Criminal Justice Involvement Research Articles

“Sick and tired of being sick and tired”: Exploring initiation of medications for opioid use disorder among people experiencing homelessness

IntroductionPeople experiencing homelessness (PEH) make up a disproportionate share of opioid overdose fatalities. We set out to identify the facilitators and barriers that shape whether PEH initiate medications for opioid use disorder (MOUDs), both generally and after an overdose. MethodsWe conducted semi-structured interviews with 29 PEH in Boston who had self-reported history of opioid overdose. Seventeen participants had taken prescribed MOUD, and 12 had not. Using NVivo software we then coded transcripts applying the Borkan Immersion Crystallization method to identify individual, social, and structural factors influencing MOUD initiation. ResultsIndividual factors: Within the “timing” theme, non-fatal overdoses often led participants to feel sick with naloxone-induced withdrawal, decreasing treatment-seeking. By contrast, chronic opioid use consequences, like daily stress with finding drugs and shelter, increased interest in MOUD. Within the “medication benefits” and “medication concerns” themes, interest in MOUD initiation hinged on whether participants believed in or doubted MOUDs' effectiveness for reducing drug use. In a related theme, participants perceived that individuals must be “ready” in order for MOUDs to be effective.Social factors: Within the “peer influence” theme, peers who use opioids were prominent sources of encouragement or deterrence for starting MOUD. “Family influence” emerged as a theme for participants with MOUD history.Structural factors: Within the “health systems” theme, participants described that experiencing stigma from care providers toward people who use drugs was a barrier to MOUD. Within the “treatment systems” theme, regulations made methadone particularly difficult to access, even though nearly all participants had Medicaid coverage to pay for treatment. Within the “criminal justice systems” theme, participants reported frequent criminal justice involvement, with jails facilitating or preventing MOUD access. ConclusionsFuture interventions should (a) increase MOUD interest by messaging—ideally via peers—that MOUDs are effective for PEH and (b) increase MOUD access by making MOUDs available across health, treatment, and carceral systems. Mobile outreach and MOUD treatment would help reach PEH when they are facing daily opioid use disorder stressors and are more open to MOUD initiation. Future research should explore how racial, ethnic, and linguistic identities affect MOUD engagement among PEH.

Characteristics of Assaultive Patients Whom Inpatient Psychiatric Staff Report to Law Enforcement.

The authors sought to identify factors that affect hospital staff's decision to pursue criminal charges against patients who assault staff on inpatient psychiatric units. Data on assaults occurring on inpatient psychiatric units in one hospital system were collected over 32 months, from November 1, 2016, to July 1, 2019. The events were grouped by whether staff pursued criminal charges after the incident. Descriptive statistics and regression models were used to describe the data and identify predictive variables. Data were reviewed from 9,654 admissions, of which 124 patient encounters involved assaults on staff. Overall, 27 (22%) of 124 assaults on staff resulted in staff pursuing criminal charges. Regression models indicated that criminal history (odds ratio [OR]=2.18, 95% CI=1.26-3.78, p=0.006), age (OR=0.92, 95% CI=0.91-0.94, p<0.001), and diagnosis of chronic mental illness with psychotic symptoms (OR=7.23, 95% CI=1.49-35.04, p=0.01) predicted patient assaults resulting in contact with law enforcement. Several variables were not statistically significantly associated with filing of criminal charges, including race, gender, degree of injury from the assault, number of instances of restraint, and number of as-needed medications. This is the largest quantitative study to examine the demographic and clinical factors that may play a role in whether staff pursue criminal charges against patients on inpatient psychiatric units. The results suggest that certain patients are more likely to be reported to law enforcement. Institutions should monitor factors that increase the likelihood of assaults on staff resulting in criminal charges and create policies that mitigate discrepancies in criminal justice involvement.

