To the Editor: Approximately two million individuals are incarcerated in the United States. Correctional institutions currently house more individuals with serious and persistent mental illness than any other type of U.S. institution (1). Given the disproportionate incarceration of African-American men and the difficulty they experience in accessing mental health treatment services outside of correctional environments (2), insight into their mental health status is critical for informing novel treatment approaches for such a vulnerable population.
This study was conducted between April and August 2008 in one of the largest maximum-security male correctional institutions in the U.S. The Beck Depression Inventory (BDI) (3) was administered to assess depressive symptoms among 134 randomly selected incarcerated African-American men. Pearson's correlation coefficients (r) were computed to examine relationships between interval and ratio variables; chi square tests evaluated differences between categorical variables. Logistic regression estimated odds ratios (ORs) and associated confidence intervals (CIs) for depression and the following participant characteristics: age, marital status (married or unmarried), education level, probation or parole status when arrested, previous incarceration, total time incarcerated, and sentence received. Each participant was required to read a non-signatory consent form; placing a check mark at the end of this form confirmed their verbal agreement to participate in the study. This study was approved by the institutional review boards of the research community and the Department of Corrections. A certificate of confidentiality was received to further protect participants' rights.
Study participants' ages ranged from 25 to 74 years (mean±SD=42.1±10.8). A majority (80%, N=107) were not married. Eighty-four percent (N=113) possessed at least a high school diploma or GED. Half of the sample (50%, N=67) reported being previously incarcerated. Most (69%, N=92) were currently incarcerated for violent offenses. On average, participants had been incarcerated for 13.1 years. The mean sentence length was 37.5±25.4 years. Overall, the mean BDI score was 11.22±7.03, an indicator of mild clinical depression according to recommended standards (4). Forty-three percent of the participants (N=57) were classified as clinically depressed. Among the depressed participants, 29% (N=39) were considered moderately depressed, 11% (N=15) were moderately to severely depressed, and 2% (N=3) were severely depressed.
There were several statistically significant differences between participants whose BDI scores were in the depressed range and those whose scores did not meet the depression criterion. [A table presenting data on these differences is available in an online supplement at ps.psychiatryonline.org.] Age was significantly correlated with depression (r=.18, p<.05); older participants were more likely to experience depression. Participants with at least a high school diploma or GED were more likely than those without a high school education to experience depression (χ2=3.82, df=1, p<.05). Participants on probation or parole when arrested were less likely to experience depression than those who were not on probation or parole when arrested (χ2=7.98, df=1, p<.05).
Participants with at least a high school education were almost three times as likely as their less educated counterparts to experience depression (OR=2.88, 95% CI= .96–8.59) [see additional table in the online supplement for this analysis]. Being on probation or parole at the time of arrest was associated with lower levels of depressive symptoms (OR=.27, 95% CI=.11–.67).
These findings suggest that corrections officials should consider age, education level, and probation-parole status when adopting treatment approaches. Helping prisoners implement a comprehensive treatment plan that could be used consistently after release could significantly improve the likelihood that they will not be reincarcerated (5), allowing them time to adjust to mainstream society after release.
Table 1.
Comparison of depressed (≥ 12) and non-depressed participants
| Not depressed; n=77(57%) | Depressed; n=57 (43%) | ||||
|---|---|---|---|---|---|
| n(%) | Mean (SD) | n(%) | Mean(SD) | χ 2 | |
| Demographics | |||||
| Age | 40.34(SD=9.84) | 44.4(SD=11.66) | |||
| Marital Status | 1.20 | ||||
| Not Married | 64(83) | 43(75%) | |||
| Married | 13(17%) | 14(25%) | |||
| Education | 3.82* | ||||
| NO GED/HS | 8(10%) | 13(23%) | |||
| GED/HS | 69(90%) | 44(77%) | |||
| Religion | .161 | ||||
| Muslim | 31(40%) | 21(37%) | |||
| Christian | 46(60%) | 36(63%) | |||
| Criminal Background | |||||
| Previous Incarceration | .031 | ||||
| No | 39(51%) | 28(49%) | |||
| Yes | 38(49%) | 29(50%) | |||
| Length of previous sentence | 39.8(SD=69.46) | 43.5(SD=67.88) | |||
| On Probation and/or Parole | 7.98* | ||||
| No | 55(71%) | 27(47%) | |||
| Yes | 22(29%) | 30(53%) | |||
| Current Offense | .028 | ||||
| Non-violent | 24(31%) | 17(30%) | |||
| Violent | 53(69%) | 40(70%) | |||
| Current Sentence (months) | 440.8(SD=304.14) | 462.5(SD=308.32) | |||
| Total Time Incarcerated (months) | 136.9(SD=113.52) | 185.3(SD=126.99) | |||
| Time to Release (months) | 318.3(SD=253.02) | 291.1(SD=255.91) | |||
Table 2.
Logistic regression on depression status among incarcerated African-American men (N=134)
| Variable | OR | 95% CI |
|---|---|---|
| Age | 1.03 | .99–1.08 |
| Marital Status (reference: unmarried) | .79 | .31–2.07 |
| Education (reference: no H.S. education/GED) | 2.88* | .96–8.59 |
| On Probation/Parole (reference: no) | .27** | .11–.67 |
| Previous Incarceration (reference: no) | 2.15 | .85–5.44 |
| Time Incarcerated | 1.12 | .66–1.89 |
| Sentence Received | .89 | .55–1.42 |
P < .05
P < .005
Acknowledgments and disclosures
The project described was supported by grant R36DA024213 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse, the National Institute of Mental Health, or the National Institutes of Health.
Footnotes
The authors report no competing interests.
References
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