Out and Down: The Effects of Incarceration on Psychiatric Disorders and Disability

Although psychiatric disorders are common among current and former inmates, a putative causal relationship is contaminated by assorted influences, including childhood disadvantage, the early onset of most disorders, and the criminalization of substance use, which is itself comorbid with a variety of other subsequent psychiatric disorders. Using the National Comorbidity Survey Replication, this study examines the relationship after statistically adjusting for these powerful and multidimensional selection processes. The analysis reveals a positive association between incarceration and both current and lifetime psychiatric disorders, while helping to unpack its underpinnings. Results indicate that (i) some of the most common disorders found among former inmates emerge in childhood and adolescence; (ii) the effects of incarceration dissipate somewhat over time, having a smaller impact on current disorders than lifetime disorders; and (iii) substance disorders anticipate both other psychiatric disorders and incarceration. Yet the results also reveal robust incarceration effects on certain disorders, which are no less consequential for being specific. In particular, incarceration has a robust relationship with subsequent mood disorders, related to feeling “down”, including major depressive disorder, bipolar disorder, and dysthymia. These disorders, in turn, are strongly related to social and economic disability. Indeed, mood disorders explain much of the additional social disability former inmates experience following release. For those concerned with prisoner reintegration, mood disorders may be an important—and generally neglected—consideration.