Older incarcerated persons' mental health before and during the COVID-19 pandemic.

PURPOSE: Older incarcerated persons are an especially vulnerable segment of the prison population, with high rates of multimorbidity. This study aims to determine the impact of the COVID-19 pandemic on older incarcerated persons' mental and physical health. DESIGN/METHODOLOGY/APPROACH: Participants were 157 currently-incarcerated persons age ≥50 years who were enrolled in an ongoing longitudinal study before the pandemic. Anxiety symptoms (seven-item generalized anxiety disorder questionnaire), depressive symptoms (eight-item patient health questionnaire) and self-rated health (SRH) were assessed during in-person interviews completed before the pandemic and via mailed surveys during the pandemic (August-September 2020). A mediation model evaluated the relationship among anxiety, depression and SRH. FINDINGS: Participants were 96% male, racially diverse (41% White, 41% Black, 18% Hispanic/Other), with average age 56.0(±5.8) years. From before to during the pandemic, anxiety symptoms increased (worsened) (from 6.4 ± 5.7 to 7.8 ± 6.6; p < 0.001), depressive symptoms increased (worsened) (from 5.5 ± 6.0 to 8.1 ± 6.5; p < 0.001) and SRH decreased (worsened) (from 3.0 ± 0.2 to 2.6 ± 0.2; p < 0.001). The total effect of worsening anxiety symptoms on worsening SRH (-0.043; p < 0.001) occurs entirely because of worsening depressive symptoms, i.e. the direct effect was statistically non-significant -0.030 (p = 0.068). PRACTICAL IMPLICATIONS: Older incarcerated persons experienced worsening mental health during the COVID-19 pandemic which was associated with worsening SRH. These findings have implications for health-care costs and services needed to care for this vulnerable group. ORIGINALITY/VALUE: This is the first study to evaluate change in older incarcerated persons' mental health from before the COVID-19 pandemic to during the pandemic.