Identifying individual and environmental predictors of opioid and psychostimulant use among adolescents and young adults following outpatient treatment

BackgroundThe United States (US) continues to grapple with a drug overdose crisis. While opioids remain the main driver of overdose deaths, deaths involving psychostimulants such as methamphetamine are increasing with and without opioid involvement. Recent treatment admission data reflect overdose fatality trends suggesting greater psychostimulant use, both alone and in combination with opioids. Adolescents and young adults are particularly vulnerable with generational trends showing that these populations have particularly high relapse rates following treatment. MethodsWe assessed demographic, psychosocial, psychological comorbidity, and environmental factors (percent below the poverty line, percent unemployed, neighborhood homicide rate, population density) that confer risk for opioid and/or psychostimulant use following substance use disorder treatment using two complementary machine learning approaches—random forest and least absolute shrinkage and selection operator (LASSO) modelling—with latency to opioid and/or psychostimulant as the outcome variable. ResultsIndividual level predictors varied by substance use disorder severity, with age, tobacco use, criminal justice involvement, race/ethnicity, and mental health diagnoses emerging at top predictors. Environmental variabels including US region, neighborhood poverty, population, and homicide rate around patients’ treatment facility emerged as either protective or risk factors for latency to opioid and/or psychostimulant use. ConclusionsEnvironmental variables emerged as one of the top predictors of latency to use across all levels of substance use disorder severity. Results highlight the need for tailored treatments based on severity, and implicate environmental variables as important factors influencing treatment outcomes.

Individual and Combined Effect of Diabetes and Lifetime Criminal Justice Involvement on Healthcare Utilization in US Adults, 2015-2019.

BackgroundDiabetes and criminal justice involvement (CJI) are both associated with poor health outcomes and increased healthcare utilization. However, little is known about the additive effects of these risk factors when combined. This study examined the individual and combined effects of diabetes and CJI on healthcare utilization.MethodsData from the National Survey of Drug Use and Health (2015–2019) was used to create a cross-sectional, nationally representative sample of US adults with diabetes, CJI, combination of both, or neither. Negative binomial regression was used to test the association between those with CJI and diabetes (compared to diabetes alone) and three utilization types (outpatient, ED, and inpatient) controlling for relevant sociodemographic and clinical covariates.ResultsOf 212,079 respondents, representing 268,893,642 US adults, 8.8% report having diabetes alone, 15.2% report having CJI alone, and 1.8 % report both diabetes and lifetime CJI. After adjustment, those with diabetes and CJI had increased acute care utilization compared to those with diabetes alone (ED visits: IRR 1.13; 95% CI 1.00–1.28; nights hospitalized: IRR 1.34; 95% CI 1.08–1.67). There was no difference in outpatient utilization between those with both diabetes and CJI compared to those with diabetes alone (IRR 1.04, 95% CI 0.99–1.10).ConclusionIndividuals with complex social and health risks such as diabetes and lifetime CJI experience increased acute healthcare utilization but no difference in outpatient utilization. Tailored interventions that target both diabetes and CJI are needed to reduce unnecessary utilization in this population.

Shame among Forensic and Non-Forensic Patients and the Impact of the Social Determinants of Health: A Pilot Study

ABSTRACT Shame is associated with various mental health and social difficulties. A broad range of social factors increase the risk of shame among individuals. One group that experiences increased shame due to their mental health diagnoses and criminal justice involvement is forensic patients. The purpose of this pilot study was to compare shame levels in forensic and non-forensic patients with a diagnosis of schizophrenia or other psychotic disorder, and to examine whether any social determinants of health impacted the levels of shame among both groups. A self-report shame questionnaire and a measure of experiences with various social determinants of health were completed by 43 patients with schizophrenia or other psychotic disorder (22 forensic and 21 non-forensic patients). Statistical analyses revealed no significant differences in levels of shame between the forensic and non-forensic patients. Early life experience as well as employment and working conditions had the most significant impact on shame levels for both forensic and non-forensic patients. We also found a significant difference between forensic and non-forensic scores in employment and working conditions (p = .046), with forensic patients rating their experiences with this factor as more positive than non-forensic participants. Clinical implications are discussed.

