Posttraumatic Stress Disorder Symptoms and Incarceration: The Impact on Sexual Risk-Taking, Sexually Transmitted Infections, and Depression Among Black Sexual Minority Men in HIV Prevention Trials Network (HPTN) 061.

Black men and people belonging to sexual minority groups are disproportionately impacted by criminal legal involvement and sexually transmitted infections (STIs). Traumatic experiences are often associated with later criminal legal involvement, depression symptoms, sexual risk behavior, and STIs. Research on the joint influence of trauma and incarceration on STI risk among racial and/or sexual minority people is limited. This study tested the association between post-traumatic stress disorder (PTSD) symptoms and incarceration on sexual risk behavior and STI among Black sexual minority men, a population that may be at higher risk for contracting STIs. Using data from the HIV Prevention Trials Network 061 Study, a longitudinal study of adult Black sexual minority men in six U.S. cities (N = 855), we tested associations between past six-month incarceration and subsequent sexual risk behavior, STI, and depression symptoms, for those with and without pre-incarceration PTSD symptoms. PTSD symptoms were elevated among participants who reported Hispanic ethnicity, having sex with both men and women, and previous incarceration. Although there were not significant differences between recent incarceration and sexual risk for those with and without PTSD, incarceration was linked to some sexual risk behaviors regardless of PTSD symptoms. Among people with PTSD symptoms, there was a higher prevalence of sexual risk and depression symptoms, regardless of incarceration. These findings suggest a potentially compounding influence of PTSD symptoms and incarceration on sexual risk and infection among Black sexual minority men.

Implementing a Treatment for People with Serious Mental Illness in Jail: A Mixed-Methods Study of Stakeholder Perspectives on Feasibility and Acceptability.

People with mental illness are over-represented in the U.S. criminal legal system. Jail presents an optimal opportunity to provide needed mental health care as the entry point to corrections. However, there is a lack of programming available in jails, which may be partly due to limited understanding of how to successfully implement interventions in this complex setting. We implemented a nine-session psychotherapeutic intervention for people with serious mental illness in a county jail. As part of a larger implementation-effectiveness hybrid study, we gathered mixed-methods data from stakeholders (treatment recipients and jail administrators) on the feasibility and acceptability of the intervention's implementation. In focus group discussions and qualitative interviews, treatment recipients (n = 29) provided qualitative and quantitative data on their perceptions of the implementation's feasibility and acceptability. Jail administrators (n = 6) completed two quantitative self-report measures on their perceptions of the treatment's feasibility and acceptability. Qualitative analyses were conducted by two coders using inductive thematic template analysis; seven global themes relating to treatment recipients' perceptions of the assets and hindrances to feasibility and acceptability were developed and are presented with supporting quotations. Quantitatively, all treatment recipients endorsed the intervention's feasibility (100%), and nearly all (97%) endorsed its acceptability. On both self-report measures, jail administrators' mean scores fell above a-priori thresholds indicating feasibility and acceptability. We found qualitative and quantitative support for the use of this intervention in jail from both sets of stakeholders. These results have implications for clinical service and policy in jail, where service providers struggle to meet the considerable demand for mental health services.

Intellectual deficits and restoration to competency to stand trial: An examination of IQ cut off scores.

Intellectual functioning impacts defendants' competence to stand trial, though research on this population remains limited. This study replicated and advanced prior work, focusing on defendants' demographic, clinical, cognitive, and criminal justice variables and their association with length of hospitalization and restoration determinations. Participants were 74 male and female criminal defendants in a midwestern state who were adjudicated incompetent to stand trial, had a diagnosis related to intellectual deficits, and completed competency restoration. Most defendants (83.7%) were restored to competency. Demographic factors were unrelated to restoration outcomes; violence of alleged offense predicted shorter hospitalization. Receiver Operating Characteristic Curve analyses determined an IQ score cut-off of 63.5 for which participants were of greater likelihood to be determined restored, providing guidance on the likelihood of restoration for defendants with intellectual disability related diagnoses. Specifically, this score can be used with clinical data to inform competency determinations for defendants with cognitive deficits.

