inmates high in religious devotion and those low in religious devotion in


2. There will be no statistically significant difference between prison

inmates high in self efficacy and those low in self-efficacy in


3. There will be no statistically significant difference between convicts and

awaiting trial inmates in manifestation of psychological distress.

74

CHAPTER THREE

METHOD

Participants

The participants for the study comprised three hundred and ninety nine

(399) prison inmates drawn from Medium Security Prison Kuje in Abuja Federal

Capital Territory. The participants were all males and comprised of (142)

convicts and (257) awaiting trials. Two hundred and eighty eight (288) were

single, eighty five (85) were married and twenty six (26) were widowers.

Incidentally, the participants were from different religious affiliations comprised

of (201) Christians, (187) Muslims and (11) African Tradition Religion.

Participants ages ranged between 18 to 59 years with a mean age of (38.50)

years.

Instruments

A sets of three instruments were employed in the study: Religious

Affiliation Scale (Omoluabi, 1995), General Self-Efficacy Scale (Schwarzer &

Jerusalem, 1995), and General Health Questionnaire -12 (Goldberg & Williams,

1988).

Religious Affiliation Scale (RAS)

This is a psychological assessment instrument developed by Omoluabi

(1995) to assess the degree of religious devotion. The instrument contains 21

items with Yes or No response pattern. Some sample items on the scale include:

“I regularly attend fellowship/prayer meetings”, “I read Bible/Koran at least

once every day”, “ I can not marry a person who is not member of my religious

75

denomination”, and “I go to church/mosque always”. The instrument is scored

by counting the number of items which the participants shaded “True” and

multiply the number by 3. The instrument has been used in research with

Nigerian samples (e.g Olowodunoye, Abiodun & Oyeboade, 2011; Ayeni, 2011;

Olorunshola & Omoluabi, 2006) and has been shown to be a reliable and valid

measure. A test-retest reliability coefficient of .97 in an interval of three weeks

was reported by Omoluabi (1995). Erinoso (1996) correlated Religious

Affiliation Scale (RAS) with Life Satisfaction Index-z by Neugarten,

Havinghurst and Tobin (1961) and obtained a divergent validity coefficient of -

.26, depicting that the more satisfied with life, the less the tendency to be

religious.

A pilot study was conducted by the researcher to determine the reliability

of this instrument for use among prison population. One hundred and nineteen

(119) prison inmates drawn from Nsukka prisons participated in the validation

study. The study conducted by the researcher yielded a Cronbach’s Alpha of .88

for Religious Affiliation Scale (RAS), which shows that the instrument is

suitable for use in this present study.

General Self-Efficacy Scale (GSES).

This is a standardized psychological assessment tool developed by

Schwarzer and Jerusalem (1995) designed to assess a general sense of perceived

self-efficacy. The instrument consists of 10 items. Some sample items on the

scale include: “I can always manage to solve difficult problems if try hard

enough”, “I am confident that I could deal efficiently with unexpected events”, If

76

I am in trouble, I can usually think of a solution.” It is measured on a 4-point

Likert scale ranging from 1= not at all true, to 4= exactly true. The instrument

which is a unidimensional scale has been used in research with Nigerian samples

(Ladebo & Awotunde, 2007; Okediji, Offiong, Umoh, Sanni, Ezeh, & Afolabi,

2008; Salami, 2010; Onyeizugbo, 2010a; & Onyeizugbo, 2010b) and has shown

to be psychometrically robust. Schwarzer and Jerusalem (1995) reported

Cronbach”s alphas in many nations which are ranged from .75 to .90, with the

majority in the high .80s. Schwarzer, Babler, Kwiatek and Zhang, (1997) found

a discriminant validity of -.52 and -.60 by correlating the scale with depression

scale by Zerssen (1976) and Anxiety Scale by Spielgerger (1983) respectively.

The validation study conducted by the present researcher using one

hundred and nineteen (119) prisoner’s from Nsukka prisons yielded a

Cronbach’s alpha coefficient of .73 for General Self-Efficacy Scale (GSES).

