Race Differences in Older Incarcerated Persons' Mental Health

Abstract

<h3>Introduction</h3> Racial/ethnic (R/E) minorities in the US experience blatant health disparities in terms of both chronic medical conditions and mental health. Among persons in mid-to late-life, these disparities are the result of factors including life-long differential access to healthcare, lower income/education, and societal discrimination. Moreover, as a disproportionate number of persons of color are incarcerated, they will be also be over-represented among the growing population of those who are ‘aging in place' in prison. Prior work shows that race differences in chronic illnesses among community-living persons in mid-to late-life are also reflected among incarcerated persons of color. Yet, little is known regarding race differences in mental health among older incarcerated persons. We sought to compare R/E differences in depressive symptoms and suicidal ideation (SI) among older, incarcerated males. <h3>Methods</h3> Subjects were enrolled in the "Aging Inmates' Suicidal Ideation and Depression Study (Aging INSIDE)." Eligible participants were sentenced male inmates age ≥50, incarcerated in 1 of 8 CT prisons, English-speaking, and not expected to be released for at least 36 months so as to target those ‘aging in place' in prison. Recruitment letters were sent to the 1,019 eligible prisoners between November 2017 and January 2019. A total of 224 inmates returned the interest form, provided written consent to participate in face-to-face baseline and 12-month interviews and chart review, and indicated that they were either Non-Hispanic White (40.4%), Non-Hispanic Black (43.6%), or Hispanic (16.0%). This R/E distribution is generally representative of the population of incarcerated males in CT. Of these, 200 (89%) completed the 12-month interviews. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9). Current Major Depressive Episode was assessed using Module D of the Structured Clinical Interview for DSM V. The Geriatric Suicidal Ideation Scale (GSIS), overall and four subscales, assessed SI severity. Responding Agree or Strongly agree to the statement "I have tried ending my life in the past," (part of the GSIS but not included in instrument scoring) indicated lifetime suicide attempt. We evaluated R/E differences at baseline and tested for changes between baseline and 12-months within and across R/E groups. <h3>Results</h3> There were several R/E differences in demographic characteristics. Average age was significantly higher among White participants (Whites 58.6[7.3], Blacks 54.9[4.8], Hispanics 55.2[4.7]p < 0.001: p values are for three-mean comparison tests). Fewer Hispanics graduated high school (31.4%) compared with Blacks (25.5%) and Whites (13.2%, p = .035). Blacks average age at first incarceration (22.4 years) was younger than Whites (34.6) and Hispanics (27.3) (p < .001), and more Blacks were repeat offenders than Hispanics and Whites, 84% vs. 71.4% and 49.5%, respectively (p < .001). The table presents R/E differences in mental health at baseline. Hispanics had the highest PHQ-9 scores (7.1[6.8] Hispanics, 6.9[6.1] Whites, 4.5[4.9] Blacks, p = .002) and had the highest proportion of those with PHQ-9>10 (clinically significant symptoms), current MDE, and lifetime suicide attempt. Average GSIS scores differed significantly by R/E (67.8[21.2] Whites, 61.2[18.4] Hispanics, and 55.7[15.0] Blacks, p<0.001). Within each R/E group, there were no significant changes in PHQ-9 scores between baseline and follow-up 12 months later. However, significantly fewer Hispanics were experiencing a current MDE at 12 months; 4 who met clinical criteria at baseline did not meet criteria at follow up (McNemar χ² (1)) = 4.00, p = .045. <h3>Conclusions</h3> Despite ‘aging in place' in a similar environment, we found considerable race differences in depression and SI among this sample of older incarcerated persons. These findings support the ‘Black-White mental health paradox' - Blacks' MH was significantly better than Whites' regardless of disparities in social determinants (e.g., age at first incarceration; repeat offenses). Notably, Hispanics' had especially high depressive symptom scores and a high proportion reported lifetime suicide attempts. This R/E group may benefit from culturally-tailored interventions. Moreover, the stability of scores over time within and across R/E groups suggests that the baseline differences are "true" differences. As the population of older incarcerated persons in the US continues to grow, research is needed to determine mechanisms contributing to poor mental health among older incarcerated Hispanics and to determine if aging in prison exacerbates or attenuates the ‘Black-White mental health paradox'. <h3>This research was funded by</h3> This work was supported by the National Institute of Mental Health (Grant Number R01-MH106529 to L.C.B.). Dr. Barry is also supported by the UConn Claude D. Pepper Older Americans Independence Center (NIA P30-AG067988).