Psychiatric morbidity among convicted male sex offenders at Kamiti maximum security prison

Abstract

BACKGROUND: Sexual offending is associated with enormous emotional pain and suffering to the victims and their families, as well as huge economic loses to the victims, their families and the state. Prevalence of, and factors associated with, sexual offending in Kenya should be determined with the view to reducing incidence to the minimum level possible. OBJECTIVE: (a).To determine the prevalence and distribution of psychiatric morbidity among convicted male sex offenders (MSOs) aged 18years and above, and (b). Establish factors associated with male sexual offending in Kenya. DESIGN: Cross-sectional descriptive survey. METHOD: Those who voluntarily came forward and gave written informed consent were individually interviewed using a socio-demographic and sexual questionnaire designed by the researcher, International Personality Disorder Examination (IPDE) and Structured Clinical Interview for the Diagnosis and Statistical Manual IV (SCID) instruments. SETTING: Seventy-six (76) convicted MSOs at Kamiti M.5.P. were interviewed. Data collected was analyzed using SPSSversion 11.5 computer software. RESULTS: Of the 76 subjects, 47 (61.8%) were convicted of defilement and attempted defilement, 23 (30.3%) were convicted of rape and attempted rape, while 6 (7.9%) were convicted of various other sex offences. Twenty-seven (27) out of 76 (35.5%) had a DSM-IV Axis I disorder while 26 (34.2%) had a DSM-IV Axis II disorder. A further breakdown of this distribution showed that 12 (15.8%)and 11 (14.?%) had Axis I and II diagnoses, respectively while 15 (19.7%) had both Axis I and II diagnoses i.e. co-morbidity. Majority of those subjects who met the criteria for DSM-IV Axis I were dependent on or abused substances (71.1% of Axis I diagnoses).The substances most commonly misused were alcohol. cannabis and khat. Noneof the subjects had psychiatric morbidity of psychotic proportions. Ofthosewho met criteria for Axis II diagnosis, Antisocial and Impulsive Personality Disorderswere the most commonly occurring disorders (twelve out of twenty-six (46.2%)).Personality disorder unspecified also accounted for a significant number (six or 23.1%)of the twenty-six. The others (30.7%) had Histrionic, Schizoid, Paranoid and BorderlinePersonality Disorders. Exposureto erotica (see Abbreviations, Acronyms and Definitions) was significantly associated with both Axes I and II (p = 0.02 and p= 0.0003 respectively) and preoccupation with thoughts about sex was associated with Axis II disorders (p= 0.01). CONCLUSIONS: The following conclusions were drawn from this study: 1. More than a third (34.2%) of the subjects had personality and/or other psychiatric disorders (DSM-IV Axis II and/or I), while about a fifth (19.7%) had both (DSMIV) Axis I and II diagnoses, 15.8% had an Axis I diagnosis alone and another 14.5% had an Axis II diagnosis alone. 2. Substance use disorders were the most commonly occurring DSM-IV Axis I disorders (71.1%). 3. Among those with Axis II disorders, those with antisocial and impulsive personality disorders accounted for nearly half of the subjects. The other half had histrionic, schizoid, obsessive-compulsive, borderline, paranoid and personality disorder unspecified. 4. There was a significant statistical association between Axes I and II disorders and exposure to sexually explicit materials but there was no such an association with other socio-demographic factors. Further Axis II disorders were significantly associated with preoccupation with thoughts about sex too. 5. Majority ~61.8%)of the offenders (defilers and potential defilers) targeted children aged less than 14 years. Most of those with psychiatric morbidity targeted children and had antisocial or impulsive personality disorder. Awareness campaigns to enlighten the public of the fact that children are the commonest victims and research to determine the most effective ways of treating and rehabilitating sexual offenders could reduce the sexual offending inthis country.