Psychological Distress in Solitary Confinement: Symptoms, Severity, and Prevalence in the United States, 2017-2018

Suicide following a conviction, solitary confinement, or transfer in people incarcerated: A comprehensive retrospective cohort study in France, 2017-2020

INTRODUCTION

Suicide rates are higher in prison than in the general population in most countries. The proximity of some suicides to prison events has only received little attention in comparative studies. The aim of this study was to assess the relationship between suicide and four prison events: conviction, disciplinary solitary confinement, nondisciplinary solitary confinement and inter-prison transfer, in a national retrospective cohort study of people in prison.

METHODS

All incarcerations in France that occurred during 2017-2020 were eligible. Data were collected from an administrative database of the National Prison Service. Survival bivariate and multivariate analyses were performed with a Cox regression model.

RESULTS

Of 358,522 incarcerations were included, among which 469,348 events and 449 suicides occurred. In multivariate analysis, suicide risk was higher the first day of disciplinary solitary confinement (HR = 42.1 [21.5-82.7] and HR = 119.0 [71.5-197.9], before and after a government decree on the disciplinary system, respectively. It was higher within 2 weeks after a transfer (HR = 3.5 [2.3-5.2])) or entry in nondisciplinary solitary confinement (HR = 6.7 [3.4-13.3]) and lower within 2 weeks after a conviction (HR = 0.6 [0.4-1.0]).

CONCLUSION

Solitary confinement and transfer were found to be precipitating factors of suicide in people who are incarcerated. These results offer interesting perspectives on prevention.

An Interpretive Description of Drug Withdrawal Among Pregnant Women in Jail

OBJECTIVE

To explore the experience of drug withdrawal among pregnant women in jail.

DESIGN

A qualitative interpretive descriptive approach.

SETTING/PROBLEM

The care of incarcerated pregnant women constitutes a complex and significant public health problem. Many have substance use disorder (SUD) and cycle in and out of jails in their community, resulting in repeated experiences of drug withdrawal. Most jails do not provide medication-assisted therapy for management of withdrawal, a situation that violates standards of care set by leading health organizations. The experience of drug withdrawal among pregnant women in jail has not been qualitatively explored in the literature.

PARTICIPANTS

Five women completed interviews for the study.

INTERVENTION

In-depth, qualitative interviews.

RESULTS

Five themes with subthemes emerged from the interviews: Framing the Story Through Life History: I Need You to Know Where I Come From, Patterns of Thinking About Substance Use, The Manifestations of Withdrawal: Body and Mind, Perceived Punishment for Drug Use During Pregnancy, and Mixed Perceptions of Withdrawal Treatment.

CONCLUSION

Participants told a story beyond that of the physical withdrawal symptoms, revealing new insights into their maternal distress and the need for compassionate, nonstigmatized care to address physical and mental symptoms, as well as advocacy for the provision of an evidence-based standard of care. Nurses who care for pregnant women with SUD in the jail setting could benefit from collaborative relationships with other health care professionals in the community to reduce disparate health outcomes for this vulnerable population.

Prior incarceration, restrictive housing, and posttraumatic stress disorder symptoms in a community sample of persons who use drugs

BACKGROUND

Criminalization of drugs in the United States (US) has extensive consequences for people who use drugs (PWUD). Incarceration and substance use overlap with 65% of the US prison population meeting substance use disorder (SUD) criteria. Exposure to the criminal-legal system negatively impacts the health of PWUD. PTSD is commonly comorbid with SUDs, and exposure to restrictive housing (RH) during incarceration may worsen mental health. Because PWUD are disproportionately incarcerated, experiences occurring during incarceration, such as RH, may contribute to the development or exacerbation of PTSD and SUDs. This study of PWUD investigated prior criminal-legal system exposure and its association with PTSD symptoms in community-dwelling PWUD.

METHODS

This cross-sectional study recruited PWUD from syringe service programs (SSP). Inclusion criteria were: age 18+, current or past opioid use disorder, and SSP enrollment. Data collected included: sociodemographics; incarceration, substance use, SUD treatment history, and PTSD assessments (Life Events Checklist for DSM-5 and the PTSD Checklist for DSM-5). Bivariate testing and multivariate logistic regression analyses, with probable PTSD as the dependent variable and a three-level variable for criminal legal history as the independent variable, were conducted to determine whether incarceration and RH were associated with probable PTSD.

RESULTS

Of 139 participants, 78% had an incarceration history with 57% of these having a history of RH. 57% of participants screened positive for probable PTSD, and physical assault was the most common traumatic exposure. Any history of incarceration was not associated with probable PTSD diagnosis; however, in multivariate testing, adjusting for age, sex, and substance use, a history of RH (adjusted odds ratio [aOR]: 3.76, 95% CI 1.27-11.11) was significantly associated with probable PTSD.

CONCLUSIONS

RH and PTSD were both exceptionally common in a sample of SSP participants. RH can be detrimental to physical and mental health. Clinicians and policy makers may not consider incarceration as a traumatic experience for PWUD; however, our data suggest that among highly marginalized PWUD, prior exposure to incarceration and RH may add an additional burden to their daily struggles, namely PTSD.

Nordic nurses' areas of research during and related to the COVID-19 pandemic. A scoping review with recommendations for evidence-based practice

BACKGROUND

The knowledge of the landscape of COVID-19 research performed by nurses in hospitals and health services is scarce. It is important to identify, map and share knowledge and thus provide a better understanding of the important research performed by nurses.

AIMS

To provide a comprehensive overview of Nordic nurses' focus areas of research during and related to the COVID-19 pandemic and to extract knowledge on recommendations for future evidence-based practice.

METHODS

The electronic databases of MEDLINE (via PubMed), CINAHL (via EBSCO) and Scopus (via Elsevier) were searched for studies describing all areas of nursing during and related to the COVID-19 pandemic conducted in the Nordic countries. Studies conducted by a nurse as the first or last author and published from March 2020 to March 2022 were included in the scoping review. The protocol for the review is registered at Open Science Framework (https://osf.io/f8kuq).

RESULTS

Of 8412 studies found in the comprehensive search, 119 studies met the inclusion criteria. The studies were written by nurses from Denmark (42%), Sweden (31%), Norway (20%), Finland (6%) and Iceland (1%). The majority of studies (39%) covered patients' and relatives' experiences of visiting restrictions and social distancing and relatives' communications with healthcare professionals. Twenty-six per cent of included studies covered healthcare professionals' experiences of caring for patients infected with COVID-19, working during the pandemic and suffering from the consequences of both.

LINKING EVIDENCE TO ACTION

The recommendations of evidence-based practice for future pandemics show that social distancing for disease prevention must be provided while considering the human consequences of social distancing. Special training is also recommended for healthcare professionals caring for COVID-19 patients accompanied by psychosocial support for their mental well-being. Additionally, virtual contact is an important supplement to personal treatment and face-to-face contact during social restrictions.

"It's just us sitting there for 23 hours like we done something wrong": Isolation, incarceration, and the COVID-19 pandemic

For the millions of people incarcerated in United States' prisons and jails during the COVID-19 pandemic, isolation took many forms, including medical isolation for those sick with COVID-19, quarantine for those potentially exposed, and prolonged facility-wide lockdowns. Incarcerated people's lived experience of isolation during the pandemic has largely gone undocumented. Through interviews with 48 incarcerated people and 27 staff at two jails and one prison in geographically diverse locations in the United States, we document the implementation of COVID-19 isolation policies from the perspective of those that live and work in carceral settings. Incarcerated people were isolated from social contact, educational programs, employment, and recreation, and lacked clear communication about COVID-19-related protocols. Being isolated, no matter the reason, felt like punishment and was compared to solitary confinement-with resultant long-term, negative impacts on health. Participants detailed isolation policies as disruptive, detrimental to mental health, and dehumanizing for incarcerated people. Findings point to several recommendations for isolation policy in carceral settings. These include integrating healthcare delivery into isolation protocols, preserving social relationships during isolation, promoting bidirectional communication about protocols and their effect between facility leadership and incarcerated people. Most importantly, there is an urgent need to re-evaluate the current approach to the use of isolation in carceral settings and to establish external oversight procedures for its use during pandemics.

