During the era of mass incarceration in the US, exposure to the criminal justice system has increasingly been recognized as a risk factor for negative health outcomes. This study of adults aged ≥50 examined whether recent “criminal justice involvement” (defined as self-reported arrest, parole, or probation in the past year) was associated with self-reported mental illness, substance use disorders, and medical multi-morbidity (i.e., having ≥2 chronic conditions). Data were derived from the 2015–2018 National Survey of Drug Use and Health (N=34,898).
- Overall, 1.2% of the sample reported recent criminal justice involvement.
- A greater percentage of individuals with (versus without) recent criminal justice involvement reported having any substance use disorder (35% versus 4%) and moderate or serious mental illness (21% versus 6%), but not medical multi-morbidity (24% versus 26%).
- In analyses adjusting for age, gender, race/ethnicity, marital status, education, income, and health insurance status, having all 3 conditions (mental illness, substance use disorder, and medical multi-morbidity) was strongly associated with recent criminal justice involvement (adjusted odds ratio, 8.56).
- Individuals with recent arrest had greater odds of reporting mental illness or multi-morbidity than those on parole or probation.
Comments: Substance use disorder prevalence tends to decrease with age, but this study demonstrates a high prevalence among middle-aged and older adults with recent criminal justice involvement. These self-reported data were not ideal to study medical multi-morbidity, however, because people without reliable access to medical care may be unaware of medical comorbidities. Future studies should move beyond descriptive analyses to examine whether criminal justice involvement can be causally linked to these conditions, and to identify interventions that best address them among this highly marginalized population.
Aaron D. Fox, MD
Reference: Han BH, Williams BA, Palamar JJ. Medical multimorbidity, mental illness, and substance use disorder among middle-aged and older justice-involved adults in the USA, 2015–2018. J Gen Intern Med. 2021;36(5):1258–1263.