General Health Questionnaire -12 (GHQ-12)

This is a standardized assessment tool developed by Goldberg and

Williams (1988) to measure current mental health. The 12-item inventory takes

about 5 minutes to complete. Some items on the scale include: Have you

recently: “lost much sleep over worry”, “been able to face up to your problems”,

“been feeling unhappy and depressed”, “been thinking of yourself as a worthless

person”. The GHQ-12 has both direct and indirect scoring pattern in order to

reduce response set bias and also to obtain consistency of scoring. Items

2,5,6,9,10,and 11 are directly scored while items 1,3,4,7,8,and 12 are reversely

scored. It is scored on a 4 point scale. Goldberg and Williams (1988) reported

77

Cronbach alphas raging from 0.77 to -.93. Hepworth (1980) reported reliability

coefficient of .85. The instrument has been used in research with Nigerian

samples (e.g., Udo, 2005; Ifeagwazi & Ezema, 2010; Ani, Kinane, & Ola, 2011;

& Ugwu, 2012) and has been shown to be a reliable and valid measure. Udo

(2005) obtained a two week test-retest reliability coefficient value of .64 and a

concurrent validity coefficient value of .59 with Derogatis, Lipman, and Covi’s

(1972) depression scale of the Symptom Check list-90 (SCL-90). In the same

vein, Ifeagwazi and Ezema (2010) reported Cronbach alpha of .72 for the GHQ-

12.

A pilot study was conducted by the researcher to determine the reliability

of this instrument for use among prison population. One hundred and nineteen

(119) prison inmates drawn from Nsukka prisons participated in the validation

study. The study conducted by the researcher yielded a Cronbach’s Alpha of .71

for the General Health Questionnaire – 12 (GHQ-12) which also indicated that

the instrument is suitable for use in this study.

Procedure

This study was made possible by the researcher securing approval from

the relevant Authorities of Nigerian Prisons Service. In addition, co-operation of

medical and paramedical staff of the prison yard was sought. The researcher

used the prisoners’ book 12A and 63 (unconvicted and convicted prisoners’

register respectively) in the Record office of the prison using table of random

numbers to select 399 participants (257 awaiting trial prisoners and 142

convicts). The researcher informed them that the exercise was not for court or

78

anything that has to do with the offence(s) they were charged or convicted of;

rather it was for academic research purposes.

Participants’ mean scores were used in categorizing them into high and

low groups because the independent variables were classificatory measures. This

approach used in the present study is consistent with that used by Greenidge,

Daire and Lewis (2011). Participants’ mean score (35.96, SD = 16.68) on

religious devotion was used to categorized them into high and low religious

devotion groups. Those who scored higher than the mean (N = 165) were

classified as high religious devotion while those who scored below the mean (N

= 234) were classified as low religious devotion. On self-efficacy, participants’

who scored above the mean (27.58, SD = 7.30) were classified to have high self

efficacy (N = 196) while those who scored below the mean (N = 203) were

classified to have low self efficacy. Participants who scored higher than the

mean score (17.15, SD = 3.83) on the GHQ-12 were classified as high in

psychological distress (N = 370) while those who scored below the mean score

were classified low in psychological distress (N = 29). The mean scores used are

shown in the Table 1 below:

79

Table 1: The mean scores used in categorizing participants on religious devotion, self-efficacy and psychological distress

Variables

N Range Minimum Maximum Mean

Std. High Low

Deviation scores (N) scores (N)

Religious devotion 399 58.00 9.00 67.00 35.9699 16.68144 165 234

Self-efficacy 399 30.00 10.00 40.00 27.5865 7.30195 196 203

Psychological distress 399 23.00 9.00 32.00 17.1579 3.83290 370 29

Each of the participants was given a booklet containing an introduction

page for demographic information and the three questionnaires for the study

(Religious Affiliation Scale, General Self-Efficacy Scale and the General Health

Questionnaire-12). To ensure for high rate of return, the researcher distributed

and collected the questionnaires on the spot. Out of (410) participants initially

participated in the study, only three hundred and ninety nine (399) participants

properly filled their questionnaires. Eleven (11) participants did not complete

their questionnaires properly, as they did not complete the necessary

demographic information and thus was discarded. Three hundred and ninety nine

(399) that were duly completed were used for the study.

Design / Statistics

The study adopted a cross sectional design with two levels of religious devotion

(high religious devotion and low religious devotion); self-efficacy (high self-

efficacy and low self-efficacy) and two levels of prisoners’ status (awaiting trial

and convicts). A 3-way analysis of variance (ANOVA) was used to analyze the

data.

80

CHAPTER FOUR

RESULTS

Table 2

Means (ẋ) and Standard Deviation (SD) of Religious devotion, Self efficacy and Prisoners’ status on the prison inmates manifestation of psychological distress

Independent Levels Mean (Χ) Standard N

variable Deviation (SD)

Religious Devotion (RD) Low (RD) 1.65 .50 242

High (RD) 1.43 .48 157

Self-Efficacy (SE) Low (SE) 1.62 .50 209

High (SE) 1.42 .49 190

Prisoners’ Status Convicts 1.37 .47 142

Awaiting Trials 1.67 .48 257

The descriptive statistics computed as shown in Table 2 indicated that

participants low in religious devotion reported high mean score (M = 1.65, SD =

.50) compared with those high in religious devotion (M = 1.43, SD = .48). It

indicates that participants with low religious devotion exhibit higher

psychological distress than participants with high religious devotion. The result

also indicated that participants low in self-efficacy obtained high mean score (M