Transgender Incarceration and Law Enforcement as a Source of Harm: Upstream and Primordial Prevention Perspectives

In the United States (US), transgender individuals are more likely to experience violence and sexual assault in jails and prisons compared with cisgender peers. Harms of incarceration on transgender individuals include limited access to medical care and hormone therapy, as well as being housed in facilities based on biological sex instead of gender identity. However, there has been insufficient research on addressing factors that lead to transgender individuals being incarcerated in the first place. In this article, we argue the need to focus on law enforcement interactions with transgender individuals in the US to reduce incarceration-related harms. Using the perspectives of primordial prevention and focusing on upstream factors that create health-related harms, we assert that focusing on law enforcement is a necessary component in addressing how the criminal justice system harms transgender individuals.

Psychopathology and history of mental healthcare among male detainees transferred to a facility for managing otherwise uncontrollable in-prison violence: An exploratory study

BACKGROUND

In-prison violence by detainees is a problem worldwide, but despite evidence of a much higher prevalence of a range of psychiatric disorders than in the general population, little is known about psychopathology among violent detainees.

AIMS

Our aim was to explore the psychopathology and mental healthcare history of Dutch detainees who were transferred to the highly restrictive facility for uncontrollably violent detainees following severe in-prison violence.

METHODS

Anonymised data for all 253 male detainees incarcerated at any time between January 2016 and January 2020 in the specialist national facility for those seriously violent while in prison-'the Violence Facility'-were obtained from the Dutch Ministry of Justice together with similarly recorded data for a matched comparison group of 253 detainees admitted to an in-prison psychiatric facility-'the Psychiatric Facility'.

RESULTS

There was no record of any psychiatric assessment for 29% of the Violence Facility men. Almost all of the detainees who had been assessed were classified with at least one disorder. Compared to detainees in the Psychiatric Facility, Violence Facility men were more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD), anxiety, behavioural and personality disorders; Psychiatric Facility men were more likely to be diagnosed with psychosis or substance use disorder. Most men in both groups had previously used mental health services.

CONCLUSIONS

This first study of detainees in the Dutch in-prison facility for violent detainees raises questions about whether the extent of violence among these men may have masked mental healthcare needs and leads to questions about potential benefits from establishing more systematic mental health assessments for them, and a need for more specialist services.

Solitary confinement and the well-being of people in prison

BACKGROUND

Solitary confinement and mental well-being has been researched extensively, with a significant increase in studies over the last ten years. These recent studies produce mixed evidence for whether placement in solitary confinement is associated with psychological distress. We advance our understanding of these relationships in two critical ways. First, we conduct both between- and within-person analyses within the same data to better understand the relationship of solitary confinement and mental well-being relative to the well-being of people in less restrictive prison settings. Second, we ask the men in our sample questions about their personality style, coping strategies, and interactions with staff, which allows us to explore how individual characteristics and prison experiences matter, alongside isolation, in understanding mental well-being.

METHODS

We gather data from interviews at three time points with 122 men in solitary confinement and 204 men in other conditions of confinement in Arizona from 2017 to 2019. We merge these interview data with administrative data on study sample and population sample to include critical measures such as mental health score, risk level, and visitation status. Our interviews contain a Global Severity Index (GSI), created from 90 self-reported psychopathological symptoms experienced, that we use to assess well-being. We estimate cross-classified multilevel models to assess between-person differences and within-person change in well-being over time.

RESULTS

There was a small relationship between solitary confinement and worsening well-bring (longitudinal, within-person) and a small relationship between solitary confinement and worse well-being (cross-sectional, between-person), with this between-person association reduced significantly upon inclusion of additional individual characteristics and prison experiences.

CONCLUSIONS

Our results suggest that the incarceration experience, including conditions of confinement, is associated with mental well-being in different ways for different people. We believe that collective confinement and well-being could receive the same scholarly attention and public concern as solitary confinement.

Neuroanatomical and neurochemical effects of prolonged social isolation in adult mice

Introduction

As social animals, our health depends in part on interactions with other human beings. Yet millions suffer from chronic social isolation, including those in nursing/assisted living facilities, people experiencing chronic loneliness as well as those in enforced isolation within our criminal justice system. While many historical studies have examined the effects of early isolation on the brain, few have examined its effects when this condition begins in adulthood. Here, we developed a model of adult isolation using mice (C57BL/6J) born and raised in an enriched environment.

Methods

From birth until 4 months of age C57BL/6J mice were raised in an enriched environment and then maintained in that environment or moved to social isolation for 1 or 3 months. We then examined neuronal structure and catecholamine and brain derived neurotrophic factor (BDNF) levels from different regions of the brain, comparing animals from social isolation to enriched environment controls.

Results

We found significant changes in neuronal volume, dendritic length, neuronal complexity, and spine density that were dependent on brain region, sex, and duration of the isolation. Isolation also altered dopamine in the striatum and serotonin levels in the forebrain in a sex-dependent manner, and also reduced levels of BDNF in the motor cortex and hippocampus of male but not female mice.

Conclusion

These studies show that isolation that begins in adulthood imparts a significant change on the homeostasis of brain structure and chemistry.

Palliating in Avoidable Death: Reconciling Psychiatrists' Roles as Treaters on Death Row With Participation in a System of Overt Harm

ABSTRACT

Although nations across the globe have eliminated capital punishment, the United States remains one of the few countries in the Americas and Europe that still uses execution. There has been little discussion around the implications of psychiatry's involvement in providing care to incarcerated individuals awaiting death. The following perspective examines the United States as an example of a democratic and highly developed country where the death penalty remains an undeniable reality; the piece provides a brief discussion on psychiatry's relationship with end-of-life care to provide context for subsequent discussion on the role of the psychiatrist on death row in the United States. Medicolegal and ethical considerations are further outlined to identify specific concessions that might be made by the US criminal justice system to truly allow death row psychiatrists to practice to the highest standard of compassionate care.

Nowhere Else to Go-Solitary Confinement as Mental Health Care

This Viewpoint examines the clinical, ethical, and legal concerns of the use of solitary confinement to manage acute psychiatric distress among incarcerated people.

Prior Incarceration Is Associated with Poor Mental Health at Midlife: Findings from a National Longitudinal Cohort Study

BACKGROUND

People with mental illnesses and people living in poverty have higher rates of incarceration than others, but relatively little is known about the long-term impact that incarceration has on an individual's mental health later in life.

OBJECTIVE

To evaluate prior incarceration's association with mental health at midlife.

DESIGN

Retrospective cohort study PARTICIPANTS: Participants from the National Longitudinal Survey of Youth 1979 (NLSY79)-a nationally representative age cohort of individuals 15 to 22 years of age in 1979-who remained in follow-up through age 50.

MAIN MEASURES

Midlife mental health outcomes were measured as part of a health module administered once participants reached 50 years of age (2008-2019): any mental health history, any depression history, past-year depression, severity of depression symptoms in the past 7 days (Center for Epidemiologic Studies Depression [CES-D] scale), and mental health-related quality of life in the past 4 weeks (SF-12 Mental Component Score [MCS]). The main exposure was any incarceration prior to age 50.