Rationale, design and methods of VA-BRAVE: a randomized comparative effectiveness trial of two formulations of buprenorphine for treatment of opioid use disorder in veterans

BackgroundTo address the US opioid epidemic, there is an urgent clinical need to provide persons with opioid use disorder (OUD) with effective medication treatments for OUD (MOUD). Formulations of sublingual buprenorphine/naloxone (SL-BUP/NLX) are considered the standard of care for OUD including within the Veterans Healthcare Administration (VHA). However, poor retention on MOUD undermines its effectiveness. Long-acting injectable monthly buprenorphine (INJ-BUP) (e.g., Sublocade®) has the potential to improve retention and therefore reduce opioid use and overdose. Designing and conducting studies for OUD pose unique challenges. The strategies and solutions to some of these considerations in designing Cooperative Studies Program (CSP) 2014, Buprenorphine for Treating Opioid Use Disorder in Veterans (VA-BRAVE), a randomized, 20-site, clinical effectiveness trial comparing INJ-BUP to SL-BUP/NLX conducted within the VHA may provide valuable guidance for others confronted with similar investigation challenges.MethodsThis 52-week, parallel group, open-label, randomized controlled trial (RCT) evaluates the comparative effectiveness of two current FDA-approved formulations of buprenorphine: (1) daily SL-BUP/NLX vs. (2) monthly (28-day) INJ-BUP for Veterans with moderate to severe OUD (n = 952). The primary outcomes are (1) retention in MOUD and (2) opioid abstinence. Secondary outcomes include measures of other drug use, psychiatric symptoms, medical outcomes including prevalence rates of HIV, hepatitis B and C as well as social outcomes (housing instability, criminal justice involvement), service utilization and cost-effectiveness. Special considerations in conducting a comparative effectiveness trial with this population and during COVID-19 pandemic were also included.DiscussionThe evaluation of the extended-release formulation of buprenorphine compared to the standard sublingual formulation in real-world VHA settings is of paramount importance in addressing the opioid epidemic. The extent to which this new treatment facilitates retention, decreases opioid use, and prevents severe sequelae of OUD has not been studied in any long-term trial to date. Positive findings in this trial could lead to widespread adoption of MOUD, and, if proven superior INJ-BUP, by clinicians throughout the VHA and beyond. This treatment has the potential to reduce opioid use among Veterans, improve medical, psychological, and social outcomes, and save lives at justifiable cost.Trial registration Registered at Clinicaltrials.gov NCT04375033

Understanding the Intersection of Homelessness and Justice Involvement: Enhancing Veteran Suicide Prevention Through VA Programming.

Veterans with a history of homelessness and justice involvement are at greater risk for mental health sequelae, including suicide. A bidirectional relationship exists between criminal justice involvement and housing instability (ie, the institutional circuit). Homelessness and justice involvement often represent a vicious cycle that is difficult to escape. The US Department of Veterans Affairs (VA) has a number of programs focused on connecting homeless and justice-involved veterans to health and social services. This paper reviews existing programing and initiatives within such services to detect risk for suicide and connect these veterans to appropriate evidence-based mental health care. The VA currently has several programs focused on enhancing care for homeless and justice-involved veterans, many of which currently incorporate suicide prevention initiatives. Understanding of factors that may impact health service delivery of suicide risk assessment and intervention may be beneficial in order to enhance veteran suicide prevention efforts.