=1.62, SD = .50) than those high in self-efficacy (M = 1.42, SD = .49). It

indicates that participants with low self efficacy exhibit higher psychological

distress than participants with high self efficacy. The result also indicated that

81

convicted prisoners had a lower mean score (M = 1.37, SD = .47) compared to

the awaiting trial prisoners (M = 1.67, SD =.48). It shows that convicts exhibit

lower psychological distress than awaiting trial prisoners. The graphical

representations are illustrated in figure 1, 2 and 3 respectively while the tests for

significance of means are presented in Table 3.

Table 3

A 3-way ANOVA Summary Table showing the influence of Religious devotion, Self- efficacy and Prisoners’ status on the prison inmates’ manifestation of psychological distress

Source of variance (SOV) Sum of Squares (SS) Degree of freedom (df) Mean Square (MS) F-ratio (F)

Religious Devotion (A) .933 1 .933 4.304*

Self Efficacy (B) 2.115 1 2.115 9.757*

Prisoners Status ( C) 5.239 1 5.239 24.165**

A X B .074 1 .074 .342

A X C .180 1 .180 .831

B X C .884 1 .884 4.076*

A X B X C .166 1 .166 .765

Error 84.767 391 .217

Total 1017.000 399

Corrected Total 99.644 398

a. R Squared = .149 (Adjusted R Squared = .134)

Note * P < .05, ** P < .001

The result in Table 3 shows that religious devotion produced significant main

effect on prison inmates’ manifestation of psychological distress F (399 = 4.30,

82

P < .05). It indicates that religious devotion significantly influenced prison

inmates’ manifestation of psychological distress. Self-efficacy also produced

significant main effects on the inmates manifestation of psychological distress F

(399 = 9.76, P <.05). It shows that self-efficacy has a significant influence on the

inmates’ manifestation of psychological distress. In the same vein, prisoners’

status also produced a significant influence on the inmates manifestation of

psychological distress F (399 = 24.17, P <.001).

However, the interaction between religious devotion and self-efficacy

produced no significant effect on inmates’ manifestation of psychological

distress. In the same vein, there is no significant effect on the interaction

between religious devotion and prisoners’ status. Nonetheless, self-efficacy and

prisoners’ status produced an interaction effect on the prison inmates

manifestation of psychological distress F (399 = 4.08, P <.05). Finally,

interaction between religious devotion, self-efficacy and prisoners’ status

produced no significant effect on the prison inmates’ manifestation of


83

Figure 1

Graphical representation of religious devotion on prison inmates manifestation

of psychological distress.

Figure 2

Graphical representation of self efficacy on prison inmates manifestation of


Figure 3

Graphical representation of prisoners’ status on prison inmates manifestation of


84

Summary of main findings

The results of the influence of religious devotion, self-efficacy and prisoner’s

status can be summarized as follows:

A 3-way analysis of variance showed that religious devotion significantly

influenced prison inmates’ manifestation of psychological distress F (399 = 4.30,

P < .05). Self-efficacy significantly influenced prison inmates’ manifestation of

psychological distress F (399 = 9.76, P <.05). Prisoners’ status was also found to

have significant influence on prison inmates’ manifestation of psychological

distress F (399 = 24.17, P <.001). There was a significance interaction effect

between self-efficacy and prisoners’ status on prison inmates manifestation of

psychological distress F (399 = 4.08, P <.05).

85

CHAPTER FIVE

Discussion

The result of the present study failed to confirm the first hypothesis that there

will be no statistical significant difference between prison inmates high in

religious devotion and those low in religious devotion in their manifestation

of psychological distress. The result showed that religious devotion exert

significant influence on the prison inmates manifestation of psychological

distress F (399= 4.30, P< .05). As shown in Table 2, inmates high in religious

devotion scored lower mean (M = 1.43, SD = .48) than those low in religious

devotion (M = 1.65, SD = 50). Thus, the null hypothesis was rejected.

The findings is in harmony with Ahrean et al. (2010) who reported that

people who use religious coping experience high level of psychological well-

being. It is also consistent with the findings of Ferraro and Albrecht-Jensen

(1991); Glenn (1997) and Ayeni (2011). The explanation for these

differences may be due to the fact that the inmates high in religious devotion

will do anything within their reach to cushion the effects of incarceration. In

other words, prison inmates will like to embark on any activity to ameliorate

the negative effects of imprisonment. One of the major ways they do it is by

engaging in religious activities.