KEY RESULTS

Among 7889 participants included in our sample, 577 (5.4%) experienced at least one incarceration prior to age 50. Prior incarceration was associated with a greater likelihood of having any mental health history (predicted probability 27.0% vs. 16.6%; adjusted odds ratio [aOR] 1.9 [95%CI: 1.4, 2.5]), any history of depression (22.0% vs. 13.3%; aOR 1.8 [95%CI: 1.3, 2.5]), past-year depression (16.9% vs. 8.6%; aOR 2.2 [95%CI: 1.5, 3.0]), and high CES-D score (21.1% vs. 15.4%; aOR 1.5 [95%CI: 1.1, 2.0]) and with a lower (worse) SF-12 MCS (-2.1 points [95%CI: -3.3, -0.9]; standardized mean difference -0.24 [95%CI: -0.37, -0.10]) at age 50, when adjusting for early-life demographic, socioeconomic, and behavioral factors.

CONCLUSIONS

Prior incarceration was associated with worse mental health at age 50 across five measured outcomes. Incarceration is a key social-structural driver of poor mental health.

The Utility of Meditation and Mindfulness-Based Interventions in the Time of COVID-19: A Theoretical Proposition and Systematic Review of the Relevant Prison, Quarantine and Lockdown Literature

As of July 20, 2021, Covid-19 has killed 4,086,000 people, infected at least 190,169,833 others, and devastated the world's economy. To slow the spread of the virus, numerous governments instituted "lockdown" policies and quarantines, limiting social interactions to the immediate household. The experience of isolation and uncertainty have contributed to increased fear, anxiety, and loneliness; with limited options of research-supported interventions. Although different in nature, the experiences of quarantine and lockdown have been likened to incarceration. Past research has found meditation and mindfulness-based interventions (MBIs) to be effective psychological treatments for prisoners and may therefore translate well into effective methods for the maintenance of psychological well-being for individuals quarantined during the pandemic. More recently, research investigating the effects of meditation and MBIs during the pandemic have demonstrated preliminary evidence for beneficial psychological improvements. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), the current narrative review paper: 1) examines the parallels and differences between the experience of quarantine and imprisonment, 2) investigates the mechanisms through which meditation and mindfulness enact their effects, and 3) systematically reviews literature on the benefits of various types of meditation and MBIs for inmates and individuals in lockdown or quarantine. With this knowledge, the public can garner applicable insight into the potential use of meditation and MBIs for individuals forced to cope with pandemic lockdowns and quarantines. Two hundred and twenty one (221) articles were identified through Pubmed and Google Scholar, and 24 articles were ultimately included in the manuscript.

Self-injury and the embodiment of solitary confinement among adult men in Louisiana prisons

Solitary confinement is a harrowing human rights and public health problem that is currently inflicted as a routine punishment for a litany of prison rule violations, a reactionary tactic to quell resistance to prison conditions, and as a destination of last resort for people serious mental illnesses (SMI) who are especially vulnerable to its harms. An extensive body of research has documented clusters of psychiatric symptoms-emotional distress, cognitive deficits, social withdrawal, anxiety, paranoia, sleeplessness, and hallucinations-linked to solitary confinement that often manifest in decompensating behaviors, which include self-injury and suicide. This study summarizes the historical evolution of solitary confinement, recaps its linkages to self-injury and suicidality, and offers a theoretical framework grounded in ecosocial theory, and supplemented with concepts from theories of dehumanization and carceral geography. Findings bolster extant evidence on the harms of solitary confinement by focusing on whether and how exertions of power by prison staff to deploy mechanisms of dehumanization-as a pathway between SMI and self-injury among a cross section of adult men (n = 517) exposed to solitary confinement in Louisiana prisons in 2017. Findings reinforce the need for structural interventions that diffuse forms of carceral power and practices that continue to subject people to isolation, dehumanization, and violence.

Depression in Male Inmates

Introduction: The prevalence of psychiatric morbidity is high among incarcerated individuals. Severe mental disorder is five to ten times higher among prisoners compared to the general population. Several factors are held to be responsible for the high prevalence of depression in prison: mainly poor living conditions (narrow room, loss of privacy), limited interpersonal relationships, and lack of mental health access. Inmates are at increased risk of all-cause mortality, suicide, self-harm, violence, and victimization while those with mental disorders are involved in conflicts and are more likely to be charged with prison rules. Purpose: To explore depression among male inmates. Methods and material: In the study, 101 male inmates were enrolled. Data were collected by the completion of a “self-rating depression scale (SDS)-Zung” which included participants’ characteristics. The statistical significance level was p < 0.05. Results: Of the 101 participants, 51.4% of inmates were under 40 years old, 54.5% were married, 45.6% had been convicted of homicide and 38.6% had a life sentence. Normal depression levels were experienced by 62.4% of the participants, while 21.8% were mildly depressed, 14.9% were moderately depressed and 1.0% severely depressed. Foreign prisoners had statistically significant higher scores of depression compared to Greeks (median 48 vs. 45, p = 0.012); those suffering from a chronic disease compared to those who did not (median 48 vs. 45, p = 0.038); those who had spent time in solitary confinement compared to those who had not (median 46 vs. 43.5, p = 0.038) as well as those who had not considered harming themselves compared to those who had thought of it (median 46 vs. 44, p = 0.017). Conclusion: Given that prison populations are marginalized and deprived of the rights that people in the community benefit from, establishing the prevalence of depression in male inmates and its associated characteristics may help to formulate recommendations for future prison health care services. Clinical, research, and policy efforts are needed to improve prison mental health.

"Prison life is very hard and it's made harder if you're isolated": COVID-19 risk mitigation strategies and the mental health of incarcerated women in California

PURPOSE

This study aims to describe the COVID-19 risk mitigation strategies implemented in California prisons and the impact of these policies on the mental health of incarcerated women.

DESIGN/METHODOLOGY/APPROACH

The authors conducted semi-structured qualitative interviews with ten women who were over the age of 50 and/or had a chronic illness and had been incarcerated in California prisons during the COVID-19 pandemic. The authors also interviewed ten health-care providers working in California jails or prisons during the pandemic. Interviews were analyzed using a grounded theory coding framework and triangulated with fieldnotes from ethnographic observations of medical and legal advocacy efforts during the pandemic.

FINDINGS

Participants described being locked in their cells for 23 hours per day or more, often for days, weeks or even months at a time in an effort to reduce the spread of COVID-19. For many participants, these lockdowns and the resulting isolation from loved ones both inside and outside of the prison were detrimental to both their physical and mental health. Participants reported that access to mental health care for those in the general population was limited prior to the pandemic, and that COVID-19 risk mitigation strategies, including the cessation of group programs and shift to cell-front mental health services, created further barriers.

ORIGINALITY/VALUE

There has been little qualitative research on the mental health effects of the COVID-19 pandemic on incarcerated populations. This paper provides insight into the mental health effects of both the COVID-19 pandemic and COVID-19 risk mitigation strategies for the structurally vulnerable older women incarcerated in California prisons.

Sustained impacts of North Carolina prison therapeutic diversion units on behavioral outcomes, mental health, self-injury, and restrictive housing readmission

Therapeutic Diversion Units (TDUs) in North Carolina prisons are intended to reduce cycling of individuals with mental health conditions through restrictive housing (i.e., solitary confinement). This paper investigates if previously identified benefits of TDU are sustained when individuals return to the general prison population. Using administrative data on 3170 people, we compare individuals placed in TDUs to TDU-eligible individuals (i.e., individuals with mental health needs) placed in restrictive housing. We use survival analysis methods to estimate hazard ratios (HRs) with confidence intervals (CIs), controlling for confounders. Compared to restrictive housing placement, TDU placement reduced the hazard of infractions (HR: 0.66; 95% CI: 0.52, 0.84) and subsequent restrictive housing placement (HR: 0.64; 95% CI: 0.55, 0.73) but increased the hazard of self-harm (HR: 2.67; 95% CI: 1.66, 4.29) upon program release to the general prison population. These findings suggest a need for additional investments and research on restrictive housing diversion programming, including post-diversion program supports.

