Functional neurological disorder and functional somatic syndromes among sexual and gender minority people: A scoping review.

OBJECTIVE: To describe the current literature on functional neurological disorder and functional somatic syndromes among sexual and gender minority people (SGM). METHODS: A search string with descriptors of SGM identity and functional disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles published before May 24, 2022, yielding 3121 items entered into Covidence, where 835 duplicates were removed. A neurologist and neuropsychiatrist screened titles and abstracts based on predefined criteria, followed by full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent systematic data extraction and statistical description. RESULTS: Our search identified 26 articles on functional disorders among SGM people. Most articles were case (13/26, 46%) or cross-sectional (4/26, 15%) studies. Gender minority people were represented in 50% of studies. Reported diagnoses included fibromyalgia (n = 8), functional neurological disorder (n = 8), somatic symptom disorder (n = 5), chronic fatigue syndrome (n = 3), irritable bowel syndrome (n = 2), and other functional conditions (n = 3). Three cohort studies of fibromyalgia or somatic symptom disorder reported an overrepresentation of gender minority people compared to cisgender cohorts or general population measures. Approximately half of case studies reported pediatric or adolescent onset (7/13, 54%), functional neurological disorder diagnosis (7/13, 54%), and symptom improvement coinciding with identity-affirming therapeutic interventions (7/13, 58%). CONCLUSION: Despite a methodologically rigorous literature search, there are limited data on functional neurological disorder and functional somatic syndromes among SGM people. Several studies reported increased prevalence of select conditions among transgender people. More observational studies are needed regarding the epidemiology and clinical course of functional disorders among SGM people.

Functional Neurological Disorder Among Sexual and Gender Minority People.

Sexual and gender minority (SGM) people can face unique stressors and structural discrimination that result in higher rates of neuropsychiatric symptoms, such as depression, anxiety, and suicidality. Although more rigorous studies are needed, emerging data suggest a possible higher prevalence of functional neurological disorder and other brain-mind-body conditions in SGM people. Representation and iterative feedback from affected community members is critical to the process of developing affirming environments. More research is needed to explore the relevance of functional neurologic disorder in SGM people within a biopsychosocial framework.

COVID-19 stigma and depression across race, ethnicity and residence.

Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics.

Race, masks, residency and concern regarding COVID-19 transmission.

To explore sociodemographic predictors for concern regarding COVID-19 transmission and how these factors interact with the identities of others, we conducted a web-based survey where we asked 568 respondents in the United States to indicate their level of COVID-19 concern in response to a series of images with short vignettes of masked and unmasked individuals of different racial/ethnic backgrounds. Using a linear mixed effects model, we found that regardless of the race of the image being presented in the vignette, concern regarding COVID-19 transmission was associated with respondents' older age (b = 0.029, p < 0.001), residing in NYC (b = 0.556, p = 0.009), being heterosexual (b = 1.075, p < 0.001), having higher levels of education, that is, completion of a Bachelor's degree (b = 1.10, p = 0.033) or graduate degree (b = 1.78, p < 0.001), and the person in the vignette being unmasked (b = 0.822, p < 0.001). Asian respondents were more likely than White respondents to be concerned regarding COVID-19. Individuals who self-reported themselves to be at high risk for COVID-19 were more likely to be concerned about COVID-19 over those who considered themselves to be low risk. These findings highlight the importance of acknowledging interactions between race, mask status, and residency in predicting COVID-19 concern.

Aging With Mental Disorders in the Criminal Justice System: A Content Analysis of the Empirical Literature.

To fill a current gap in the literature on aging, mental health, and the criminal justice system, a content analysis of international peer-reviewed research studies was conducted. A comprehensive literature search was conducted to identify English language research studies published in 2018-19. Forty-four articles were located using keyword search terms, such as aging, mental health, and criminal justice. The methods and major findings were analyzed using deductive and inductive approaches. It was found that the majority of the research studies were conducted in the United States and England. The results of the inductive analyses revealed major themes related to mental health detection and access to services, comorbid conditions, and the relationship of age, mental health, criminal behavior, and the social determinants of mental health. Findings from this review have significant implications for advancing epidemiological research, practice, and policy, especially as it relates to the influence of the social determinants of health of aging on life course mental health and criminal justice involvement. Research findings about the correlates and consequences of the social determinants of health, especially as it relates to aging, mental health, and criminal justice involvement, can be used to inform prevention and intervention efforts that target the social determinants of life course health and criminal justice involvement. It also provides a comprehensive assessment of the m methods used in prior studies to help improve future studies in this important area of investigation.

