A Systematic Review on Complementary Approach for Depression Among Adult Prison Inmates
Last reviewed: March 2026
Key Findings
- From 158 initially identified studies, only 5 met the rigorous inclusion criteria for final review after screening and elimination of duplicates.
- Yoga, music therapy, and cognitive bibliotherapy demonstrated potential as complementary approaches for reducing depressive symptoms in prison inmates.
- “Seeking safety,” a short-term behavioural intervention, was found to have an insignificant effect on depression in the prison context.
- The Beck Depression Inventory was the most commonly used outcome measurement instrument across the reviewed studies.
Background and Context
Depression is highly prevalent among incarcerated populations worldwide. Meta-analytic evidence suggests that approximately 10–12% of male prisoners and 12–15% of female prisoners suffer from major depressive disorder, rates significantly higher than those observed in the general population. In prison settings, depression is associated with increased risk of self-harm, suicide, behavioural problems, and poor rehabilitation outcomes.
While pharmacological treatment is the conventional first-line approach for moderate to severe depression, several factors make it challenging to implement effectively in prison settings. These include limited psychiatric resources, medication non-compliance, security concerns related to medication stockpiling, and the need for ongoing monitoring. Complementary and alternative approaches therefore represent a potentially valuable adjunct to standard treatment, offering non-pharmacological interventions that may be more feasible to deliver in correctional environments.
This systematic review sought to evaluate the evidence for complementary approaches in reducing depressive symptoms among adult prison inmates, focusing on randomised controlled trials published between 2012 and June 2017.
Methods
The review followed systematic methodology, searching PubMed, EBSCOhost, Science Direct, and Wiley Online Library using predefined keywords. Inclusion criteria specified English-language full-text articles reporting on randomised controlled trials of complementary approaches for depression among adult prison inmates. Exclusion criteria included studies focused solely on diagnostic instruments or pharmacological trials.
An initial search yielded 158 studies. After removing 21 duplicates, 137 articles were screened. Of these, 22 met criteria for full-text review, and ultimately 5 studies were included in the final synthesis. The small number of eligible studies reflects the limited research attention given to non-pharmacological depression interventions in correctional settings.
Summary of Reviewed Interventions
| Intervention | Duration | Outcome |
|---|---|---|
| Yoga programme | 10 weeks | Improved behavioural control; decreased psychological distress |
| Music therapy | Variable | Reduced depressive symptoms; pilot RCT showed positive effects |
| Cognitive bibliotherapy | 4 weeks (self-administered) | Demonstrated efficacy for mild to moderate depression in prison |
| Seeking safety (behavioural) | 16 weeks | No significant effect on depressive symptoms at 4-month follow-up |
| Combined complementary approach | Variable | Depression scores improved from pre-test to post-test in both intervention and control groups |
Analysis of Specific Approaches
Yoga
The yoga-based intervention, conducted over a ten-week programme, demonstrated improvements in behavioural control and decreases in psychological distress among participants. The structured nature of yoga, combining physical postures, breathing exercises, and meditative practices, appeared well-suited to the prison environment where stress reduction and emotional regulation are particularly valuable.
Music Therapy
Music therapy showed promise in reducing depressive symptoms among inmates. A pilot randomised controlled trial demonstrated positive effects, suggesting that creative, non-verbal therapeutic approaches may be particularly effective for individuals who struggle with traditional talk-based therapies, a common challenge in correctional populations with low educational attainment or trust barriers.
Cognitive Bibliotherapy
Self-administered cognitive bibliotherapy, involving structured reading materials based on cognitive-behavioural principles, demonstrated efficacy for mild to moderate depression. Its self-directed nature makes it a scalable and cost-effective intervention that does not require extensive therapist involvement, making it particularly practical in resource-limited prison settings.
Implications for Correctional Health
The findings highlight the need for diversified mental health interventions in prisons. Reliance on pharmacotherapy alone is insufficient and impractical in many correctional settings. The review supports the development of structured complementary programmes that can be delivered by trained prison staff or through self-directed formats. Yoga, music therapy, and bibliotherapy represent viable options that deserve further evaluation through larger, more rigorous randomised trials.
Limitations
The most significant limitation is the small number of eligible studies, reflecting the overall paucity of rigorous research on complementary depression interventions in prison populations. The included studies varied considerably in sample sizes, intervention protocols, and follow-up durations, limiting the ability to draw definitive conclusions. The review did not include pharmacological trials, which may represent the standard of care in many settings. Future systematic reviews should consider expanding the search timeframe and including quasi-experimental designs.
Gunenthira R, Minhat HS, Nor Afiah MZ, Anisah B, Ahmad N. A systematic review on complementary approach for depression among adult prison inmates. Malaysian Journal of Public Health Medicine. 2018;18(2):20–27.
License: Content shared under CC BY-NC 4.0 — Malaysian Journal of Public Health Medicine.