The Natural History of Initial Antipsychotic Treatment Among Men Admitted to a State Prison

OBJECTIVE

This study examined the natural history of antipsychotic medication treatment for men with a psychotic disorder who entered the North Carolina prison system in 2016-2017.

METHODS

The authors used prison records to identify individuals with a psychotic illness who were prescribed an index antipsychotic medication on prison entry (N=245). Data were analyzed to determine persistence of antipsychotic therapy and potential associations with treatment discontinuation.

RESULTS

About 28% of the patients had stopped their antipsychotic medication by day 50; the median time until stopping was 248 days (95% confidence interval=147-355). Younger patients and those not continuing a preincarceration medication regimen discontinued treatment sooner than their respective counterparts.

CONCLUSIONS

The early weeks of incarceration are a period of increased risk for antipsychotic discontinuation, particularly among younger individuals and those prescribed a new medication. These findings may help guide prison systems in implementing interventions that reduce antipsychotic treatment interruptions.

Mental health outcomes in formerly incarcerated Black men: A systematic mixed studies review

AIMS

The aim of this review was to evaluate the current state of scientific knowledge describing the mental health of Black men who have experienced incarceration.

DESIGN

This systematic mixed studies review employed a sequential explanatory design integrating quantitative and qualitative published research.

DATA SOURCES

PubMed, CINAHL, PsycINFO, Social Work and Criminal Justice databases were searched using search terms addressing core constructs of mental health, Black men, incarceration and re-entry, January 2010 through October 2021.

REVIEW METHODS

Articles identified through a search protocol were screened for inclusion as: peer-reviewed original research, published in English and relevant to the mental health of formerly incarcerated Black men in the United States.

RESULTS

Twenty-three articles met inclusion criteria. Quantitative findings demonstrated significant associations between incarceration history and poor mental health, including higher levels of psychological distress, increased severity of depressive and PTSD symptoms, and delayed mental health treatment. Discrimination, negative police encounters, solitary confinement and difficulty finding employment were associated with the relationship between incarceration and mental health outcomes. Four themes were identified from the qualitative synthesis: (1) Social Determinants of Mental Health (2) Pushing Through Emotional Despair (3) Challenges to Healthcare Engagement and (4) Gender, Race and Intersections between Social Identities.

IMPACT

The United States has the highest rate of incarceration in the world and disproportionately incarcerates Black men. This review contextualizes the relationship between incarceration history and mental health in the lived experiences and perspectives of formerly incarcerated Black men. Findings indicate the need for interventions to support mental health needs and prevent downstream health consequences in this population.

CONCLUSION

Mental health concerns are pervasive in formerly incarcerated Black men; to address key gaps in current scientific understandings future research should focus on how Black men navigate help-seeking experiences and use mental health services in the context of an incarceration history.

Incarceration and subsequent risk of suicide: A statewide cohort study

INTRODUCTION

Increasing suicide rates across the United States are disproportionate among populations most impacted by mass incarceration. We sought to determine if incarceration is associated with risk of suicide and firearm suicide after release from prison.

METHODS

Using a population-based Washington cohort from Department of Corrections and vital statistics administrative records 1990-2017, individuals were compared to the sex-, age-, and race-matched population of Washington using Poisson regression. Among previously incarcerated individuals, we included incarceration history characteristics to calculate sub-hazard ratios using Cox proportional-hazards models.

RESULTS

Of 140,281 individuals released from prison, 484 died by suicide. Suicide risk was 62% higher among previously incarcerated individuals compared with the general population (RR: 1.62; 95% CI: 1.46-1.79). Suicide risk was higher among individuals convicted of firearm-involved crimes (RR: 2.27; 95% CI: 1.79-2.89). Individuals released prior to age 18 had substantially higher risk of firearm suicide than those whose first release occurred between ages 18-24 (sHR: 11.91; 95% CI: 4.30-32.96).

CONCLUSION

Our findings highlight the need for improved mental health resources and lethal means safety in this population. Mental health and substance use treatment have been proposed as effective alternatives to incarceration-continuing to study their impacts may reveal additional benefits of reducing suicide.

Disparities in use of disciplinary solitary confinement by mental health diagnosis, race, sexual orientation and sex: Results from a national survey in the United States of America

BACKGROUND

Solitary confinement is still used in prisons in the USA, despite its links to poor health. Past research suggests that there may be disparities by race, ethnicity, sex and mental disorders regarding who is placed in solitary confinement, although nationwide studies have been sparse.

AIMS

To explore possible disparities by race, ethnicity, sex, sexual orientation, adverse childhood experiences and mental disorders in solitary confinement as a disciplinary action for adults incarcerated in USA prisons.

METHODS

Data come from a recently released national survey of 24,848 adults incarcerated in the USA-the 2016 Survey of Prison Inmates. Logistic regression models were used to identify disparities in the use of disciplinary action and solitary confinement as a disciplinary action, while controlling for type of rule violation.

RESULTS

After controlling for rule violation type, solitary confinement was used as a disciplinary action at higher rates for people who: were multiracial, as compared to white (aOR = 1.30), male, as compared to female (aOR = 1.46), bisexual, as compared to heterosexual (aOR = 1.64), had multiple mental disorders, as compared to none (aOR = 1.22) or had more adverse childhood experiences (aOR = 1.13).

CONCLUSIONS

Findings highlight demographic and health disparities in the use of solitary confinement, which may further widen health disparities. More effective implementation of policies to reduce the use of solitary confinement are still needed. Mental health professionals should have an active role in advising on measures when mental disorder is a factor and must ensure adequate treatment of disorders in prison or transfer to health facilities.

Triaged out of Care: How Carceral Logics Complicate a ‘Course of Care’ in Solitary Confinement

Incarceration, along with its most restrictive iteration, solitary confinement, is an increasingly common experience in America. More than two million Americans are currently incarcerated, and at least one-fifth of incarcerated people will experience solitary confinement. Understanding the barriers to care people experience in prison, and especially in solitary confinement, is key to improving their access to care during and after incarceration. Drawing on in-depth qualitative interviews with a random sample of 106 people living in solitary confinement and a convenience sample of 77 people working in solitary confinement in Washington State, we identify two key barriers to care that people in solitary confinement face: cultural barriers (assumptions that incarcerated people do not need or do not deserve care) and structural barriers (physical spaces and policies that make contacting a healthcare provider difficult). While scholarship has documented both the negative health consequences of solitary confinement and correctional healthcare providers’ challenges navigating between the “dual loyalty” of patient care and security missions, especially within solitary confinement, few have documented the specific mechanisms by which people in solitary confinement are repeatedly triaged out of healthcare access. Understanding these barriers to care is critical not only to improving correctional healthcare delivery but also to improving healthcare access for millions of formerly incarcerated people who have likely had negative experiences seeking healthcare in prison, especially if they were in solitary confinement.

Anxiety and Worries of Individuals with Down Syndrome During the COVID-19 Pandemic: A Comparative Study in the UK

The present study explored the effects of the pandemic on individuals with Down Syndrome (DS; n = 67) compared to other groups with Special Education Needs and Disabilities (SEND; n = 48) and their Typically Developing Siblings (TDS; n = 56). In total, 115 caregivers reported on their own anxiety and worries and of their children. Anxiety levels for individuals with DS appeared to be lower compared to other SEND populations and to TDS. In terms of worries, individuals with DS worried more about social-related worries but worried less about family-related aspects compared to the other groups. In sum, individuals with DS might show less anxiety but still worried more about specific aspects related to the impact of COVID-19 pandemic on their lives.