The result also failed to support the second hypothesis which states that

there will be no statistical significant difference between prison inmates high

in self-efficacy and those low in self-efficacy in the manifestation of

86

psychological distress. The result showed that self-efficacy significantly

influence prison inmates manifestation of psychological distress F (399=

9.76, P < .05) and thus the null hypothesis was rejected. Hence the mean

scores in Table 2 revealed that inmates categorized as having low self-

efficacy scored lower (M = 1.42, SD = .49) than those with higher self-

efficacy (M = 1.62, SD = .49). These differences could be possibly explained

from the point of view that prison inmates who have capacities to believe in

themselves do not approach any adverse conditions with negative mindset

and as threats to be avoided, but rather approach a given adverse condition as

a situation to be mastered. This result is in harmony with the study by

Grembowki and colleagues (1993) which suggests that people with high self-

efficacy had better health and lower health risk in all behaviour. It implies

that people with strong belief in their capabilities, makes every effort to cope

even in the face of adverse condition. A sense of control over ones

behaviour, environment, thoughts and feelings is essential for happiness and

a sense of well-being. The present finding is also consistent with the study by

Clark, Martin and Martin (2009) which revealed that individuals who

reported higher self-efficacy viewed their environment as less stressful. In

other words, the higher the self-efficacy scores, the lower the reported stress.

The result also rejected the third hypothesis which stated that there will be

no statistical significant difference between convicted prisoners and awaiting

trial inmates in manifestation of psychological distress. The present finding

indicated that prisoners’ status significantly influence inmates manifestation

87

of psychological distress F (399 = 24.17, P < .001). The mean scores in Table

1 revealed that convicts scored lower (M =1.37, SD = .47) than the awaiting

trial inmates (M = 1.67, SD = .48). This finding is consistent with Singleton

and colleagues (1998) who reported among other things that remand

prisoners (both males and females) were generally more likely to report each

neurotic symptom than their sentenced counterparts.

Implications of the Study

The result of the study provided valuable information about prison

inmates’ manifestation of psychological distress. It indicated that the three

independent variables (religious devotion, self-efficacy and prisoners’ status)

independently exerted significant influence on the prisoners’ manifestation of

psychological distress. It also shows that self efficacy and prisoner’s status

jointly produced significant influence in the prisoners’ manifestation of

psychological distress. The finding imply that prisoners high in religious

devotion, high in self-efficacy and have been convicted are less likely to

manifest psychological distress than those low in religious devotion, low in

self-efficacy and are on awaiting trials. However, findings of this research

work have shown that apart from the effect of deplorable prison conditions

on mental health other factors like the level of ones dedication to his or her

religious faith, degree at which one strongly believe in their capabilities to

successfully engage in and adapt to a stressful condition, and also the status

88

of the inmate; that is whether the inmate has been convicted or on awaiting

trial influence inmates manifestation of psychological distress.

The implication of engaging in religious activities, is that inmates take

solace in God as they listen to teachings from the holy books of their

respective faiths, thus, reducing the effects of psychological distress and

enhancing their adaptation to prison environment within the period of

incarceration. Religion usually offers support and structure for coping with

such stressful life events. It may also enhance positive experiences such as

hope and optimism. While on the contrary, those that neglect religious

activities are more likely to breakdown mentally as they have limited social

support provided by religious bodies.

Furthermore, high self-efficacy belief helps prison inmates to set goals at

the border of their competence and maintain strong commitment to such

goals until they accomplish their aspirations including adaptation to stressful

environment. On the contrary, low self-efficacy belief makes prison inmates

to feel and think that they can no longer succeed in life after being released

from the prison. Therefore, they tend to be unserious in any activities in the

prison yard because of their already built negative belief. Furthermore, prison

psychologists and other mental health workers should plan intervention

aimed at improving self-efficacy to promote their health status. In a

rehabilitation centre like prison, self-efficacy is important for understanding

psychological, cognitive and physical functioning of the inmates. Since

89

greater levels of self-efficacy are typically associated with less psychological

distress, this suggests that improving self-efficacy may be one way of

positively influencing, psychological, cognitive and physical functioning

among people attending rehabilitation centres.

The uncertainty of not being in the know of the outcome of their cases in

the court, exacerbate the awaiting trial prisoners manifestation of

psychological distress than their convicted counterparts. Some may even stay

longer on remand than the duration the judge would have pronounced if

found guilty. Therefore, there is a need for the court which is one of the arms

of the criminal justice system to expedite action on the speedy dispensation

of case because justice delayed is justice denied. As long remand of prisoners

can led to overcrowding, overstretching of prison facilities, development of

both physical and mental illness, prison riot and jail break.

Limitations of the Study

The limitation encountered in this research is that the participants for this

study were taken from one geo-political zone in Nigeria (North – Central)

and thus may not generalize to entire prison population of Nigeria.

