History of Solitary Confinement Is Associated with Post-Traumatic Stress Disorder Symptoms among Individuals Recently Released from Prison

Abstract

This study assessed the relationship between solitary confinement and post-traumatic stress disorder (PTSD) symptoms in a cohort of recently released former prisoners. The cross-sectional design utilized baseline data from the Transitions Clinic Network, a multi-site prospective longitudinal cohort study of post-incarceration medical care. Our main independent variable was self-reported solitary confinement during the participants' most recent incarceration; the dependent variable was the presence of PTSD symptoms determined by primary care (PC)-PTSD screening when participants initiated primary care in the community. We used multivariable logistic regression to adjust for potential confounders, such as prior mental health conditions, age, and gender. Among 119 participants, 43% had a history of solitary confinement and 28% screened positive for PTSD symptoms. Those who reported a history of solitary confinement were more likely to report PTSD symptoms than those without solitary confinement (43 vs. 16%, p < 0.01). In multivariable logistic regression, a history of solitary confinement (OR = 3.93, 95% CI 1.57-9.83) and chronic mental health conditions (OR = 4.04, 95% CI 1.52-10.68) were significantly associated with a positive PTSD screen after adjustment for the potential confounders. Experiencing solitary confinement was significantly associated with PTSD symptoms among individuals accessing primary care following release from prison. Larger studies should confirm these findings.

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

“…Although there is an overrepresentation of inmates with mental illnesses in SC (2,20), such settings have been reported to affect inmates regardless of a pre-existing diagnosis (21). Hence, SC is not only particularly deleterious for inmates with existing mental health needs (22), but may bring forth new psychiatric symptoms and disorders, particularly stress-related disorders (adjustment, affective, and post-traumatic stress disorders) (23,24). Early observations (21) were followed by case-studies (25)(26)(27) and a number of larger studies documenting adverse effects (19,28).…”

What Does Health Justice Look Like for People Returning from Incarceration?

“…We clinicians would like to think we are objective, but we are just as susceptible to being discriminatory based on a criminal record as employers, who have been shown to call back fewer than half as many equally qualified applicants with a fictive criminal record [20]. Although there is no consensus, from our personal experience, we believe it is important to ask patients about their experiences while incarcerated-for instance, their experience with trauma or solitary confinement, which pose individual health risks [21]. But asking details about a patient's crimes is usually not medically relevant, can be emotionally taxing on the clinician, and might promote bias when documented in the medical record.…”

Solitary confinement, post-release health, and the urgent need for further research

“…3,4 Currently, there is little research investigating the lasting effects of solitary confinement after people leave prison. Experience of solitary confinement during recent incarceration has been found to be associated with post-traumatic stress disorder symptoms after release 5 and with increased likelihood of reincarceration. 6 In The Lancet Public Health, Christopher Wildeman and Lars Andersen make an important new contribution to this literature with their study examining the association between the experience of solitary confinement and mortality after release.…”