Impact of a Prison Therapeutic Diversion Unit on Mental and Behavioral Health Outcomes

INTRODUCTION

Incarcerated individuals with mental health disorders are disproportionally sent to restrictive housing (i.e., solitary confinement), which is known to have deleterious impacts on mental health. In response, North Carolina's prison system developed Therapeutic Diversion Units, treatment-oriented units for incarcerated individuals with high mental health needs who cycle in and out of restrictive housing. This analysis compares the impact of restrictive housing and Therapeutic Diversion Units on infractions, mental health, and self-harm among incarcerated individuals.

METHODS

Data were 2016-2019 incarceration records from North Carolina prisons. Outcomes were rates of infractions, inpatient mental health admissions, and self-harm in restrictive housing and Therapeutic Diversion Units. Inverse probability of treatment weights was used to adjust for confounding, and Poisson regression with generalized estimating equations was used to estimate adjusted rate ratios. Analyses were conducted between January and December 2020.

RESULTS

The analytic sample was 3,480 people, of whom 463 enrolled in a Therapeutic Diversion Unit. Compared with Therapeutic Diversion Unit rates, the rate of infractions was 3 times as high in restrictive housing (adjusted rate ratio=2.99, 95% CI=2.31, 3.87), the inpatient mental health admissions rate was 3.5 times as high (adjusted rate ratio=3.57, 95% CI=1.97, 6.46), and the self-injury incident rate was 3.5 times as high (adjusted rate ratio=3.46, 95% CI=2.11, 5.69).

CONCLUSIONS

Therapeutic Diversion Unit use had strong impacts on infractions, mental health, and self-harm. Therapeutic Diversion Units provide a promising alternative to restrictive housing for individuals with mental health disorders.

Mental health risk factors during the first wave of the COVID-19 pandemic

BACKGROUND

During the first wave of the COVID-19 pandemic, distancing measures were enforced to reduce virus spread, which likely had an impact on the overall mental health of the population.

AIMS

To investigate the prevalence of mental health outcomes (depression, anxiety and insomnia), and associated risk factors, during a physical distancing period imposed in the first wave of COVID-19.

METHOD

During the first month of Portugal's state of emergency, an online survey was created and disseminated through social media channels. Sociodemographic and clinical variables were assessed via self-reported questionnaires. Univariate linear regressions were used to identify associations between the collected variables and mental health outcomes. Multivariate regression analyses were performed to identify independent risk factors for clinical outcomes, with adjustment for potential confounders.

RESULTS

We analysed data from 1626 participants: a significant proportion showed depression (30.2%), anxiety (53.1%) and insomnia (36.3%) symptoms. Multivariate regression models showed that being male and working from home were protective for all mental health outcomes analysed, whereas the perception of infection, being under psychiatric care and taking medication were risk factors (P < 0.05). Days in isolation and being unemployed were risk factors for depression and insomnia (P < 0.05). Younger age and being a student were risk factors for depression, whereas being a healthcare professional was protective (P < 0.05). Indirect contact with COVID-19 was a risk factor for anxiety (P < 0.05).

CONCLUSIONS

COVID-19-related distancing measures were associated with high levels of adverse mental health symptoms. Several risk factors were associated with these symptoms, which highlight the importance of identifying vulnerable groups during physical distancing periods.

"We just needed to open the door": a case study of the quest to end solitary confinement in North Dakota

Solitary confinement is a widespread practice in US correctional facilities. Long-standing concerns about the physical and mental health effects of solitary confinement have led to litigation, legislation, and community activism resulting in many prison systems introducing policies or implementing legal mandates to reduce or eliminate its use. Yet little is known about the nature and effectiveness of policies that states have adopted to reduce their use of solitary confinement and exactly how various reforms have actually impacted the lives of people living and working in the prisons where these reforms have taken place.

METHODS

We conducted an embedded case study, analyzing changes in policies and procedures, administrative data, and focus groups and interviews with incarcerated persons and staff, to describe the circumstances that led to changes in solitary confinement policies and practices in the North Dakota Department of Corrections and Rehabilitation (ND DOCR) and the perceived impact of these changes on incarcerated persons and prison staff. .

RESULTS

North Dakota's correctional officials and staff members attributed the impetus to change their solitary confinement policies to their participation in a program that directly exposed them to the Norwegian Correctional Service's philosophy, policies, and practices in 2015. The ensuing policy changes made by North Dakota officials were swift and resulted in a 74.28% reduction in the use of solitary confinement between 2016 and 2020. Additionally, placements in any form of restrictive housing decreased markedly for incarcerated persons with serious mental illness. In the two prisons that had solitary confinement units, rule infractions involving violence decreased at one prison overall and it decreased within the units at both prisons that were previously used for solitary confinement. Although fights and assaults between incarcerated people increased in one of the prison's general population units, during the initial months of reforms, these events continued to decline compared to years before reform. Moreover, incarcerated people and staff attributed the rise to a concomitant worsening of conditions in the general population due to overcrowding, idleness, and double bunking. Both incarcerated persons and staff members reported improvements in their health and well-being, enhanced interactions with one another, and less exposure to violence following the reforms.

CONCLUSIONS

Immersing correctional leaders in the Norwegian Correctional Service' public health and human rights principles motivated and guided the ND DOCR to pursue policy changes to decrease the use of solitary confinement in their prisons. Ensuing reductions in solitary confinement were experienced as beneficial to the health and wellness of incarcerated persons and staff alike. This case-study describes these policy changes and the perspectives of staff and incarcerated persons about the reforms that were undertaken. Findings have implications for stakeholders seeking to reduce their use of solitary confinement and limit its harmful consequences and underscore the need for research to describe and assess the impact of solitary confinement reforms.

Association Between Prison Crowding and COVID-19 Incidence Rates in Massachusetts Prisons, April 2020-January 2021

IMPORTANCE

COVID-19 incidence and mortality are higher among incarcerated persons than in the general US population, but the extent to which prison crowding contributes to their COVID-19 risk is unknown.

OBJECTIVE

To estimate the associations between prison crowding, community COVID-19 transmission, and prison incidence rates of COVID-19.

DESIGN, SETTING, AND PARTICIPANTS

This was a longitudinal ecological study among all incarcerated persons in 14 Massachusetts state prisons between April 21, 2020, and January 11, 2021.

EXPOSURES

The primary exposure of interest was prison crowding, measured by (1) the size of the incarcerated population as a percentage of the prison's design capacity and (2) the percentage of incarcerated persons housed in single-cell units. The analysis included the weekly COVID-19 incidence in the county where each prison is located as a covariate.

MAIN OUTCOMES AND MEASURES

The primary outcome was the weekly COVID-19 incidence rate as determined by positive SARS-CoV-2 tests among incarcerated persons at each prison over discrete 1-week increments.

RESULTS

There was on average 6876 people incarcerated in 14 prisons during the study period. The median level of crowding during the observation period ranged from 25% to 155% of design capacity. COVID-19 incidence was significantly higher in prisons where the incarcerated population was a larger percentage of the prison's design capacity (incidence rate ratio [IRR] per 10-percentage-point difference, 1.14; 95% CI, 1.03-1.27). COVID-19 incidence was lower in prisons where a higher proportion of incarcerated people were housed in single-cell units (IRR for each 10-percentage-point increase in single-cell units, 0.82; 95% CI, 0.73-0.93). COVID-19 transmission in the surrounding county was consistently associated with COVID-19 incidence in prisons (IRR [for each increase of 10 cases per 100 000 person-weeks in the community], 1.06; 95% CI, 1.05-1.08).