Criminogenic risk and mental health: a complicated relationship.

The relationship between criminogenic risk and mental illness in justice involved persons with mental illness is complex and poorly understood by clinicians, researchers, administrators, and policy makers alike. Historically, when providing services to justice involved persons with mental illness, clinicians have emphasized mental health recovery (eg, psychiatric rehabilitation) at the exclusion of treatments targeted at criminogenic risk. More recently, however, researchers have demonstrated with great clarity that criminogenic risk not only contributes but is likely the leading factor in the criminal behavior committed by persons with mental illness. Yet, we still do not know the nature of this criminogenic-mental illness relationship, how this relationship impacts treatment needs, and of ultimate concern, what this relationship means in terms of individual and societal outcomes. In this paper we briefly define criminogenic risk and the research that demonstrates the role of criminogenic risk in criminal justice involvement of persons with mental illness. We also review prevalence rates of persons with mental illness justice involvement, and then discuss important factors to be considered when assessing risk to include both criminogenic and mental illness risk. We conclude this paper by reviewing treatment and management strategies for persons with mental illness that are criminal justice involved particularly reviewing and building off the recommendations put forth by Bartholomew & Morgan.

Examining violence among Not Guilty by Reason of Insanity state hospital inpatients across multiple time points: the roles of criminogenic risk factors and psychiatric symptoms.

OBJECTIVE: Institutional violence in state hospitals is a public health problem that has been severely understudied. Given the personal (ie, staff and patients) and fiscal harms associated with institutional violence, more research into contributing factors for violence is needed. The overarching aim of this study then was to examine associations among psychiatric symptoms, criminal risk factors, and institutional violence. METHODS: Participants were 200 male, female, and transgender forensic mental health inpatients adjudicated Not Guilty by Reason of Insanity and committed to the California Department of State Hospitals. Participants completed a psychiatric symptom measure, and measures of and associated with criminal risk. Institutional violence was recorded from file review and includes physical violence toward staff or patients for 6-months prior to and post patient participation in this study. RESULTS: After adjusting for previous institutional violence, results indicated that psychiatric symptoms were not associated with follow-up institutional violence; however, criminal risk was associated with follow-up institutional violence. Unexpectedly, 2 aspects of criminal risk, antisocial cognitions and associates, were not associated with follow-up institutional violence after adjusting for previous institutional violence. Results also provided a tentative cutoff score on the Self-Appraisal Questionnaire for predicting follow-up institutional violence. CONCLUSIONS: These results have important implications for treating and managing patients at risk for institutional violence, including the need to assess criminogenic risk and leverage treatments that target these risk factors as a best practice approach.

Tried and True? A Psychometric Evaluation of the Psychological Inventory of Criminal Thinking Styles-Short Form.

The Psychological Inventory of Criminal Thinking Styles-Short Form (PICTS-SF) is an abbreviated 35-item version of the PICTS, a measure of cognitions that support a criminal lifestyle. Despite use in research and clinical work, the PICTS-SF's psychometric properties have not been tested. Using two archival datasets, we analyzed the PICTS-SF's reliability and structural validity in multiply imputed data from adult males and females on probation in a residential treatment facility (n = 514). We also tested the PICTS-SF's reliability and discriminant and postdictive validities among adult males in administrative segregation in prison (n = 95). We found evidence for the PICTS-SF's internal consistency (α and ω ≥ .89), structural validity (CFI = .90, RMSEA = .05), discriminant validity (.22 ≤ r ≤ .39), and postdictive validity for receiving disciplinary infractions (incident rate ratio = 1.04). These results support the PICTS-SF's use in research, and qualified use in clinical applications.

Criminal risk and mental illness in psychiatric inpatient units: An opportunity to provide psychological services for unmet criminogenic needs.

