Health and Justice最新文献

Background: Over 600,000 individuals are released from correctional institutions annually in the United States. Substance use disorders (SUDs) are highly prevalent in this population, and only a small proportion receive adequate treatment during incarceration. Post-incarceration, substance use increases considerably, and the risk of drug overdose is higher among formerly incarcerated individuals than among their counterparts in the general population, especially among individuals who use illicit opioids. However, significant gaps exist in our understanding of individual- and environment-level pathways of post-incarceration substance use, limiting treatment effectiveness. For those who receive substance use treatment services post-incarceration, research suggests that these services are not medically appropriate and/or responsive to their unique needs - thereby jeopardizing substance use outcomes.

Objectives: The Addiction Treatment Adequacy Post-Incarceration (ATAP) Study aims to examine individual and environmental factors associated with changes in substance use and substance use treatment adequacy over a one-year period post-incarceration among formerly incarcerated individuals in New York City (NYC). We will examine the extent to which participants receive appropriate substance use treatment services, as recommended by their scores on the American Society of Addiction Medicine patient placement criteria (ASAM PPC).

Methods: We will use innovative spatially informed multi-level modeling strategies to investigate individual- and environment-level factors that influence substance use among individuals released from correctional institutions and residing in the NYC metropolitan area. Guided by social ecological theory, this study will address the following specific aims: 1) Characterize substance use over a 12-month period (every three months) among 350 formerly incarcerated individuals who have been released in NYC during the past three years; 2) Identify individual (e.g., race, gender, income, mental health) and environmental (e.g., proximity to drug purchasing sites, neighborhood characteristics, residential mobility, access to treatment services) risk factors for drug use among formerly incarcerated individuals; and 3) Investigate discrepancies between ASAM PPC composite scores (a measure of addiction severity) generated and levels of substance use treatment.

Potential implications: The proposed research will identify substance use treatment gaps and influential factors that are amenable to intervention in the interest of informing effective responses to the current opioid crisis.

Background: In many jurisdictions world-wide, the government agency that manages prisons also provides prison health care services. However, the World Health Organization (WHO) and United Nations (UN) have recommended that health ministries provide prison health care. In Canada, the province of British Columbia (BC) transferred responsibility for correctional health services to the health ministry in accordance with this guidance. The objective of this study was to estimate the association between the transfer in BC and all-cause and overdose mortality within 1 year of release from prison.

Methods: We used a retrospective cohort study design employing the difference-in-differences (DiD) method to compare mortality among formerly-incarcerated people in the pre- and post-transfer periods against a matched community control group to control for province-wide trends in mortality. The data source was a longitudinal linkage of administrative databases. The DiD effect was estimated with survival time-to-event models.

Results: In the formerly-incarcerated group (N = 6912), all-cause (3.7% vs 2.6%) and overdose (2.7% vs 1.7%) mortality in the first-year post-release decreased from the pre-transfer period to the post-transfer period, while mortality risk changed little in the community control group (N = 6881) during this time period (all-cause: 0.7% vs 0.9%; overdose: 0.4% vs 0.4%). The transfer was associated with statistically significant reductions in the hazards of all-cause mortality (DiD HR: 0.52, 95% CI: [0.32, 0.83]) and overdose mortality (DiD HR: 0.51, 95% CI: [0.26, 0.99]) in the first-year post-release.

Conclusions: This study provides empirical evidence in support of WHO and UN guidance and indicates that the delivery of correctional health services by community health authorities may reduce deaths, particularly overdose deaths, among people released from correctional centres.

Background: Suicide attempts represent a critical public health concern in prison settings, where rates are substantially higher than in the general population. The COVID-19 pandemic introduced additional stressors, yet little is known about its impact on suicide attempts among detained persons. This study aimed to identify the underlying reasons and motivations for suicide attempts in a Swiss pre-trial prison and to examine changes before and during the pandemic. We analyzed 205 suicide attempts by 125 detained persons between 2016 and 2021. Data were collected from clinical and prison records. Reasons and motivations were extracted using content analysis. Population-averaged logistic regression models were used to examine differences between periods.

Results: Suicide attempts were associated with health-related and personal issues (85%), prison-related problems (76%), and interpersonal conflicts (61%). Psychological distress, juridical issues, and conflicts with correctional officers were the most common reasons. Motivations included protest against the institution (39%), desire to die (18%), escape (11%), and help-seeking (7%). There was an increase in health-related and personal problems during the pandemic, particularly dissatisfaction with medical care (+104%), physical pain (+181%), and psychological distress (+18%), while help-seeking motivations decreased (-72%). Psychiatric morbidity and self-harm history were associated with these outcomes. Sample characteristics remained largely stable across periods.

Conclusions: This study highlights the multifaceted nature of suicide attempts in prison and the impact of the COVID-19 pandemic on health-related and personal issues. While preventive measures were essential for infection control, they may have increased psychological distress, and reduced medical resources likely exacerbated clinical needs. These findings underscore the importance of balancing public health measures with continuous access to care during public health emergencies.

Background: Communicators in public safety, such as 911 telecommunicators, emergency medical dispatchers, and police and fire dispatchers, frequently deal with distressing calls, traumatic narratives, and high-stakes decisions. Despite not being physically present at crisis scenes, these experts endure psychological stress on par with first responders. This scoping review examines the prevalence and determinants of depression and suicidal ideation among public safety communicators and their co-occurrence, summarizes the occupational and personal risk factors contributing to these outcomes, and evaluates proposed mitigation strategies.