CONCLUSIONS AND RELEVANCE

This longitudinal ecological study found that within 14 Massachusetts state prisons, increased crowding was associated with increased incidence rates of COVID-19. Researchers and policy makers should explore strategies that reduce prison crowding, such as decarceration, as potential ways to mitigate COVID-19 morbidity and mortality among incarcerated persons.

Relationships between Psychopathology, Psychological Process Variables, and Sociodemographic Variables and Comparison of Quarantined and Non-Quarantined Groups of Malaysian University Students in the COVID-19 Pandemic

The COVID-19 pandemic has had considerable psychological health impacts across the globe. This study aimed to establish the psychological process variables underlying psychopathology in Malaysian public university students during the national Movement Control Order (MCO). The aim was to craft structured and sustainable psychological support programs with these students. We conducted a cross-sectional study involving Malaysian university students subjected to the Malaysian MCO. Structured questionnaires measuring sociodemographic factors, measures of depression, anxiety, stress, psychological mindedness, psychological flexibility and state mindfulness were employed. A total of 515 students participated in this study with 12 students (2.3%) being quarantined at the time. Many of them scored 'moderate' or above on the Depression, Anxiety and Stress Scale (DASS) with 20.2%, 25.0% and 14.2%, respectively. Quarantined students had higher depressive symptoms, with female students scoring significantly higher for depression, anxiety, and stress. Multiple regressions suggested gender and quarantine status predicted depression scores. However, only gender significantly predicted anxiety and stress. Psychological flexibility and psychological mindedness (Insight subscale) are significantly correlated with depression, anxiety, and stress, with psychological mindedness predicting all three psychopathologies. This study demonstrates that gender, psychological flexibility, and psychological mindedness are key demographic and psychological factors impacting students. Targeting psychological flexibility and psychological mindedness may enable timely prevention and intervention programs for our students to support their mental and physical health as we move through, and out of, the pandemic.

Reforming solitary confinement: the development, implementation, and processes of a restrictive housing step down reentry program in Oregon

BACKGROUND

Over the past decade there have been numerous and impassioned calls to reform the practice of solitary confinement in U.S. prisons. This article examines the development, implementation, and processes of a restrictive housing reentry program in the Oregon Department of Corrections. It draws on data from official documents, site observations, and interviews with 12 prison officials and 38 prisoners. The Step Up Program (SUP) seeks to improve the living conditions in restrictive housing over business-as-usual, alleviate physiological and psychological harms of solitary confinement, and use rehabilitative programming to increase success upon returning to the general prison population or community.

RESULTS

The impetus to change the culture and structure of restrictive housing was primarily the result of internal administrative reform. Prisoners assigned at random to housing assignments offered accounts of their daily activities suggesting that the SUP provides more time out-of-cell and greater access to other services and activities. Program participants preferred the living conditions in the SUP because they had more opportunities for social interaction and incentives for compliant behavior. However, views on the value of programming among respondents were mixed.

CONCLUSIONS

The launch of the SUP occurred in early 2020, which was soon followed by the COVID-19 pandemic. As a result, the program was never fully implemented as intended. As Oregon returns to more normal operations, it is possible that the SUP will be able to include even more out-of-cell time, greater socialization opportunities, and increased access to programming and other beneficial activities. As we await the opportunity to conduct prospective psychological and behavioral analyses, this study provides tentative support for the use of step down reentry programs in restrictive housing units.

TRIAL REGISTRATION

Open Science Framework, Preparing adults in custody for successful reentry: An experimental study of a restrictive housing exit program in Oregon. Registered 4 October 2019, https://osf.io/t6qpx/.

Psychological Distress and Psychosocial Factors in the Non-Formal Context of Basketball Coaches in Times of the COVID-19 Pandemic

Psychological distress and psychosocial factors are studied in the sports context in players of various specialties, but are only little studied with coaches who carry out their work with these athletes; that is where we put the emphasis, trying to determine the perception of coaches on psychological distress and psychosocial risk factors that may influence their sports work in times of a pandemic. It is an ex post facto study with a single-group retrospective design, with a representative sample of 94 coaches out of a possible 109. The Kessler Psychological Distress Scale and the short version of the ISTAS21 Psychosocial Risk Assessment at Work Questionnaire were adapted to the sports context. The results show that the youngest, those with the least experience and level 1 and level 2 coaches show the highest levels of stress. According to the psychosocial risk assessment, level 1 and 2 coaches, with experience between 6 to 10 years, are in the risk zone. Therefore, it is important to work with a group of coaches who are in the psychosocial risk zone and with high levels of psychological discomfort in order to avoid mental, emotional and physical stress, for the good performance of their work in the best possible conditions.

Window dressing: possibilities and limitations of incremental changes in solitary confinement

BACKGROUND

In light of mounting evidence of the physical and psychological harms associated with solitary confinement, many correctional systems, state legislators, courts, and even international human rights bodies are increasingly recommending and implementing reforms to mitigate the harms of solitary confinement, if not abolish the practice entirely. In this piece, we examine three specific infrastructural changes to solitary confinement conditions and practices implemented in Washington state prisons with such harm minimization goals in mind: (1) building so-called "nature imagery rooms" to play videos of outdoor spaces, (2) eliminating punishments for self-harm, and (3) conducting daily cell-front wellness checks.

RESULTS

Drawing on 183 in-depth qualitative interviews with both staff working in and people imprisoned in solitary confinement units conducted in Washington state restrictive housing units in 2017, we find that these three reforms not only resulted in limited successes but also generated new conflicts. Institutional logics such as deprivation, risk-management, and responsibilization ultimately impeded even the most modest attempts to mitigate the inherently harsh practice of solitary confinement. The limits of these reforms are due in part to individual choices made by people imprisoned in solitary confinement and staff working in these units, as well as the larger cultural norms that shape life in restrictive housing units.

CONCLUSIONS

Incrementalist reforms aimed at softening the environment of solitary confinement may actually serve to increase the strain and stress experienced by people confined to and working within them. Even the most well-intentioned reforms, like those attempted by the Washington DOC, should be scrutinized in order to determine if they are producing the desired outcomes, or instead, reproducing a different, but nonetheless damaging set of harms to people imprisoned in solitary confinement. Further, even well-intentioned reforms are often stymied by the underlying institutional logics of restrictive housing spaces.

COVID-19 Pandemic and Physical Exercise: Lessons Learnt for Confined Communities

The novel pandemic called "Coronavirus Disease 2019" (COVID-19), as a global public health emergency and global threat, has affected many countries in unpredictable ways and impacted on physical activity (PA) behaviors to various extents. Specific populations including refugees, asylum seekers, and prisoners, are vulnerable groups with multiple complex health needs and worse health outcomes with respect to the general population worldwide and at high risk of death from the "Severe Acute Respiratory Syndrome-related Coronavirus type 2" (SARS-CoV-2). Governments around the world have been implementing preventive healthcare policies, including physical and social distancing, isolation, and confinement, to mitigate against the burden imposed by the COVID-19 outbreak. This pandemic period is characterized by reduced or lack of movement. During this period of lockdown, PA can represent an immunotherapy and a preventative approach to avoid the harmful effects of inactivity due to the pandemic. Moreover, PA could be prescribed to improve the immune system of specific populations (refugees, asylum seekers, and prisoners), which particularly experience the condition of being confined. The present narrative review discusses the potential impacts of COVID-19 pandemic on these specific populations' health status and the importance of performing PA/exercise to reduce the deleterious effects of COVID-19 pandemic. In addition, we aim to provide useful recommendations on PA/exercise for these specific populations to maintain their level of independence, physical, and mental health as well as their wellbeing.