Cumulative Racial and Ethnic Disparities Along the School-to-Prison Pipeline

Using the cumulative disadvantage theoretical framework, the current study explores whether school suspension and expulsion provide an indirect path through which race and ethnicity affect the likelihood of experiencing arrest, any incarceration, and long-term incarceration in adulthood. To address these issues, we use data from Waves I, II, and IV of the Add Health survey (N = 14,484), and we employ generalized multilevel structural equation models and parametric regression methods using counterfactual definitions to estimate direct and indirect pathways. We observe that Black (but not Latinx) individuals are consistently more likely than White persons to experience exclusionary school discipline and criminal justice involvement. However, we find a path through which race and Latinx ethnicity indirectly affect the odds of adulthood arrest and incarceration through school discipline. Disparate exposure to school suspension and expulsion experienced by minority youth contributes to racial and ethnic inequalities in justice system involvement. By examining indirect paths to multiple criminal justice consequences along a continuum of punitiveness, this study shows how discipline amplifies cumulative disadvantage during adulthood for Black and, to a lesser extent, Latinx individuals who are disproportionately funneled through the “school-to-prison pipeline.”

Stakeholder Perspectives on Implementing a Police-Mental Health Collaborative to Improve Pathways to Treatment.

High rates of criminal justice involvement among individuals with mental illness have led to collaborative efforts between law enforcement agencies and mental health providers to improve crisis responses and pathways to treatment. The development and implementation of these police-mental health collaborations (PMHCs) have received little attention in the literature, but these processes are crucial in understanding feasibility and sustainability. The PMHC discussed here is an interagency effort to identify individuals involved with law enforcement who have unmet behavioral health needs and engage them in services. Perspectives from leaders, service providers, and clients highlight the importance of developing PMHCs that support individuals with serious mental illness at multiple points, from initial crisis to independent management of treatment. In an environment where police responses to individuals with mental health and substance use disorders are increasingly scrutinized, it is critical to highlight and evaluate ways that behavioral health and law enforcement agencies work together to collaboratively address these problems.

A longitudinal cross-sectional analysis of substance use treatment trends for individuals experiencing homelessness, criminal justice involvement, both, or neither - United States, 2006-2018

SummaryBackgroundIndividuals experiencing homelessness or criminal justice involvement (CJI) have higher rates of substance use than the general public. Despite documented barriers to accessing treatment, few studies have compared substance use treatment patterns between these groups.MethodsThis paper uses data from the Treatment Episode Dataset-Admissions between 2006 to 2018 to describe characteristics and trends in substance use treatment admissions indicating homelessness (n=2,524,413), CJI (4,764,750), both (509,902), or neither (8,950,797) in the United States. We used multivariable logistic regression to examine trends independent of demographic differences between groups.FindingsBetween 2006 and 2018, the proportion of treatment admissions related to heroin increased across all groups. Methamphetamine-related admissions rose substantially for individuals experiencing homelessness, CJI, or both. By 2018, 27·8% (95% CI: 27·4-28·2%) of admissions for individuals experiencing both were methamphetamine-related and 16·7% (95% CI: 16·3-17·0%) were heroin-related. Conversely, among individuals experiencing neither, 7·5% (95% CI: 7·4-7·5%) of admissions were methamphetamine-related and 33·6% (95% CI: 33·4-33·7%) were heroin-related. Individuals experiencing both homelessness and CJI received lower rates of medications for opioid use disorder (OUD) (8·3%; 95% CI: 8·2-8·3%) compared to individuals experiencing neither (36·4%; 95% CI: 36·4-36·4%).InterpretationCommunity treatment facilities should be supported to provide medications for OUD and accommodate rising rates of methamphetamine and polysubstance-related treatment admissions in populations experiencing complex social drivers of health such as homelessness, CJI, or both.FundingNational Institute of General Medical Sciences and National Institute of Diabetes and Digestive and Kidney Diseases.

Rates and implications of fetal alcohol spectrum disorder among released offenders with mental disorder in Canada.

Fetal alcohol spectrum disorder (FASD) is prevalent among individuals involved in the justice system. However, many of the characteristics of justice-involved individuals with FASD remain unknown. We assessed patients in a forensic mental health hospital (n=26) for FASD before their release. The two objectives were to establish the prevalence of FASD in this unique environment and to describe the mental health and neurocognitive characteristics of individuals with FASD compared to patients with complex needs and those without FASD. The prevalence of FASD was 46%. We found the FASD group to have more than six impaired brain domains, greater than the other groups, and a higher prevalence of ADHD. Given the high prevalence of FASD reported in this study, along with the complexities and adversities associated with FASD and criminal justice involvement, this is a population that requires screening, assessment, and intervention.