Although the overrepresentation of people with mental illness in the criminal justice system is known, research is needed to identify the frequency of criminal justice involvement and criminogenic treatment needs in inpatient populations to improve continuity of care and access to appropriate treatments. The purpose of this study is to document the frequency of criminal justice involvement among people receiving inpatient community care, as has been done for persons with mental illness in correctional institutions, and to test the association between criminogenic risk and psychiatric symptomatology. The present study uses two samples (n = 94 and n = 142) of adults from two separate acute psychiatric inpatient hospitals in Texas. Data on psychiatric symptoms, mental health history, criminal risk, and criminal justice history were gathered from file review and self-report. Linear and negative binomial regressions were used to test associations of interest. In both samples, the frequency of prior criminal justice involvement was over 50%. The current results indicate there is a significant, positive association between measures of criminal risk and psychiatric symptoms. These findings highlight the need to address the reciprocal association between mental illness and criminal risk among people receiving inpatient psychiatric treatment with appropriate assessment and treatment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Age Differences in the Associations Between Incarceration and Subsequent Substance Use, Sexual Risk-Taking, and Incident STI Among Black Sexual Minority Men and Black Transgender Women in the HIV Prevention Trials 061 Cohort.

Incarceration can lead to different risk behaviors often due to increased distress and disruption of social networks. It is not well known, however, how these associations may differ by age. In this study, we measure age differences in longitudinal associations between incarceration and substance use, sex risk, and sexually transmitted infection (STI) among Black sexual minority men and Black transgender women (BSMM/BTW). We recruited BSMM/BTW from 2009 to 2011 that were part of the HIV Prevention Trials Network 061 study. We compared those less than 30 years old (n = 375) to those 30 years old or greater (n = 794) examining substance use, sex risk, and STI infection stratified by age. Logistic regression with inverse probability weighting was used for the statistical analysis. Approximately 59% of the sample reported incarceration history. In adjusted analysis, incarceration was more strongly associated with alcohol use and stimulant use among older individuals as was sexual risk behaviors including buying and selling sex. Concurrent partnerships were associated with the younger age groups. STI incidence was associated with younger individuals while associations with HIV infection were similar for the two age groups. Understanding differences in substance use and STI risk among age cohorts is imperative to the design and implementation of re-entry programs. Younger BSMM/BTW participating in re-entry support programs may benefit in particular from HIV/STI prevention and care efforts, while post-release substance abuse treatment and harm reduction programs should target older individuals with continued substance abuse.

The relation between the working alliance on mental illness and criminal thinking among justice-involved people with co-occurring mental illness and substance use disorders.

OBJECTIVE: The therapeutic working alliance is an important factor in producing treatment change and positive therapeutic outcomes for people with mental illness, yet little is known about the working alliance's role in treatment change in people with mental illness that is justice involved. In addition to treating the mental illness symptoms of justice-involved people with mental illness, addressing factors known to predict criminal behavior (including criminal thinking) could optimize posttreatment outcomes and reduce future justice involvement. This study examines the role of the working alliance in treatment change in a clinical treatment sample of 265 adult male and female justice-involved people with mental illness and substance use disorders completing probation sentences in a residential treatment facility. METHOD: Repeated measures moderation analyses were used to test participants' reported working alliance as a moderator of change from pre- to posttreatment scores of self-reported mental illness symptoms and criminal thinking. RESULTS: The working alliance significantly moderated reductions in depression, anxiety, anger, and manic symptoms (R 2 ranging from .03 to .09), and general, reactive, and current criminal thinking (R 2 ranging from .04 to .11). CONCLUSIONS: These findings expand the literature on the relation between working alliance and changes in mental illness symptoms by testing this association in the understudied population of justice-involved people with mental illness; these results also suggest the working alliance is associated with changes in criminal thinking. Treatment providers working with justice-involved people with mental illness should assess and emphasize the development of a working alliance to maximize treatment change. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The active ingredients in a treatment for justice-involved persons with mental illness: The importance of addressing mental illness and criminal risk.