COVID-19 in the New York City Jail System: Epidemiology and Health Care Response, March-April 2020

OBJECTIVES

People detained in correctional facilities are at high risk for infection with severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). We described the epidemiology of the COVID-19 outbreak in a large urban jail system, including signs and symptoms at time of testing and risk factors for hospitalization.

METHODS

This retrospective observational cohort study included all patients aged ≥18 years who were tested for COVID-19 during March 11-April 28, 2020, while in custody in the New York City jail system (N = 978). We described demographic characteristics and signs and symptoms at the time of testing and performed Cox regression analysis to identify factors associated with hospitalization among those with a positive test result.

RESULTS

Of 978 people tested for COVID-19, 568 received a positive test result. Among symptomatic patients, the most common symptoms among those who received a positive test result were cough (n = 293 of 510, 57%) and objective fever (n = 288 of 510, 56%). Of 257 asymptomatic patients who were tested, 58 (23%) received a positive test result. Forty-five (8%) people who received a positive test result were hospitalized for COVID-19. Older age (aged ≥55 vs 18-34) (adjusted hazard ratio [aHR] = 13.41; 95% CI, 3.80-47.33) and diabetes mellitus (aHR = 1.99; 95% CI, 1.00-3.95) were significantly associated with hospitalization.

CONCLUSIONS

A substantial proportion of people tested in New York City jails received a positive test result for COVID-19, including a large proportion of people tested while asymptomatic. During periods of ongoing transmission, asymptomatic screening should complement symptom-driven COVID-19 testing in correctional facilities. Older patients and people with diabetes mellitus should be closely monitored after COVID-19 diagnosis because of their increased risk for hospitalization.

A Legal Right to Clozapine Therapy for Incarcerated Individuals With Treatment-Resistant Schizophrenia

People with serious mental illnesses increasingly are being treated in jails and prisons, and during incarceration are afforded a constitutional right to medical care. This right pertains to both general medical and mental illnesses and both acute and chronic conditions. However, incarcerated patients with treatment-resistant schizophrenia (TRS) often are not offered clozapine, the only medication for this debilitating illness approved by the U.S. Food and Drug Administration. In this column, the authors argue that incarcerated individuals with TRS have a statutory and constitutional right to treatment with clozapine.

Does a Public Health Crisis Justify More Research with Incarcerated People?

Covid-19 has infected thousands and killed hundreds in prisons, jails, and immigration detention facilities across the United States. Responding to this crisis, leading medical researchers have called for expanding opportunities for people in prison to participate in vaccine trials. These calls, like current regulations, focus on individualized risk assessments around consent, coercion, and harm, while ignoring the unnaturalness of deprivation conditions in U.S. prisons. We need new frameworks of analysis that refocus on structural, rather than individual, risk assessments. Integrating structural perspectives-including skepticism of claims of scarcity, avoidance of representational distortions, and attention to institutional agency-into our existing, overly individualistic frameworks might permit the design of more ethical research projects involving people who are incarcerated. Still, the unnatural deprivations of incarceration might be so great that research subjects might need to be removed from prison entirely in order to ethically participate in research.

Athletes' Psychological Adaptation to Confinement Due to COVID-19: A Longitudinal Study

Studies of individuals under conditions of confinement or severe social and physical restrictions have consistently shown deleterious mental health effects but also high levels of adaptability when dealing with such conditions. Considering the role of physical activity and sport in psychological adaptation, this paper describes a longitudinal study to explore to what extent the imposed restrictions due to the outbreak of SARS-CoV-2 may have affected athletes' mental health outcomes and how far the process of adaptation to confinement conditions is differentially affected depending on whether the sports activity was practiced individually or in a group, and outdoors, indoors, or both. Two hundred and seventy-four athletes were assessed over 7 weeks using the GHQ-28 and an ad hoc survey exploring the practice of physical activity. A mixed-model fixed effects ANCOVA was used to analyze the effects of time, place, and company in which the sport was practiced, with an index of the amount of physical activity expended as a covariate. Results show a significant effect of time in three out of four of the GHQ-28 subscales, in all cases showing a consistent adaptation to conditions over time. Results also show that playing sport indoors, outdoors, or both, and practicing alone vs. with others differentially affect the somatic symptoms exhibited during confinement: Athletes who practiced sport with others showed higher levels of somatic symptoms at the beginning of the set of data but a quicker rate of adaptation. Differences arising from practicing sport alone or with others were more pronounced in the case of indoor sports, which could be related to the fact that physical activity that can be practiced during confinement is more similar to that practiced indoors alone. Implications relating to what sport psychologists and other health professionals may offer to athletes in stressful situations are discussed.

Personality, Coping Strategies, and Mental Health in High-Performance Athletes During Confinement Derived From the COVID-19 Pandemic

The COVID-19 outbreak has affected the sports field unprecedentedly. The emergency alert has deprived athletes of training in a suitable environment, as they are faced with cancellations of relevant events in their sports careers. This situation can cause stress levels and other emotional disorders similar to those experienced by athletes during periods of injury. Since the relationship between psychological factors and sports injuries is well-studied, the Global Psychological Model of Sports Injury (MGPLD) is applied to this historical situation for athletes. The purpose of this study was to analyze the relationships between perfectionism and trait anxiety with indicators of mental health (mood, depression, state anxiety, and stress) in high-performance athletes during confinement due to the COVID-19 pandemic, as well as to explore the coping strategies that athletes have applied and whether they are perceived as useful for managing negative emotional states. A cross-sectional study was conducted through online questionnaires during April 2020, adapting the Psychological Assessment Protocol of the High-Performance Sports Center of Murcia (Spain), to assess the psychological effects of confinement in a cross-cultural sample of 310 athletes (141 women and 169 men) from different countries in Europe, Asia, and America, and from diverse sports disciplines. The protocol comprised six instruments that test perfectionism, trait anxiety, mood states, stress, depression, coping strategies, and sleep. It was answered online via Google Forms. The results show that maladaptive perfectionism was related to all the indicators of athletes' mental health. However, athletes' levels of anxiety, stress, and depressive symptoms are relatively low, and the use of coping strategies such as cognitive restructuring and emotional calm was associated with lower levels of negative emotional states. Besides, the Iceberg Profile, a suitable fit for the mental health model, is observed in the mood of athletes, both in men and in women, although women showed higher levels of anxiety, stress, and depression than men. A strong relationship was observed between maladaptive perfectionism and martial arts sports discipline, superior to other sports. In short, it can be concluded that high-performance athletes in the studied sample showed negative emotional state values below the expected average. Finally, the proposals for practical applications of the results collected are discussed.

A nationwide evaluation of the prevalence of and risk factors associated with anxiety, depression and insomnia symptoms during the return-to-work period of coronavirus disease 2019 in China

PURPOSE

To evaluate the prevalence of and risk factors associated with anxiety, depression, and insomnia symptoms during the return-to-work period of coronavirus disease 2019 in China.

METHODS

The authors conducted a large-scale, nationwide, multicenter, cross-sectional study in China. A population-based quota and snowball sampling were designed to recruit a representative sample. Online questionnaires and telephone reviews were used to collect characteristics and assess psychological and sleep problems. Anxiety, depression, and insomnia symptoms were measured by the generalized anxiety disorder-7, patient health questionnaire-9, and insomnia severity index tools.