Trauma-informed care and elder abuse: a synergistic alliance.

Elder abuse is a global systemic problem in which one or more traumatic or stressful life experiences directly affect older adults, their families, and communities. Despite its devastating impact, the understanding of-and response to-elder abuse has rarely been explored through a trauma-informed lens. Despite the prevalence of traumatic and stressful life experiences, research and practice are just beginning to target the intersection of elder abuse and life course trauma. This article demonstrates how knowledge about the causes, consequences, and responses to elder abuse can be integrated with the principles of trauma-informed care to improve agency and community responses to preventing or intervening with elder abuse and neglect. In order to address the ongoing problems with detection and treatment of elder abuse, we assert that instilling trauma and elder abuse informed care in organizational services and policies forms a synergistic alliance and would address many of these concerns.

Exploring the Association between Race and Health among Older Adults Who Are Incarcerated.

One of the little known ironies in the field of prison health is the notion that prison may actually have health-stabilizing effects for some groups. This study contributes to this line of inquiry by examining a variety of physical and mental health indicators among an older cohort of prisoners. Furthermore, this study's focus on race addresses a notable gap in the growing literature on older prisoner health. A cross-section of 625 males who were incarcerated residing in a northeastern state prison system was surveyed and data on self-reported health status and stress and individual demographics characteristics were collected. Univariate and multivariate logistic regressions were used to quantify racial differences with respect to self-reported stress after adjusting for potential confounders. Results suggest that Black men who are older and incarcerated appear to be more resilient than White men who are older. An association was found between race and self-reported stress though not statistically significant. Health status is a significant predictor of self-reported stress in univariate and multivariate analyses. Having ever committed a violent offense and having received mental health services (in and out patient) are statistically associated with self-reported stress. Black men who were older in this study appear to cope better with stress related to incarceration than White men who were older, which may in turn affect other physical and mental health outcomes. Future research is needed to address factors that stabilize health and reduce stress among a racially diverse, aging prison population.

Human Rights and Dignity Behind Bars.

Death and dying in prisons constitute a topic of growing importance across the globe. Based on the contributions made in this special issue, we reflect on current debates and outline recommendations for dialogue and practice. Scientific dialogue across the Atlantic, and across the globe, provides insights into different national carceral systems and their ways of dealing with end of life behind bars. At the same time, the comparison also helps to identify basic needs and practices that can work in various settings. We identify several issues where further efforts need to be taken to deepen the dialogue. A common ground for all advancement of legislation and practice constitute the minimal level of rights to which every human being is entitled.

"Coming Out" of Prison: An Exploratory Study of LGBT Elders in the Criminal Justice System.

This two-phase qualitative study explores the experiences of 10 formerly incarcerated LGBT elders' experiences prior to, during, and after release from prison. A core theme of self and the social mirror emerged from the data that represented LGBT elders ongoing coming-out process of unearthing their "true selves" despite managing multiple stigmatized identities or social locations, such as being LGBT, elderly, HIV positive, formerly incarcerated, and a racial/ethnic minority. These findings further our awareness of an overlooked population of LGBT who are older and involved in the criminal justice system. Recommendations that incorporate suggestions from formerly incarcerated LGBT elders for services and policy reform are presented.

Insight, Motivation and Outcome in Drug Treatment for Offenders: A Review of the Recent Literature.