[Correction Notice: An Erratum for this article was reported online in Psychological Services on Oct 8 2020 (see record 2020-75253-001). In the article, the authors listed the wrong version of a measure in the Method section of Study 2. The article should have listed PICTS-Layperson-Short Form (PICTS-L-SF) instead of the PICTS-Short Form (PICTS-SF) as the measure used. The correct citation for the measure appears in the erratum.] Corrections research literature is replete with treatment and intervention outcome studies but lacking empirical examinations of the process of change in justice-involved populations. The current studies expand upon previous outcome evaluations of Changing Lives and Changing Outcomes (CLCO), a treatment program for justice-involved persons with mental illness, by using process research designs to examine therapeutic mechanisms of change. Study 1 used CLCO participants' (n = 264) pre and post module quizzes to examine differences in content retention between Mental Illness, Criminalness, and Both mental illness and criminalness domains to determine if participants differentially learn treatment content. In Study 2, 1 CLCO module was administered to 9 groups of adult men on probation in a residential treatment facility (n = 4 to 8 per group) in 3 iterations: (a) Mental Illness-only content (n = 16), (b) Criminalness-only content (n = 20), (c) Full module (mental illness and criminalness content; n = 22). Results for both studies indicated significant treatment gains across outcome measures of interest (namely content retention and symptomology). Contrary to expectations in Study 1, effect sizes of Mental Illness and Criminalness content retention were similar, suggesting there are not differential effects in the magnitude of content retained between the 2 domains. In Study 2, the integration of mental illness and criminalness content produced greater global improvement than focusing on mental illness or criminalness alone. These results underscore the necessity and effectiveness of integrating mental illness and criminalness in the treatment of justice-involved persons with mental illness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Lifetime History of Suicide Attempts among Not Guilty by Reason of Insanity State Hospital Inpatients: The Roles of past Harmful Substance Use and Current Social Support.

This study tested current perceived social support (CPSS) as a moderator of the relation between previous substance use (PSU) and lifetime suicide attempt (SA) history among 200 NGRI inpatients. Results indicated no significant CPSS main effect. PSU was associated with greater odds of multiple prior lifetime SA. Moderation indicated those low in PSU but high in CPSS were least likely to report multiple prior lifetime SA. Conversely, NGRI inpatients with high CPSS and high PSU were most likely to report multiple lifetime SA. Our study suggests CPSS and PSU assessments may inform suicide risk assessments and interventions among NGRI inpatients.

The Moderating Effect of Criminal Thinking on Certainty of Apprehension in Decisions to Engage in Antisocial Behavior: Replication and Extension.

This study explored whether the rational (certainty of punishment) and nonrational (criminal thinking) aspects of antisocial decision-making interact. A convenience sample of 319 undergraduates (106 men, 213 women) completed a measure of criminal thinking and responded to three fictional vignettes (i.e., cheating on a final examination in a class they were in jeopardy of failing, stealing $50 off a table in a dorm room, and selling marijuana for a friend) at three different levels of risk or certainty of apprehension (50%, 10%, and 1%). Results indicated that participants reported that they would be more likely to engage in antisocial behavior when the certainty of getting caught was low and the level of proactive (P) or reactive (R) criminal thinking was high. An interaction between certainty and criminal thinking was also observed in which the gap between lower and higher criminal thinking respondents grew as the probability of getting caught fell.

Internalizing and externalizing factors on the pathway from adverse experiences in childhood to non-medical prescription opioid use in adulthood.