RESULTS

A total of 42,000 participants were recruited from 15 centers, and 36,795 valid questionnaires were received. Generally, 18.3, 14.9, and 17.9% of the participants had anxiety, depression, and insomnia symptoms, respectively, and 2.2-2.7% had severe symptoms. Engaging in outside activity once in ≥ 30 days (OR = 2.719, OR = 2.074, OR = 2.225) and age 50-64 years (OR = 2.431, OR = 1.936, OR = 2.036) were common risk factors for anxiety, depression and insomnia symptoms. Living in Hubei Province (OR = 1.304, OR = 1.242) was a common risk factor for anxiety and insomnia symptoms. Working as frontline medical staff (OR = 2.150) was another risk factor for anxiety symptoms. The health education rate of the samples reached 98.9%. However, the psychological intervention rate was only 16.2%, and 2.5% received targeted interventions.

CONCLUSIONS

An increasing number of people might have psychological and sleep problems. However, the current psychological interventions are not sufficient. Efforts should be made to strengthen interventions for high-risk populations.

The body in isolation: The physical health impacts of incarceration in solitary confinement

We examine how solitary confinement correlates with self-reported adverse physical health outcomes, and how such outcomes extend the understanding of the health disparities associated with incarceration. Using a mixed methods approach, we find that solitary confinement is associated not just with mental, but also with physical health problems. Given the disproportionate use of solitary among incarcerated people of color, these symptoms are most likely to affect those populations. Drawing from a random sample of prisoners (n = 106) in long-term solitary confinement in the Washington State Department of Corrections in 2017, we conducted semi-structured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for these subjects. We also conducted a paper survey of the entire long-term solitary confinement population (n = 225 respondents) and analyzed administrative data for the entire population of prisoners in the state in 2017 (n = 17,943). Results reflect qualitative content and descriptive statistical analysis. BPRS scores reflect clinically significant somatic concerns in 15% of sample. Objective specification of medical conditions is generally elusive, but that, itself, is a highly informative finding. Using subjective reports, we specify and analyze a range of physical symptoms experienced in solitary confinement: (1) skin irritations and weight fluctuation associated with the restrictive conditions of solitary confinement; (2) un-treated and mis-treated chronic conditions associated with the restrictive policies of solitary confinement; (3) musculoskeletal pain exacerbated by both restrictive conditions and policies. Administrative data analyses reveal disproportionate rates of racial/ethnic minorities in solitary confinement. This analysis raises the stakes for future studies to evaluate comparative prevalence of objective medical diagnoses and potential causal mechanisms for the physical symptoms specified here, and for understanding differential use of solitary confinement and its medically harmful sequelae.

Medical Isolation and Solitary Confinement: Balancing Health and Humanity in US Jails and Prisons During COVID-19

In the face of the continually worsening COVID-19 pandemic, jails and prisons have become the greatest vectors of community transmission and are a point of heightened crisis and fear within the global crisis. Critical public health tools to mitigate the spread of COVID-19 are medical isolation and quarantine, but use of these tools is complicated in prisons and jails where decades of overuse of punitive solitary confinement is the norm. This has resulted in advocates denouncing the use of any form of isolation and attorneys litigating to end its use. It is essential to clarify the critical differences between punitive solitary confinement and the ethical use of medical isolation and quarantine during a pandemic. By doing so, then all those invested in stopping the spread of COVID-19 in prisons can work together to integrate medically sound, humane forms of medical isolation and quarantine that follow community standards of care rather than punitive forms of solitary confinement to manage COVID-19.

Shedding Light on "the Hole": A Systematic Review and Meta-Analysis on Adverse Psychological Effects and Mortality Following Solitary Confinement in Correctional Settings

OBJECTIVES

To systematically review and meta-analyze the psychological effects and mortality rate in inmates having been exposed to solitary confinement in correctional settings.

METHODS

PubMed, PsycINFO, Web of Science, and Google Scholar were searched using keywords describing solitary confinement in combination with keywords for psychological or mortality outcomes. Eligible case-control studies for the systematic review met an operational definition for solitary confinement and evaluated outcomes after exposure to such confinement. Studies presenting statistical data which allowed to compute standardized mean differences for symptom scales or odds ratio for mortality were further meta-analyzed using random-effects models.

RESULTS

Systematic review identified 13 studies for inclusion, with a total sample of 382,440 inmates (23% having been exposed to solitary confinement). Higher quality evidence showed solitary confinement was associated with an increase in adverse psychological effects, self-harm, and mortality, especially by suicide. Meta-analysis of five studies (n = 4,517) showed a standardized mean difference of 0.45 for general psychological symptomatology, which increased to 0.51 upon outlier exclusion. Small to moderate significant effects were observed for mood, psychotic, and hostility symptoms specifically. In addition, meta-analysis of two mortality studies (n = 243,050) showed a trend for a moderate effect for mortality by any or unnatural causes (i.e., suicide, homicide, overdose, and accidents).

CONCLUSIONS

Analyses showed that solitary confinement is associated with the psychological deterioration of inmates. This effect appears to be beyond that of general incarceration or presence of prior mental illness. Thus, solitary confinement may pose significant harm for inmates. Still, further studies are required to show that exposure to SC can increase risk of post-release death. Finally, add-on treatments and alternatives to solitary confinement that could alleviate the associated psychological harm are discussed.

[Mental health care in French correctional facilities during the Covid-19 pandemic]

OBJECTIVE

The impact of the Covid-19 pandemic on the 11 million people currently incarcerated worldwide is the subject of many concerns. Prisons and jails are filled with people suffering from many preexisting medical conditions increasing the risk of complications. Detainees' access to medical services is already limited and overcrowding poses a threat of massive contagion. Beyond the health impact of the crisis, the tightening of prison conditions worries. On March 16, 2020, in France, the lockdown measures have been accompanied by specific provisions for prisons: all facilities have suspended visitations, group activities and external interventions. Over 10,000 prisoners have been released to reduce the prison population and the risk of virus propagation. These adjustments had major consequences on the healthcare system in French prisons. The objectives of this article are to describe the reorganization of the three levels of psychiatric care for inmates in France in the context of Covid-19 pandemic and to have a look at the impact of lockdown measures and early releases on mental health of prisoners.

METHODS

This work is based on a survey conducted in April 2020 in France among psychiatric healthcare providers working in 42 ambulatory units for inmates and in the 9 full-time inpatient psychiatric wards exclusively for inmates called "UHSAs" (which stands for "unités hospitalières spécialement aménagées", and can be translated as "specially equipped hospital units"). A review of the international literature on mental healthcare system for inmates during the Covid-19 epidemic has also been performed.

RESULTS

The Covid-19 epidemic has been rather contained during the period of confinement in French prisons but the impact of confinement measures on the prison population is significant. The three levels of psychiatric care for inmates have implemented specific measures to ensure continuity of care, to support detainees during Coronavirus lockdown and to prevent an infection's spread. Among the most important are: limitation of medical consultations to serious and urgent cases, creation of "Covid units", cancellation of voluntary psychiatric hospitalizations, reinforcement of preventive hygiene measures and reshuffling of medical staff. Prolonged confinement has consequences on mental health of detainees. Currently, mental health workers are facing multiple clinical situations such as forced drug and substance withdrawal (linked to difficulties in supplying psychoactive substances), symptoms of anxiety (due to concerns for their own and their relatives' well-being) and decompensation among patients with severe psychiatric conditions. Early releases from prison may also raise some issues. People recently released from prison are identified as at high risk of death by suicide and drug overdose. The lack of time to provide the necessary link between health services within prisons and health structures outside could have serious consequences, emphasizing the well-known "revolving prison doors" effect.

DISCUSSION

The current lockdown measures applied in French jails and prisons point out the disparities between psychiatric care for inmates and psychiatric care for general population. Giving the high vulnerability of prison population, public health authorities should pay more attention to health care in prisons.