Researchers in addiction and psychotherapy have long agreed that insight into problem severity and motivation for treatment are important client factors in successful treatment. For offenders these factors are linked to recidivism and relapse rates post-treatment. Authors in both fields agree that the combination of insight and motivation are key to positive treatment outcomes. However, this literature review found little effort to measure these factors in substance abuse literature with offenders. Articles identified contained the terms 'motivation;' 'insight;' and 'drug treatment' were paired with the term 'offenders' in varying combinations to identify articles meeting study criteria. Inductive analysis revealed that the majority of the articles did not measure insight and motivation, nor did they measure outcomes. Only seven of the 16 articles included measures of insight and motivation. Of these, only one study measured outcome as well. In addition, qualitative aspects of insight and motivation were not accounted for by assessments used. Recommendations for future research include measuring insight and motivation as well as treatment outcome, and tailoring treatment for this population accordingly, so as to better predict recidivism rates post-treatment.

Unraveling trauma and stress, coping resources, and mental well-being among older adults in prison: empirical evidence linking theory and practice.

PURPOSE OF STUDY: A theoretical integration of the life course perspective, cumulative advantage, disadvantage or inequality, and stress processing theories provide an important integrated lens to study the relationship between accumulated interpersonal, social-structural, and historical trauma and stressful experiences on mental well-being mental well-being in later life. DESIGN AND METHODS: This study builds upon the extant literature by examining the mediating role of coping resources on the relationship between trauma and stressful life experiences, post traumatic stress symptoms, and mental well-being among a sample of 677 adults aged 50 and older in prison. RESULTS: The majority (70%) reported experiencing one or more traumatic or stressful life experiences during their life span. Participants also reported on average 11 occurrences of multilevel trauma and stressful life events and lingering subjective distress related to these events. Results of a structural equation model revealed that internal and external coping resources (e.g., cognitive, emotional, physical, spiritual, and social) had a significant and inverse effect on the relationship between trauma and stressful life experiences and mental well-being. IMPLICATIONS: As prisons are forced to deal with an aging population, research in this area can take the preliminary steps to enhance understanding of risk and resilience among older adults in prison. This understanding will aid in the development and improvement of integrated theory-based interventions seeking to increase human rights, health, and well-being among older adults in prison.

An empirical assessment of the overlap between sexual victimization and sex offending.

There has been a recent proliferation in the number of studies that are investigating the phenomenon that has been coined the victim-offender overlap. There has been noticeably less attention toward examining the sexual victimization and sex offending overlap. Acknowledging this gap in the literature, the present study provides an assessment of this overlap among a large sample of male prisoners with a focus on the cycle of violence hypothesis. Bivariate results reveal a considerable degree of overlap between sexual victimization and sex offending, and multivariate results estimated from a series of bivariate probit models simultaneously assessing both outcomes suggest that experiencing emotional abuse early on in the life-course is a robust risk factor for experiencing sexual victimization and demonstrating sex offending behavior. Furthermore, being physically neglected and witnessing family violence also emerged as significant risk factors for sexual victimization. Study limitations and policy implications are also discussed.

Bridging community and prison for older adults: invoking human rights and elder and intergenerational family justice.

PURPOSE: Older adults in prison present a significant health and human rights challenge for the criminal justice system. To date, there is no known study that provides a comprehensive examination or portrait of older persons in prison. The purpose of this paper is to understand individual, family, system, and community vulnerabilities that can complicate successful community reintegration for these individuals. DESIGN/METHODOLOGY/APPROACH: This study provides a cross-sectional, descriptive analysis of biopsychosocial, spiritual, and prison use characteristics associated with a sample of 677 older prisoners, aged 50+, in a state-wide prison system. FINDINGS: Results indicate the extent of diversity within this population based on demographic, clinical, social, legal profiles, prison service use patterns, and professional and personal contacts. RESEARCH LIMITATIONS/IMPLICATIONS: Due to the diversity within this population, an interdisciplinary approach is needed to address the complex social and health care needs of an aging prison population and to plan for their reentry. Practical implications - These findings suggest the need for holistic prevention, assessment, and interventions to interrupt the social-structural disparities that foster and support pathways to incarceration and recidivism. ORIGINALITY/VALUE: The human rights implications for the current treatment of older adults in prison include providing in-prison treatment that promotes safety, well-being, reconciliation, and seamless bridges between prison and community for older adults and their families. The True Grit Program is presented as an example of a humanistic and holistic approach of such an approach.