Suggestions for Further Studies

Future researchers should endeavour to involve a larger prison

population from other geo-political zones of Nigeria than was used by this

research in order to improve generalizability of their findings.

90

Also, researchers in future should include other variables like,

gender, marital status and age in their study to ascertain their influence on the


Summary and Conclusion

The research investigated the influence of religious devotion, self-efficacy

and prisoners’ status on the prison inmates’ manifestation of psychological

distress. A sample of three hundred and ninety nine (399) Kuje prison

inmates participated in the study. The Religious Affiliation Scale (RAS),

General Self-Efficacy Scale (GSES), and General Health Questionnaire-12

(GHQ-12) including other demographic data were used to collect data.

Three hypotheses were postulated as follows:

There will be no statistically significant difference between prison inmates

high in religious devotion and those low in religious devotion in


There will be no statistically significant difference between prison inmates

high in self-efficacy and those low in self-efficacy in manifestation of


There will be no statistically significant difference between convicts and

awaiting trial inmates in manifestation of psychological distress.

91

Cross-sectional design was adopted for this work, while a 3-way analysis

of variance (ANOVA) statistic was used to analyze the data. Results showed

that:

1. Religious devotion significantly influences prison inmates’ manifestation

of psychological distress.

2. Self-efficacy significantly influences prison inmates’ manifestation of


3. Prisoners’ status significantly influences prison inmates’ manifestation of


In conclusion, the research findings oblige that prison inmates should not

take for granted the place of religious devotion in their health status. Prison

authority should employ resident clerics to attend to the spiritual needs of the

teaming prison population instead of relying only on visiting clergies, thus

resuscitating chaplaincy programme in the prison. Prison inmates should also

have strong beliefs in their capabilities to face any stressful situations. The

Criminal Justice System (CJS) should expedite actions on the speedy

dispensation of justice to avoid unnecessary long remand of inmates, thus

decongesting the prison.

92

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108

APPENDIX A

SECTION A

Department of Psychology,

University of Nigeria,

Nsukka.

Dear Respondent,

I am a postgraduate student of the Department of Psychology, University of Nigeria Nsukka. The

questionnaire is for academic research on the: Influence of Religious devotion, Self-efficacy and prisoners’ status

on the prison inmates’ manifestation of Psychological distress. Your kind cooperation in completing as well as

returning the attached questionnaire will be highly appreciated.

Your responses will be treated as confidential.

Thank you.

Dennis I. Ozioko

PERSONAL CONSENT

I have been briefed by the researcher that:

• My participation in this study is voluntary

• I will not be identified in any report of the study

• The researcher has nothing to do with the offense(s) I was charged with or convicted of.

DO YOU HEREBY CONSENT TO PARTICIPATE IN THE STUDY? YES NO

PERSONAL DATA: Please tick “√” in the boxes below as it applies to you.

1. Religion: Christianity Islamic ATR Others (specify)…

2. Prison Status: Convict Awaiting trial

3. Marital Status: Married Single Widow(er)

4. Age: 18-28 29-39 40 - 50 51 and above

109

SECTION B

(RAS)

INSTRUCTION: Please if the question accurately applies to you, shade “T” (TRUE) in front of the statement but if it does not

apply to you shade “F” (FALSE). There are no right or wrong answers.

1. I believe in a supreme God/Allah……………………………………………………. …………………….. .. T F

2. I am a born-again Christian/Muslim…………………………………………………………..……………......T F

3. I go to Church/Mosque always……………………………………………………………….…………….. .....T F

4. I an a member of some Christian /Muslim societies…………………………………………….…..………..…T F

5. I pay my levies/dues/tithes in the Church/Mosque regularly…………………………….…………………..….T F

6. I regularly attend Bible/Koranic classes during the week apart from Friday/Saturday/Sunday.……………..…T F

7. I take part in evangelical activities often to places outside the town I live in ………….………………..…..….T F

8. I regularly go with other colleagues to preach from house to house……………………………………...…..…T F

9. I regularly attend fellowship/prayer meetings…………………………..……….……………………………....T F

10. I listen regularly to Christian/Muslim programmes on radio…………….…………………………….......….T F

11. I regularly watch Christian/Muslim programmes on television….………………………………….…….…..T F

12. I usually take part in fasting……………………………….………………………………………………..….T F

13. I regularly attend night services in my Church/Mosque……..…………………………………………….…..T F

14. I pray at least two times a day…………………………………………………………………………..…..….T F

15. I read the Bible/Koran at least once everyday………………………………………………………...………..T F

16. I regularly give alms to the poor………………………………………………………………….…………....T F

17. I have a miracle Handkerchief/Tira…………………………………………….………………….………..….T F

18. I am Baptized/Confirmed/consecrated member of my religion…………………………………………..…....T F

19. I always dress in a manner prescribed of me during my religious festivals……………………………………T F

20. I faithfully do what is expected of me during my religious festivals………………………………………..…T F

21. I cannot marry a person who is not a member of my religious denomination……………………………….....T F

110

SECTION C

(GSES)

INSTRUCTION: Please indicate by ticking (√ ) beside each questions as it applies to how you see yourself.

