Associations Between Adverse Childhood Experiences and Tobacco, Alcohol, and Drug Use Among Individuals with Serious Mental Illnesses in Public-Sector Treatment Settings.

Adverse childhood experiences (ACEs) increase risk of substance use disorders (SUDs). Little research has focused on individuals with serious mental illnesses (SMI), despite their high prevalence of both ACEs and SUDs. We combined two datasets from prior studies (n = 299 and n = 240, total n = 539) that measured ACEs and made research diagnoses for SUDs. When controlling for other variables-age, gender, race, diagnostic category (psychotic disorder versus mood disorder), and study site (Washington, DC-area versus southeast Georgia)- in logistic regression models, ACE score was associated with tobacco use, presence of any SUD, alcohol use disorder, cannabis use disorder, and cocaine use disorder. Each one-unit increase in the ACE score increased the odds of SUD-related outcomes by 9-18%. Clinicians, program planners, and researchers should be aware of the powerful and long-lasting impact of ACEs, and the need for thorough screening and assessment of both SUDs and ACEs among patients with SMI.

Predictors of Criminal Sentiments Scale-Modified Scores in Outpatients with Legal System Involvement.

The Criminal Sentiments Scale-Modified (CSS-M) has been widely used as a measure of criminal attitudes. This analysis examined CSS-M scores in a large sample of outpatients with serious mental illnesses and a criminal legal system history. We compared total and subscale scores in our sample to scores from two other previously published U.S. studies in which the CSS-M was used, and evaluated associations between total CSS-M score and nine variables (age, educational attainment, gender, race, marital status, employment status, diagnostic category, substance use disorder comorbidity, and adverse childhood experiences (ACE) score). Scores were higher than in two prior U.S. studies involving other types of samples. Independently significant predictors of higher CSS-M scores included being younger (P < .001), having a higher ACE score (P < .001), being male (P = 03), not identifying as White (P < 001), not having a psychotic disorder (P < 001), and having a comorbid substance use disorder (P = 002). Future research should test the hypothesis that these factors increase risk for arrest and that arrest events, and subsequent criminal legal system involvement, are characterized by negative experiences and perceptions of poor procedural justice, which in turn underpin the negative opinions referred to as "criminal sentiments" or criminal attitudes.

Adverse Childhood Experiences and Arrest Rates among Individuals with Serious Mental Illnesses.

Adverse childhood experiences (ACEs) are linked to both poor mental health and adverse social outcomes, including arrest and incarceration. Furthermore, individuals with serious mental illnesses (SMI) are known to have high rates of childhood adversity and are overrepresented in all facets of the criminal justice system. Few studies have examined the associations between ACEs and arrests among individuals with SMI. We examined the impact of ACEs on arrest among individuals with SMI while controlling for age, gender, race, and educational attainment. In a combined sample from two separate studies in different settings (N = 539), we hypothesized that ACE scores would be associated with prior arrest, as well as rate of arrests. The prevalence of prior arrest was very high (415, 77.3%) and was predicted by male gender, African American race, lower educational attainment, and mood disorder diagnosis. Arrest rate (number of arrests per decade, which thus accounted for age) was predicted by lower educational attainment and higher ACE score. Diverse clinical and policy implications include improving educational outcomes for individuals with SMI, reducing and addressing childhood maltreatment and other forms of childhood or adolescent adversity, and clinical approaches that help clients reduce the likelihood of arrest while addressing trauma histories.

Characterizing Arrests and Charges Among Individuals With Serious Mental Illnesses in Public-Sector Treatment Settings.