Palliative and end-of-life care in prisons: a content analysis of the literature.

PURPOSE: The growing numbers of terminally ill and dying in prison has high economic and moral costs as global correctional systems and the society at large. However, to date little is known about the extent to which palliative and end-of-life care is infused within global prison health care systems. The purpose of this paper is to fill a gap in the literature by reviewing and critically appraising the methods and major findings of the international peer-reviewed literature on palliative and end-of-life care in prison, identify the common elements of promising palliative and end-of-life services in prison, and what factors facilitate or create barrier to implementation. DESIGN/METHODOLOGY/APPROACH: A content analysis was conducted of the existing peer-reviewed literature on palliative and end-of-life care in prison. English-language articles were located through a comprehensive search of peer-reviewed journals, such as Academic Search Premier Literature databases using differing combinations of key word search terms, "prison," "palliative care," and "end-of-life care." A total of 49 studies published between 1991 and 2013 met criteria for sample inclusion. Deductive and inductive analysis techniques were used to generate frequency counts and common themes related to the methods and major findings. FINDINGS: The majority (n=39) of studies were published between 2001-2013 in the USA (n=40) and the UK (n=7). Most were about US prison hospice programs (n=16) or barriers to providing palliative and end of life care in prisons (n=10). The results of the inductive analysis identified common elements of promising practices, which included the use of peer volunteers, multi-disciplinary teams, staff training, and partnerships with community hospices. Obstacles identified for infusing palliative and end-of-life care in prison included ethical dilemmas based on custody vs care, mistrust between staff and prisoners, safety concerns, concern over prisoners' potential misuse of pain medication, and institutional, staff, and public apathy toward terminally ill prisoners and their human rights to health in the form of compassionate and palliative care, including the use of compassionate release laws. RESEARCH LIMITATIONS/IMPLICATIONS: Implications for future research that foster human rights and public awareness of the economic and moral costs of housing the sick and dying in prisons. More research is needed to document human rights violations as well as best practices and evidence-based practices in palliative and end-of-life care in prisons. Future studies should incorporate data from the terminally ill in prison, peer supports, and family members. Future studies also should employ more rigorous research designs to evaluate human rights violations, staff and public attitudes, laws and policies, and best practices. Quantitative studies that use experimental designs, longitudinal data, and multiple informants are needed. Qualitative data would allow for thick descriptions of key stakeholders experiences, especially of the facilitators and barriers for implementing policy reform efforts and palliative care in prisons. Practical implications - This review provides a foundation on which to build on about what is known thus far about the human right to health, especially parole policy reform and infusing palliative and end-of-life care for the terminally ill and dying in prisons. This information can be used to develop or improve a new generation research, practice, policy, and advocacy efforts for that target terminally ill and dying in prison and their families and communities. SOCIAL IMPLICATIONS: There are significant social implications to this review. From a human rights perspective, the right to freedom from torture and cruel and unusual punishment is a fundamental human right along with prisoners' rights for an appropriate level of health care. These rights should be guaranteed regardless of the nature of their crime or whether they are in a prison placement. The information provided in this review can be used to educate and possible transform individual's and society's views toward the terminally ill and dying who are involved in the criminal justice system. ORIGINALITY/VALUE: This paper extends the extant literature by using both quantitative and qualitative analysis methods to organize, summarize, and critically analyze the international literature on palliative care and end of life care in prison. This review is designed to increase awareness among the international community of the pain and suffering of the terminally ill in prison and the facilitators and barriers to providing them compassionate care while in custody.

The case for human agency, well-being, and community reintegration for people aging in prison: a statewide case analysis.

This study profiled 2,913 adults aged 50 and older sentenced to a statewide correctional system and their parole eligibility status with implications for community reintegration, resettlement, and recovery needs. The research team developed the Correctional Tracking Data Extraction Tool to gather official data and personal and legal characteristics from a state department of corrections website. The majority of older prisoners were men from racial/ethnic minorities between the ages of 50 and 59 with a range of minor to serious offenses. Time served in prison ranged from 1 month to 45 years; more than 40% were eligible for parole within 5 years. These findings underscore the need for an intervention that can address the differing typologies and individual-level and systemic issues that gave rise to the aging prisoner population. Promising practices that address elements of a conceptual model in prison and community reintegration and recovery for older adult prisoners are reviewed.