1 = Not at all true

2 = Hardly true

3 = Moderately true

4 = Exactly true

1. I can always manage to solve difficult problems if I try hard enough 1 2 3 4

2. If someone oppose me, I can find the means and ways to get what I want 1 2 3 4

3. It is easy for me to stick to my aims and accomplish my goals. 1 2 3 4

4. I am confident that I could deal efficiently with unexpected events. 1 2 3 4

5. Thanks to my resourcefulness, I know how to handle unforeseen situations. 1 2 3 4

6. I can solve most problems if I invest the necessary effort. 1 2 3 4

7. I can remain calm when facing difficulties because I can rely on my coping abilities. 1 2 3 4

8. When I am confronted with a problem, I can usually find several solutions. 1 2 3 4

9. If am in trouble, I can usually think of a solution. 1 2 3 4

10. I can usually handle whatever comes my way. 1 2 3 4

111

SECTION D

(GHQ-12)

INSTRUCTION: We want to know how you health has been in general over the last few weeks. Please read the questions

below and each of the four possible answers. Tick the response that best applies to you.

Have you recently:

1. Been able to concentrate on what you’re doing?

Better than usual Same as usual Less than usual Much less than usual

2. Lost much sleep over worry?

Not at all no more than usual rather more than usual much more than usual

3. Felt that you are playing a useful part in things?

More so than usual same as usual less so than usual much less than usual

4. Felt capable of making decisions about things?

More so than usual same as usual less than usual much less than usual

5. Felt constantly under stain?

Not at all no more than usual rather more them usual much more than usual

6. Felt you couldn’t overcome your difficulties?


7. Been able to enjoy your normal day to day activities?


8. Been able to face up to your problems?


9. Been feeling unhappy or depressed?


10. Been losing confidence in yourself?


11. Been thinking of yourself as a worthless person?


12. Been feeling reasonably happy all things considered?


112

APPENDIX B

RELIABILITY STATISTICS FOR RELIGIOUS AFFILIATION SCALE (RAS)

Case Processing Summary

N %

Cases Valid 119 100.0

Excludeda 0 .0

Total 119 100.0

a. Listwise deletion based on all variables in the

procedure.

