Sociodemographic and Health-Related Predictors of Anxiety and Fear of COVID-19 in the Prison Population: Cross-Sectional Study

Background The COVID-19 pandemic generated a notable emotional impact on the general population, yet its effects on incarcerated individuals have been far less explored, despite the particular vulnerabilities associated with prison environments. Objective This study aimed to assess levels of anxiety and fear related to COVID-19 among incarcerated adults in Spain and identify sociodemographic and health-related factors associated with greater emotional distress. Methods A cross-sectional study was conducted between May 2022 and February 2023 among 711 inmates from 3 Spanish prisons using a nonprobability convenience sampling strategy. Anxiety and fear related to COVID-19 were assessed using the Anxiety and Fear of COVID-19 Assessment Scale (AMICO)–Inmates scale, an adaptation of the original AMICO, developed for the general Spanish population, and subsequently validated for use among prison inmates. Descriptive analyses, bivariate comparisons, and categorical regression (CATREG) were performed to examine factors associated with the total AMICO score. Results The mean AMICO score was 5.58 (SD 2.55), indicating high levels of anxiety and fear related to COVID-19. In the bivariate analyses, significant differences were observed according to sex, having children, sharing a cell, and the presence of chronic illness. The CATREG model explained 17.4% of the variance in AMICO scores ( R 2 =0.174; P <.001). Female sex (β=0.214; P <.001), sharing a cell (β=0.112; P =.001), and chronic illness (β=0.086; P =.01) were independently associated with higher levels of anxiety and fear. Conclusions Incarcerated individuals experienced high levels of anxiety and fear related to COVID-19. Women, inmates sharing a cell, and those with chronic illnesses appeared particularly vulnerable to emotional distress. These findings highlight the importance of incorporating targeted psychological support and mental health strategies into prison preparedness plans for future public health emergencies.