BACKGROUND: Research demonstrates strong associations between adverse childhood experiences (ACEs) and non-medical prescription opioid use (NMPO), but pathways are not understood, hindering prevention and treatment responses. METHODS: We assessed hypothesized mediators of the association between ACEs and NMPO in a nationally-representative U.S. SAMPLE: National Longitudinal Study of Adolescent to Adult Health data (N = 12,288) yielded an ordinal exposure comprising nine ACEs (neglect; emotional, physical, sexual abuse; parental incarceration and binge drinking; witnessed, threatened with, experienced violence) and a binary lifetime NMPO outcome. Nine potential mediators measured in adolescence and/or adulthood included depression, anxiety, suicidality, delinquency, impulsivity, and risk-taking. We estimated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for sex-stratified associations of: ACEs and mediators; mediators and NMPO; and ACEs and NMPO adjusting for mediators individually and simultaneously. RESULTS: All associations of ACEs and mediators were statistically significant and similar by sex. All mediators had statistically significant associations with NMPO (except one depression measurement for each sex). Delinquency was strongly associated with ACEs and NMPO and was the strongest individual mediator. Every ACE increase was associated with increased NMPO odds of 32% for males and 27% for females. Adjusting for all mediators, odds of NMPO were attenuated partially for males [AOR = 1.18 (95% CI:1.07, 1.31)] and somewhat more for females [AOR = 1.11 (95% CI:1.00, 1.25)]. CONCLUSIONS: Internalizing and externalizing factors partially explained the pathway from ACEs to NMPO. Substance abuse may be more difficult to treat with co-occurring psychopathologies and maladaptive behaviors, highlighting the need to address trauma early in life.

National Study of Childhood Traumatic Events and Adolescent and Adult Criminal Justice Involvement Risk: Evaluating the Protective Role of Social Support From Mentors During Adolescence.

OBJECTIVE: With nearly 11 million people in the United States arrested in 2015, the need to identify antecedent risk factors driving criminal justice involvement (CJI) and possible mitigating factors is crucial. This study examines the relation between childhood trauma and CJI in adolescence and adulthood and assesses how this relation is moderated by mentoring during young adulthood. METHODS: The analysis included 3 waves of data-adolescents, young adults, and adults-collected from 1995 to 2008 from 12,288 adolescents who participated in the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adolescents in grades 7 to 12. Logistic regression was used to examine how having a close mentor in adolescence moderated the relation between criminal justice involvement and 9 childhood traumatic events: (1) neglect, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, (5) parental incarceration, (6) parental binge drinking, (7) witnessed violence, (8) threatened with violence, and (9) experienced violence. RESULTS: Cumulative exposure to childhood trauma was associated with CJI in adolescence (adjusted odds ratios [AORs] ranging from 2.24 to 25.98) and adulthood (AOR range, 1.82-6.69), and parental incarceration was consistently one of the, if not the, most strongly associated with each form of CJI; the strength of these associations was weakened for those who reported a close mentor compared to those who did not. CONCLUSIONS: This study advances the literature regarding trauma and CJI, highlighting the role of social support and mentorship as protective factors for youth who experience childhood trauma. Interventions aimed at protecting vulnerable children from the harms of trauma should be the next priority.

Depression, Executive Dysfunction, and Prior Economic and Social Vulnerability Associations in Incarcerated African American Men.

Low executive function (EF) and depression are each determinants of health. This study examined the synergy between deficits in EF (impaired cognitive flexibility; >75th percentile on the Wisconsin Card Sorting Test perseverative error score) and depressive symptoms (modified Centers for Epidemiologic Studies-Depression) and preincarceration well-being among incarcerated African American men ( N = 189). In adjusted analyses, having impaired EF and depression was strongly associated with pre-incarceration food insecurity (odds ratio [ OR] = 3.81, 95% confidence interval [CI] = [1.35, 10.77]), homelessness ( OR = 3.00, 95% CI [1.02, 8.80]), concern about bills ( OR = 3.76, 95% CI [1.42, 9.95]), low significant other support ( OR = 4.63, 95% CI [1.62, 13.24]), low friend support ( OR = 3.47, 95% CI [1.30, 9.26]), relationship difficulties ( OR = 2.86, 95% CI [1.05, 7.80]), and binge drinking ( OR = 3.62, 95% CI [1.22, 10.80]). Prison-based programs to treat depression and improve problem-solving may improve postrelease success.