Reliability Statistics

Cronbach's

Alpha

Cronbach's

Alpha Based on

Standardized

Items N of Items

.880 .885 21

Item Statistics

Mean Std. Deviation N

VAR00001 2.8235 .70887 119

VAR00002 2.3193 1.26178 119

VAR00003 2.4706 1.14850 119

VAR00004 2.3697 1.22727 119

113

VAR00005 1.8403 1.46706 119

VAR00006 1.4874 1.50629 119

VAR00007 1.4622 1.50586 119

VAR00008 1.3613 1.49989 119

VAR00009 1.8403 1.46706 119

VAR00010 1.8403 1.46706 119

VAR00011 1.1345 1.46093 119

VAR00012 2.4706 1.14850 119

VAR00013 1.0084 1.42315 119

VAR00014 2.5210 1.10353 119

VAR00015 2.1681 1.34869 119

VAR00016 1.7899 1.47794 119

VAR00017 .7311 1.29338 119

VAR00018 2.2941 1.27793 119

VAR00019 1.9412 1.43972 119

VAR00020 2.3697 1.22727 119

VAR00021 1.5378 1.50586 119

114

Item-Total Statistics

Scale Mean if

Item Deleted

Scale Variance if

Item Deleted

Corrected Item-

Total Correlation

Squared Multiple

Correlation

Cronbach's

Alpha if Item

Deleted

VAR00001 36.9580 225.600 .431 .474 .878

VAR00002 37.4622 214.607 .516 .618 .874

VAR00003 37.3109 210.453 .706 .724 .869

VAR00004 37.4118 207.583 .741 .728 .867

VAR00005 37.9412 211.819 .499 .537 .874

VAR00006 38.2941 206.192 .620 .757 .870

VAR00007 38.3193 207.524 .588 .629 .871

VAR00008 38.4202 209.483 .543 .643 .873

VAR00009 37.9412 202.361 .737 .695 .866

VAR00010 37.9412 213.649 .454 .586 .876

VAR00011 38.6471 216.637 .384 .673 .878

VAR00012 37.3109 212.741 .634 .656 .871

VAR00013 38.7731 211.753 .519 .633 .874

VAR00014 37.2605 218.669 .472 .608 .875

VAR00015 37.6134 211.697 .555 .659 .873

VAR00016 37.9916 230.229 .364 .233 .889

VAR00017 39.0504 225.913 .398 .512 .883

VAR00018 37.4874 224.218 .247 .499 .882

VAR00019 37.8403 212.661 .490 .687 .875

VAR00020 37.4118 214.753 .529 .601 .874

115


Scale Mean if

Item Deleted

Scale Variance if

Item Deleted

Corrected Item-

Total Correlation

Squared Multiple

Correlation

Cronbach's

Alpha if Item

Deleted

VAR00001 36.9580 225.600 .431 .474 .878

VAR00002 37.4622 214.607 .516 .618 .874

VAR00003 37.3109 210.453 .706 .724 .869

VAR00004 37.4118 207.583 .741 .728 .867

VAR00005 37.9412 211.819 .499 .537 .874

VAR00006 38.2941 206.192 .620 .757 .870

VAR00007 38.3193 207.524 .588 .629 .871

VAR00008 38.4202 209.483 .543 .643 .873

VAR00009 37.9412 202.361 .737 .695 .866

VAR00010 37.9412 213.649 .454 .586 .876

VAR00011 38.6471 216.637 .384 .673 .878

VAR00012 37.3109 212.741 .634 .656 .871

VAR00013 38.7731 211.753 .519 .633 .874

VAR00014 37.2605 218.669 .472 .608 .875

VAR00015 37.6134 211.697 .555 .659 .873

VAR00016 37.9916 230.229 .364 .233 .889

VAR00017 39.0504 225.913 .398 .512 .883

VAR00018 37.4874 224.218 .247 .499 .882

VAR00019 37.8403 212.661 .490 .687 .875

VAR00020 37.4118 214.753 .529 .601 .874

VAR00021 38.2437 219.999 .292 .630 .882

116

Scale Statistics

Mean Variance Std. Deviation N of Items

39.7815 235.291 15.33919 21

117

RELIABILITY STATISTICS FOR GENERAL SELF-EFFICACY SCALE (GSES)


N %


Excludeda 0 .0

Total 119 100.0


procedure.


Cronbach's

Alpha

Cronbach's

Alpha Based on

Standardized

Items N of Items

.734 .670 10

Item Statistics


VAR00001 3.2353 .88973 119

VAR00002 3.0756 .92204 119

VAR00003 3.2437 .94749 119

VAR00004 3.2437 .72447 119

VAR00005 2.8319 .89556 119

VAR00006 3.4202 .67014 119

118

VAR00007 3.1513 .97110 119

VAR00008 3.2773 .70017 119

VAR00009 3.4118 .81731 119

VAR00010 3.2017 .84952 119


Scale Mean if

Item Deleted

Scale Variance if

Item Deleted

Corrected Item-

Total Correlation

Squared Multiple

Correlation

Cronbach's

Alpha if Item

Deleted

VAR00001 28.8571 12.090 .386 .231 .534

VAR00002 29.0168 12.000 .385 .270 .535

VAR00003 28.8487 10.757 .383 .289 .472

VAR00004 28.8487 12.452 .207 .306 .527

VAR00005 29.2605 13.449 -.033 .149 .595

VAR00006 28.6723 11.273 .514 .374 .457

VAR00007 28.9412 14.598 -.203 .266 .648

VAR00008 28.8151 11.627 .401 .219 .482

VAR00009 28.6807 10.490 .543 .609 .431

VAR00010 28.8908 10.674 .475 .555 .449

Scale Statistics


32.0924 14.034 3.74617 10

119

RELIABILITY STATISTICS FOR GENERAL HEALTH QUESTIONNAIRE-12 (GHQ-12)


N %


Excludeda 0 .0

Total 119 100.0


procedure.