The high cost of the international aging prisoner crisis: well-being as the common denominator for action.

The aging prisoner crisis continues to gain international attention as the high human, social, and economic costs of warehousing older adults with complex physical, mental health, and social care needs in prison continues to rise. According to the United Nations, older adults and the serious and terminally ill are considered special needs populations subject to special international health and social practice and policy considerations. We argue that older adults in prison have unique individual and social developmental needs that result from life course exposure to cumulative risk factors compounded by prison conditions that accelerate their aging. We position these factors in a social context model of human development and well-being and present a review of international human rights guidelines that pertain to promoting health and well-being to those aging in custody. The study concludes with promising practices and recommendations of their potential to reduce the high direct and indirect economic costs associated with mass confinement of older adults, many of whom need specialized long-term care that global correctional systems are inadequately equipped to provide.

Probation officers' perspectives on interagency collaboration for juvenile offenders with mental health problems.

OBJECTIVES: This study examined the interagency collaboration strategies used by juvenile probation officers in the treatment of delinquent youths. METHODS: Thirty-one juvenile probation officers were interviewed about the strategies they use with youths who have mental disorders. Transcriptions of these interviews were analyzed with grounded-theory conventions. RESULTS: Interagency collaboration was described in a framework of three models. The monitoring model involved minimal involvement of probation officers with treatment providers, the teamwork model involved collaborative decision making and frequent consultation, and the partnership model involved the direct involvement of probation officers in the treatment process. CONCLUSIONS: Results of this study provide a framework for conceptualizing interagency collaboration and juvenile court authority. This framework may be used in case and program planning as well as in research to develop evidence-based strategies for the treatment of court-involved youths with mental disorders.

Forget me not: dementia in prison.

The number of older adults with dementia in U.S. prisons is rapidly rising. Yet, the vast majority of this marginalized subgroup of the aging population is left neglected behind bars without access to adequate medical and mental health care services. We assert that proactive, interdisciplinary collaborative efforts to improve practice, policy, and research and to develop a high-quality evidence-based continuum of care for this aging population are urgently needed. The overarching goals of this paper are to raise awareness of the life and experiences of persons with dementia in prison and to stimulate discussion, research, and advocacy efforts for this forgotten subgroup of older Americans. We describe the growing number of older adults with dementia in U.S. prisons, high-risk factors for dementia present in the prison population, and the life and experience of persons with dementia in the culture and environment of prison that is primarily not designed for them. We review the current state of services and programs for dementia in prison. We conclude by proposing practice, policy, and research-related priority areas and strategies for interdisciplinary gerontological responses.

Age, cumulative trauma and stressful life events, and post-traumatic stress symptoms among older adults in prison: do subjective impressions matter?

BACKGROUND: The aging prison population in the United States presents a significant public health challenge with high rates of trauma and mental health issues that the correctional system alone is ill-prepared to address. The purpose of this study was to examine the relationship of age, objective, and subjective measures of trauma and stressful life events and post-traumatic stress symptoms among older adults in prison. METHODS: Data were gathered from 334 prisoners (aged 55+) housed in the New Jersey Department of Corrections, as of September 2010. An anonymous self-report, self-administered survey was mailed to the total population of 1,000 prisoners aged 55 years and older. Objective and subjective trauma was measured using the Life Stressors Checklist-Revised (LSC-R), and post-traumatic stress symptoms were measured using the Civilian Version of the Post-traumatic Stress Scale. FINDINGS: Results of a path analysis revealed that past year subjective impressions of traumatic and stressful life events had a positive and significant relationship to current post-traumatic stress symptoms. Age was found to have a significant and inverse relationship to subjective traumatic and stressful life events. That is, younger participants reported higher levels of cumulative traumatic and stressful life events and past year subjective ratings of being bothered by these past events. IMPLICATIONS: These findings have significance for interdisciplinary/interprofessional practice and appropriate institutional and community care, including reentry planning of older adults in the criminal justice system.