Objective: Individuals with serious mental illnesses are overrepresented in all facets of the legal system. State-level criminal histories of patients with serious mental illnesses were analyzed to determine the proportion who had been arrested and number of lifetime arrests and charges, associations of six variables with number of arrests, and the most common charges from individuals' first two arrests and most recent two arrests. Methods: A total of 240 patients were recruited at three inpatient psychiatric facilities and gave consent to access their criminal history. Information was extracted from Record of Arrest and Prosecution (RAP) sheets for lifetime arrests in Georgia. Results: A total of 171 (71%) had been arrested. Their mean±SD lifetime arrests were 8.6±10.1, and mean lifetime charges were 12.6±14.6. In a Poisson regression, number of arrests was associated with lower educational attainment, Black or African American race, the presence of a substance use disorder, the presence of a mood disorder, and female sex. Common early charges included marijuana possession, driving under the influence of alcohol, and burglary and shoplifting. Common recent charges included probation violations, failure to appear in court, officer obstruction­related charges, and disorderly conduct. Conclusions: Findings point to a need for policy and program development in the legal system (e.g., pertaining to charges such as willful obstruction of an officer), the mental health community (e.g., to ensure that professionals know about clients' legal involvement and can partner in strategies to reduce arrests), and social services sectors (to address charges, such as shoplifting, often related to material disadvantage).

Associations Between Childhood and Adolescence Adversity and Risk for Arrest Among Patients With First-Episode Psychosis.

OBJECTIVE: The authors assessed associations between childhood and adolescent adversity and arrest among individuals with first-episode psychosis (FEP). The authors also sought to determine which domains of adversity had the greatest impact and whether associations varied by gender. METHODS: Data were analyzed from 247 patients with FEP admitted to inpatient psychiatric units between August 2008 and June 2013. Analyses focused on self-reported history of arrest and seven scales of past adversity, with 14 subscales reduced to three factors. Binary logistic regression and negative binomial regression determined associations between the three childhood adversity factors and having ever been arrested and number of arrests, respectively. RESULTS: Past experience of violence and environmental adversity was significantly (p<0.001) associated with both history of arrest (odds ratio=2.29) and number of arrests (ß=0.60), and this association was stronger for female patients than for male patients. CONCLUSIONS: Findings suggest a need to address both past adversity and criminal justice system involvement in the context of early psychosis specialty care.

Subjective social status, objective social status, and substance use among individuals with serious mental illnesses.

Subjective social status (SSS) and objective socioeconomic status (OSS) may appear to be similar social determinants of mental health, but are actually independently associated with diverse health outcomes including substance use and substance use disorders (SUDs). Such associations have not been examined among individuals with serious mental illnesses (SMI) despite their high prevalence of comorbid substance use; frequent treatment and recovery complications associated with such use; and high levels of economic disadvantage, discrimination, and inequities in this marginalized population. These psychosocial adversities manifest as poor mental illness outcomes, poor physical health, and early mortality in populations with SMI. We hypothesized that both SSS and OSS would predict substance use severity and SUD diagnoses in 240 patients with SMI. SSS, measured by the MacArthur Scale of Subjective Social Status, was unassociated with a composite measure of income and education used to operationalize OSS. Additionally, SSS and OSS were differentially associated with various types of substance use disorders. Only OSS was associated with whether individuals smoked cigarettes, or the level of nicotine dependence. Conversely, only SSS was associated with drug use severity. Our results shed light on the potential for differential impacts of SSS and OSS among persons with SMI.

Effects of perceived social status and discrimination on hope and empowerment among individuals with serious mental illnesses.

Hope and empowerment are key elements of recovery in the context of serious mental illnesses (SMI). We examined predictors of hope among individuals with SMI and tested a hypothesized path model in which perceived social status and perceived discrimination adversely impact hope, directly and through their impacts on depressive symptoms. Data from 232 individuals with SMI receiving care in public-sector settings were used in both a multiple linear regression (predicting Herth Hope Scale scores), and in path analyses examining both direct and indirect effects of perceived social status (Social Status Ladder) and perceived discrimination (Everyday Discrimination Scale). Depressive symptoms, perceived social status, and perceived discrimination were predictive of hope. Path analyses revealed that perceived social status has a direct effect on hope and empowerment but also impacts hope through its effects on depression. Similarly, perceived everyday discrimination affects hope and empowerment, though this effect is mediated through its effects on depression. Two alternative models and a trimmed hypothesized model did not fit the data or improve fit. These social determinants of mental health should provoke program and policy change to improve mental health and enhance recovery among persons with SMI.