Unseen and underserved: the first multifactorial assessment of mental health among Paraguayan male prisoners

BACKGROUND: This study provides the analysis of mental health among incarcerated men in Paraguay from a representative sample of 621 adult prisoners in two major penitentiaries. AIMS: To assess the prevalence and correlates of psychiatric symptoms, suicide risk, and substance use among incarcerated men, and their associations with sociodemographic, penal, and health-related factors. METHODS: We employed the Symptom Checklist-90-R (SCL-90-R), the Columbia-Suicide Severity Rating Scale (C-SSRS Screener), and the MULTICAGE CAD-4 for alcohol and substance use. We assessed the prevalence and statistical associations between psychiatric symptoms and relevant variables. RESULTS: Findings revealed substantial levels of psychoticism (28.2%) and phobic anxiety (25.4%). Specifically, nearly one in five participants exhibited suicide risk (19.5%), and problematic drug and alcohol use were identified in 57.0% and 44.9% of users, respectively. Statistically significant associations were observed between SCL-90-R symptom dimensions and variables including suicide risk, prior mental health diagnoses, substance use, and access to treatment. Symptom severity was also associated with pre-incarceration socioeconomic vulnerability and legal status. CONCLUSION: The results underline the need for early psychiatric screening, care pathways, and integrated carceral mental health systems to address psychiatric morbidity among incarcerated men in Paraguay.