POSA88 Annual Health Insurance Treatment Cost of Mental and Behavioural Disorders Due to Use of Alcohol Based on Routinely Collected Financing Data

Alcohol use has a significant public health, social, and economic impact, and is associated with criminal justice involvement. Our aim was to determine the annual health insurance treatment cost of mental and behavioural disorders due to use of alcohol in Hungary.

POSA87 Annual Health Insurance Treatment Cost of Mental and Behavioural Disorders Due to Use of Opioids Based on Routinely Collected Financing Data

Mental and behavioural disorders caused by opioid use have a significant public health, social, and economic impact, and is associated with criminal justice involvement. Our aim was to determine the annual health insurance treatment cost of mental and behavioural disorders due to use of opioids in Hungary.

Overlapping needs for sexual and reproductive health and HIV prevention in women with substance use disorders.

Objectives:Women with substance use disorders have high unmet needs for HIV prevention and drug treatment and face challenges accessing care for other unique health issues, including their sexual and reproductive health.Methods:We did a cross-sectional evaluation of sexual and reproductive health behaviors and outcomes among women with substance use disorders, who were enrolled in one of two concurrent clinical trials of pre-exposure prophylaxis for HIV prevention. Descriptive analyses and bivariate logistic regression were used to assess factors driving contraceptive use, and other essential sexual and reproductive health services utilization and outcomes.Results:Among 226 women, 173 (76.5%) were of reproductive age. Most women had histories of unintended pregnancy (79.2%) or miscarriage (45.1%) and high HIV risk behaviors (53.5%). Most (61%) participants did not use any form of contraception at the time of assessment, although few (15%) reported pregnancy intentions. In bivariate models, ongoing criminal justice involvement was associated with 2.22 higher odds of not using contraception (95% confidence interval = 1.09–4.53; p = 0.03) and hazardous drinking was protective against not using contraception (odds ratio = 0.33, 95% confidence interval = 0.13–0.81; p = 0.02). Contraception use was not significantly associated with any other individual characteristics or need factors.Conclusions:This is the first study that identifies the unmet sexual and reproductive health needs of women with substance use disorders who are engaging with pre-exposure prophylaxis. We found that women accessed some health services but not in a way that holistically addresses the full scope of their needs. Integrated sexual and reproductive care should align women’s expressed sexual and reproductive health intentions with their behaviors and outcomes, by addressing social determinants of health.

Barriers to drug treatment in police diversion programs and drug courts: A qualitative analysis.

Drug treatment courts and police diversion programs are designed to divert people away from incarceration and into drug treatment. This article explores barriers in linking people who use drugs (PWUD) into drug treatment facilities in urban, suburban, and rural areas of Connecticut, Kentucky, and Wisconsin. Between December 2018 and March 2020, study teams in the three states conducted in-depth, semistructured interviews with key informants involved in programs to divert PWUD from criminal justice involvement including police, lawyers, judges, and others who work in drug treatment courts, and substance use disorder treatment providers who received referrals from and worked with police diversion programs or drug courts. Police diversion programs and drug treatment courts showed intraprogram variation in the structure of their programs in the three states and in different counties within the states. Structural barriers to successfully linking PWUD to treatment included a lack of resources, for example, a limited number of treatment facilities available, difficulties in funding mandated treatment, particularly in Wisconsin where Medicaid expansion has not occurred, and PWUDs' need for additional services such as housing. Many police officers, judges, and others within drug treatment court, including drug treatment specialists, hold stigmatizing attitudes toward medications to treat opioid use disorder (MOUD) and are unlikely to recommend or actively refer to MOUD treatment. Drug courts and police diversion programs offer a welcome shift from prior emphases on criminalization of drug use. However, for such programs to be effective, more resources must be dedicated to their success. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Homelessness and publicly funded substance use disorder treatment in California, 2016–2019: Analysis of treatment needs, level of care placement, and outcomes

