When University of Pennsylvania doctoral student Helena Addison worked as a nurse in an inpatient psychiatric hospital, she met many people who had previously been incarcerated. Her interactions made her want to better understand the mental health implications of such an experience.
“Initially, I was looking at incarceration as a source of trauma for blacks,” says Addison, a fourth-year presidential PhD. She is a fellow at Penn’s School of Nursing. “As I learned more, it expanded to the idea of incarceration as a social determinant of health, still looking specifically at mental health.”
In collaboration with Sara Jacoby, assistant professor at the School of Nursing, Addison evaluated what science currently knows about the psychological ramifications for black men to undergo such detention. By examining nearly two dozen articles from the past decade, she found that for this group in the United States, there is a link between incarceration and higher levels of psychological distress, more severe symptoms of PTSD and depression, and many other aspects of ill health. mental.
She, Jacoby, and Penn’s nursing colleagues Therese Richmond and Lisa Lewis shared their findings in Journal of Advanced Nursing.
“Imprisonment is underestimated as a social determinant of health,” says Jacoby, whose research focuses on trauma and violence. “It’s something we talk about, but it’s not something that is always so specifically articulated. This work does it in a way that has been lacking for nursing and a wider healthcare public. “
Understanding health inequalities and mental health has always interested Addison. In addition to his clinical experience of inpatient psychiatry, he had previously studied trauma and exposures to interpersonal violence among men, women and young people. When he started his doctoral program at Penn, he thought he was researching incarceration as a source of trauma for black men, who are being held nearly six times as high as white men in the United States.
But after digging into the literature and with Jacoby’s guidance, Addison broadened the scope of her project, both in terms of how she viewed the mental health implications of incarceration, and who she sought to include. “My parents are immigrants from Ghana. When I think of blacks, I think of the diaspora, “says Addison.” The census defines blacks in a certain way, but I wanted to make sure that in this job and in the future, I think broadly about what it means to be black in the United States. ”
To that end, Addison incorporated peer-reviewed literature from 2010 to 2021 on men who identified as black in the United States. She intended to get more detailed regarding the different identities: African American, Afro-Caribbean, Afro-Latin or from African immigrant groups – but the literature is still not expansive enough. In total, she found 16 quantitative, six qualitative and one mixed-method studies that met her criteria, with sample sizes ranging from seven participants to more than 5,000. The studies took place in the United States
“It’s a drop in the bucket,” says Jacoby. “If we were to look at research on health disparities on physical health conditions like heart disease or diabetes, there would be thousands of studies to understand the problem. Here we found 23 ”. Yet the literature, limited as it was, began to reveal a story to Addison.
His main goal had been to identify differences in mental health outcomes between previously incarcerated and never incarcerated black men. “In that context,” he says, “both have had poor mental health outcomes associated with things like unemployment and family conflicts. But blacks who had been incarcerated had more PTSD symptoms. This is an example where you can see, although these groups have experienced some of the same trauma, incarceration had a specific impact. “
Longer imprisonment and time spent in solitary confinement were also important, increasing the negative mental health symptoms previously incarcerated black men suffered later on. Despite this, Addison and Jacoby found that few of these men discussed seeking help, reporting obstacles such as long waits and the need to prioritize different aspects of their return such as housing or work.
Addison says she hopes this and future work can shed light on how to better support the mental health needs of this community. “Things like health insurance after returning are important,” she says, “but also, should we talk to the community center or churches? Who and what resources are available and which ones need to be adapted or improved to help support the mental health needs of this population? “
This research is an important start to better understand incarceration as a social determinant of health, Jacoby says. “Mass incarceration is one of the most important forms of structural racism in society,” she says. “How would you imagine in a possible reality that incarceration would have no impact on a person’s psyche and mental health?”
Future work, the Penn researchers say, should examine how previously incarcerated black men navigate community and health care resources to support their mental health needs. It should also incorporate efforts to minimize barriers to care and improve health outcomes.
Funding for this research came from the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) (Grant 5H79SM080386-03).
Elena Addison is a fourth-year doctoral student and a presidential doctorate. Companion in the School of Nursing to the University of PennsylvaniaJonas Scholar 2021-2023 and fellow in the SAMHSA Minority Fellowship program at the American Nurses Association.
Sara Jacob is an assistant professor of nursing and an assistant professor of nursing in surgery in Department of Family and Community Health by Penn School of Nursing.