Results: The research indicates that depression is reported at elevated rates in this workforce, ranging from 8.4% to 73%, depending on the population and the sensitivity of the instrument, based on 11 quantitative studies published between 1995 and 2025. Although less studied, suicidal ideation appears to be significantly higher in this group compared to the general population. Contributing factors include indirect trauma exposure, shift work, emotional suppression, organizational neglect, and a history of trauma. The frequent co-occurrence of depression and suicidal ideation supports the Interpersonal Theory of Suicide as a relevant explanatory framework.

Conclusions: Despite accumulating evidence, research is methodologically limited due to cross-sectional designs, inconsistent screening tools, and sample homogeneity. Existing interventions, such as peer support, debriefing, and trauma-informed training, are inconsistently applied and under-evaluated. The findings highlight a pressingneed for longitudinal research, targeted interventions, and workplace reforms that take into account the unique psychological burdens associated with communicator roles. Addressing depression and suicide risk among these professionals is critical to ensuring both workforce well-being and the continued effectiveness of public safety systems.

Competency to stand trial is a legal construct in the United States whereby an individual's capacity to meaningfully and knowingly function in a legal proceeding, typically for those with mental or developmental disabilities or dementia, is questioned. The competency determination and restoration process often leads to unnecessary and excessive incarceration of those with disabilities without treatment for the underlying cause of competency concerns, often worsening health and leading to repeated incarceration. Yet, this crisis is rarely considered from a public health lens. Further, the number of individuals entangled in this legal process has risen dramatically in recent years, with 130,000 competency evaluations being conducted annually. We review what is known about this topic from legal studies, provide case studies of individuals failed by this process, and outline the responses that criminal legal systems and local and state governments have had to this crisis (e.g., increase in jails' competency beds, diversion programs). We conclude that the competency process is a public health crisis which merits both study by public health researchers and a public health response.

Background: Justice-involved individuals with opioid use disorder (OUD) face heightened relapse risks during the reentry period. While medications for opioid use disorder (MOUD) are effective, long-term recovery also depends on psychological and structural supports, including situational confidence (perceived ability to resist substance use in high-risk situations) and recovery capital (the internal and external resources that support recovery).

Methods: This cross-sectional study examined situational confidence and its association with recovery capital among 107 justice-involved adults receiving MOUD in an urban jail in Texas. Participants completed the Brief Situational Confidence Questionnaire (BSCQ) and the 10-item Brief Assessment of Recovery Capital (BARC-10). Mental health and substance use were assessed using the PHQ-9, GAD-7, AUDIT, and ASSIST. Bivariate associations were examined using chi-square and Fisher's exact tests, and a multivariable logistic regression model was used to assess factors associated with high situational confidence (BSCQ ≥ 80%).

Results: Participants had a mean age of 38.9 years (SD = 0.4); most were male (74.0%), non-Hispanic Black or other race/ethnicity (58.0%), and had a high school education or less (59.8%). A majority (66.4%) reported unstable housing in the 30 days prior to incarceration. Fewer than half (44.9%) reported high situational confidence, with a mean score of 67.6 (SD = 26.9). Higher recovery capital was strongly associated with high situational confidence (aOR = 2.66; 95% CI: 1.52-4.96). Depression (aOR = 0.36; 95% CI: 0.16-0.78), sexual minority status (aOR = 0.14; 95% CI: 0.01-0.78), and reliance on informal income-generating activities ("hustling") (aOR = 0.30; 95% CI: 0.10-1.01) were associated with lower situational confidence.

Conclusions: Recovery capital is a strong predictor of situational confidence among justice-involved individuals receiving MOUD. Interventions that enhance recovery capital, including access to employment, housing, and social support, integrate mental health care, and provide tailored support for marginalized subgroups, may improve recovery outcomes during incarceration and reentry. Brief, validated tools like the BSCQ and BARC-10 may help identify individuals at greater relapse risk and guide more targeted, equity-informed reentry planning.

Background: Justice-impacted persons aged 40 and up with substance use disorders (SUD) demonstrate increased health risks and health disparities relative to general population peers. Persons with SUD are less likely to age out of criminal behavior, appearing on criminal dockets, in jails, prisons, and under community supervision throughout the life course, with greater community-level cost burdens as they age. Justice system involvement presents health risks that compound with SUD to undermine well-being, which is amplified as people age and experience age-related health decline. Propensity for premature mortality from overdose is startlingly high for this population, highlighting demand for targeted policies to better meet the needs of this vulnerable group. To better understand justice-impacted older adults in treatment for SUD and inform policy, we examined opioid use outcomes among 357 low-income justice-impacted adults in SUD treatment in the Midwest, USA, including a natural oversampling of Black and American Indian or Alaska Native (AIAN) persons. We explored patterns among persons in their 40s, 50s, and 60s, relative to those under 40, conceptualizing life-course risk factors and using logistic regression to assess overdose, opioid use, and opioid agonist medication use.

Results: Significant differences in opioid use by age were observed, with older persons less likely to report opioid prescription misuse or illicit opioid use. Differences were not significant once controlling for user preferences, race/ethnicity, gender, family, childhood, and life course experiences. Overdose history was also significantly less likely for the 40 and older SUD patient, though this was no longer significant when controlling for demographic covariates. Opioid agonist medication use did not significantly differ by age.

Conclusions: Justice-involved patients aged 40 and up in SUD treatment were less likely to have experienced overdose or report opioid use, relative to their younger peers, but this variation dissipated when considering demographic, family and/or life course factors. Targeted treatment services for gender and racial minorities may be beneficial for patients 40 and up. We identify preference for one substance, versus two, as protective against overdose and opioid use among older persons who use drugs.