IntroductionBoth homelessness and substance use have increased in recent years. People experiencing homelessness (PEH) are at increased risk for health problems and early mortality, both of which can be exacerbated by substance use disorders (SUD). Specialty SUD treatment is likely needed to address substance use among PEH, and more than 232,000 PEH received treatment from U.S. publicly funded SUD programs in 2015. The objective of this paper is to develop a better understanding of the SUD services that PEH receive in publicly funded treatment programs by (1) describing the characteristics and needs of the PEH population served in publicly funded SUD treatment programs, compared to non-PEH populations; (2) determining if differences exist in treatment placement (level of care) for PEH and non-PEH; and (3) gauging how successful programs are in treating PEH compared to non-PEH. MethodsObservational study using a two-way fixed effect model to determine associations among homelessness, retention, and outcomes among Medicaid beneficiaries receiving SUD treatment in California from 2016 to 2019 (n = 638,953). The study team used ordinary least squares (OLS) regression to measure the degree to which homelessness was associated with baseline characteristics, SUD services received, and treatment outcomes. ResultsPEH were significantly more likely than non-PEH to be having methamphetamine or heroin as their primary substance. PEH had greater frequency of primary substance use prior to entering treatment, greater ER and hospital utilization, more criminal justice involvement, and greater prevalence of mental health diagnoses and unemployment. PEH were 9.82% more likely than non-PEH to receive residential treatment and 7.11% less likely than non-PEH to receive treatment intensive outpatient modalities. Homelessness was associated with an 11.90% decrease in retention, and a 19.40% decrease in successful discharge status. These trends were consistent across outpatient, intensive outpatient, and residential modalities. ConclusionsDeveloping SUD treatment capacity and housing supports can improve treatment outcomes for PEH. Potential strategies to improve SUD services for PEH include providing more contingency management, opioid pharmacotherapies, programming designed to treat individuals with co-occurring mental health disorders, and resources for housing options that can support PEH in their recovery.

Understanding risk in younger Veterans: Risk and protective factors associated with suicide attempt, homelessness, and arrest in a nationally representative Veteran sample

ABSTRACT Accumulating research suggests unique patterns of suicide risk, homelessness, and criminal-justice involvement in younger (age < 40) relative to older (aged 40+) cohorts of Veterans. However, potential explanations for these differences remain unclear. To address this gap, we analyzed data from a nationally representative sample of more than 4,000 US military Veterans to compare risk and protective correlations of prior suicidal behavior, homelessness, and justice-involvement in younger versus older Veterans. Results revealed that younger Veterans were significantly more likely than older Veterans to have a history of suicide attempt(s) (13.9% vs. 2.7%) and homelessness (22.5% vs. 8.7%). They also scored higher on measures of risk factors and lower on measures of protective factors. However, some factors – specifically, resilience, grit, impulsiveness, perceptions of the effect of the military on one’s life and social support – were less strongly associated with a history of adverse events in younger versus older Veterans. Findings highlight the need for preventative homelessness and mental health services for younger Veterans that are tailored to the unique characteristics and needs of this age cohort.

School Disengagement and Mental Health Service Intensity Need Among Clinically Referred Students Utilizing the interRAI Child and Youth Mental Health Assessment Instrument.

Although mental health challenges are widespread, impacting 1 in 5 children and youth, only 25% of these young people receive the required mental health supports. Unmet mental health needs are strongly associated with functional impairments including poor self-care, interpersonal challenges, and school difficulties among young people. School disengagement, or a student's lack of involvement in education through interest, curiosity, motivation, and active participation, is associated with a wide array of detrimental outcomes including chronic mental health difficulties, conduct and delinquent behaviors, criminal justice involvement, and unemployment in adolescence and adulthood. Disengagement observed within the school setting may be indicative of underlying mental health challenges and reflective of service intensity need. The current study extends the literature by examining the relationship between school disengagement and mental health service intensity need among 14,750 clinically referred students across elementary and secondary school utilizing the interRAI Child and Youth Mental Health instrument. Findings indicated that more than 25% of clinically referred students were at heighted risk for school disengagement and required high-intensity services. Further, mental health service intensity need was positively associated with risk of school disengagement among students, along with the specific reason for referral (i.e., psychiatric symptoms, harm to self, harm to others, or addiction or dependency), after controlling for sex and age. Implications of the findings are explored within the context of the school setting and future directions are suggested.