Cronbach's

Alpha

Cronbach's

Alpha Based on

Standardized

Items N of Items

.719 .684 12

Item Statistics


VAR00001 1.4118 1.20319 119

VAR00002 1.5546 1.10237 119

VAR00003 1.7395 1.08505 119

VAR00004 1.3782 1.06558 119

VAR00005 2.2941 .98594 119

VAR00006 1.5966 1.11476 119

VAR00007 1.8487 1.05476 119

120

VAR00008 1.2521 1.15141 119

VAR00009 1.2941 .54233 119

VAR00010 1.6218 1.08917 119

VAR00011 1.4034 1.06022 119

VAR00012 1.3109 .98933 119


Scale Mean if

Item Deleted

Scale Variance if

Item Deleted

Corrected Item-

Total Correlation

Squared Multiple

Correlation

Cronbach's

Alpha if Item

Deleted

VAR00001 17.2941 13.345 .441 .768 .130

VAR00002 17.1513 17.706 -.027 .195 .355

VAR00003 16.9664 13.287 .531 .508 .104

VAR00004 17.3277 14.273 .405 .474 .169

VAR00005 16.4118 17.888 .323 .195 .347

VAR00006 17.1092 18.590 .421 .101 .392

VAR00007 16.8571 18.446 -.098 .307 .378

VAR00008 17.4538 16.080 .437 .416 .287

VAR00009 17.4118 18.651 -.059 .096 .338

VAR00010 17.0840 19.044 -.164 .194 .405

VAR00011 17.3025 17.162 .343 .192 .325

VAR00012 17.3950 15.410 .393 .483 .227

121

Scale Statistics


18.7059 18.667 4.32053 12

122

APPENDIX C

ANOVA TABLES FOR RELIGIOUS DEVOTION, SELF-EFFICACY, PRISONERS’ STATUS AND PSYCHOLOGICAL

DISTRESS

UNIANOVA GHQ BY RAS GSES PRISONERSSTATUS

/METHOD=SSTYPE(3)

/INTERCEPT=INCLUDE

/EMMEANS=TABLES(OVERALL)

/PRINT=DESCRIPTIVE

/PLOT=RESIDUALS

/CRITERIA=ALPHA(.05)

/DESIGN=RAS GSES PRISONERSSTATUS RAS*GSES RAS*PRISONERSSTATUS GSES*PRISONERS

STATUS RAS*GSES*PRISONERSSTATUS.

Univariate Analysis of Variance

[DataSet1] C:\Users\user\Documents\DENIS BOOK 11.sav

Descriptive Statistics

N Mean Std. Deviation Kurtosis

Statistic Statistic Statistic Statistic Std. Error

RAS 399 36.0150 16.68490 -1.267 .243

GSES 399 27.5525 7.32437 -.398 .243

PRISONERSSTATUS 399 1.5000 .50063 -2.010 .243

GHQ 399 17.1850 3.86628 .916 .243

Valid N (listwise) 399

123

Between-Subjects Factors

Value Label N

RAS 1 Low Religious

Devotion 242

2 High Religious

Devotion 157

GSES 1 Low Self

Efficacy 209

2 High Self

Efficacy 190

PRISONERSSTATUS 1 Convicts 142

2 Awaiting 257

Descriptive Statistics

Dependent Variable:GHQ

RAS GSES

PRISONERS

STATUS Mean Std. Deviation N

Low Religious Devotion Low Self Efficacy Convicts 1.2907 .45675 86

Awaiting 1.5303 .50291 66

Total 1.3947 .49041 152

High Self Efficacy Convicts 1.3621 .48480 58

Awaiting 1.7187 .45680 32

Total 1.4889 .50268 90

124

Total Convicts 1.3194 .46789 144

Awaiting 1.5918 .49402 98

Total 1.4298 .49607 242

High Religious Devotion Low Self Efficacy Convicts 1.4583 .50898 24

Awaiting 1.5152 .50752 33

Total 1.4912 .50437 57


Awaiting 1.8529 .35680 68

Total 1.7400 .44084 100


Awaiting 1.7426 .43940 101

Total 1.6497 .47860 157

Total Low Self Efficacy Convicts 1.3273 .47137 110

Awaiting 1.5253 .50190 99

Total 1.4211 .49491 209


Awaiting 1.8100 .39428 100

Total 1.6211 .48641 190


Awaiting 1.6683 .47200 257

Total 1.5163 .50036 399

125

Tests of Between-Subjects Effects

Dependent Variable:GHQ

Source

Type III Sum of

Squares df Mean Square F Sig.

Corrected Model 14.877a 7 2.125 9.803 .000

Intercept 773.979 1 773.979 3.570E3 .000

RAS .933 1 .933 4.304 .039

GSES 2.115 1 2.115 9.757 .002

PRISONERSSTATUS 5.239 1 5.239 24.165 .000

RAS * GSES .074 1 .074 .342 .559

RAS * PRISONERSSTATUS .180 1 .180 .831 .363

GSES *

PRISONERSSTATUS .884 1 .884 4.076 .044

RAS * GSES *

PRISONERSSTATUS .166 1 .166 .765 .382

Error 84.767 391 .217

Total 1017.000 399

Corrected Total 99.644 398

a. R Squared = .149 (Adjusted R Squared = .134)

FACULTY OF THE SOCIAL SCIENCES - University of Nigeria General Work Main.pdf · Acknowledgement iv...

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