Callous-unemotional traits linked to earlier onset of self-reported and official delinquency in incarcerated boys.

Research shows that youth who engage in early delinquency have higher callous-unemotional (CU) traits than youth with a later start. This study extends prior research to determine the optimal delinquency onset age cutoff for identifying youth high versus low on CU traits and the average age of delinquency onset for youth with clinically significant CU traits. We hypothesized that youth with childhood-onset delinquency would have higher CU traits than those with adolescent-onset delinquency. We hypothesized that youth with clinically significant CU traits would have an earlier delinquency onset than youth without CU traits. We explored differences in delinquency onset between antisocial youth categorized into low-anxious primary CU variant, high-anxious secondary CU variant, and low-CU/low-anxious control groups. Participants were 456 adjudicated, incarcerated boys (M age = 16.24 years, SD = 1.33, range 12-19; 40.4% White, 39.7% Black, 13.8% Hispanic/Latino, 6.1% other race/ethnicity) in the United States. We measured age of delinquency onset using self-report and official records. Boys who were 11 years old or younger when they first engaged in delinquency had higher CU traits than those who were 12 years old or older (η p 2 range = .009-.012), controlling for conduct problem severity and race/ethnicity. On average, boys with clinically significant CU traits first engaged in delinquency 1 year earlier (at 7.81 years old) than those without CU traits (η p 2 = .012). Low-anxious primary CU variants were 1 year younger at their first official charge (12.65 years old) than controls (η p 2 = .026). There were no statistically significant differences between low-anxious primary and high-anxious secondary CU variants. Elevated CU traits were over-represented among boys who were youngest at their first legal contact, suggesting that this may be an opportune time to identify this subgroup of youth to provide nuanced intervention to prevent later serious delinquency and criminal justice involvement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Association between mental health outcomes and lifetime criminal justice involvement in U.S. adults with diabetes

BackgroundDiabetes is a leading cause of death in the United States, and comorbid mental illness is associated with worse diabetes outcomes. Those with criminal justice involvement (CJI) have high rates of mental illness and diabetes prevalence. However, little is known about the relationship between CJI and mental illness among those with diabetes. MethodsUsing a nationally representative sample of U.S. adults with diabetes from the National Survey of Drug Use and Health (2015–2018), we investigated the relationship between CJI and mental health outcomes (depression, serious psychologic distress, serious mental illness, moderate mental illness, any mental illness, functional status). Multiple linear and logistic regression models were used to assess the relationship between CJI and each mental health outcome adjusting for multiple socio-demographic and comorbidity variables. ResultsOf 11,594 respondents, representing 25,834,422 adults with diabetes, 17.1% reported prior CJI. In fully adjusted models, CJI was independently associated with all mental health outcomes: depression (aOR 1.80, 95% CI: 1.41, 2.30), serious psychologic distress (aOR 1.53, 95% CI: 1.23, 1.90), serious mental illness (aOR 2.00, 95% CI: 1.58, 2.52), moderate mental illness (aOR 1.72, 95% CI 1.30, 2.26), any mental illness (aOR 1.92, 95% CI: 1.56, 2.35) and functional status (regression coefficient 3.6, 95% CI: 3.53, 3.79). ConclusionThose with diabetes and criminal justice involvement experience concentrated risk for poor mental health outcomes. Our findings suggest that mental health interventions may be imperative to achieving control of diabetes in the justice-involved population.