Helena Addison, a doctoral student at the University of Pennsylvania who worked as a nurse in a psychiatric hospital, came across many people who had previously been incarcerated. The interaction sought to better understand the mental health implications of such an experience.
“Initially, I saw imprisonment as a source of trauma for black men,” says Addison, a fourth-year doctor in the presidency. Member of Penn’s School of Nursing. “As we learned more, imprisonment spread as a social determinant of health, while still focusing on mental health.”
In collaboration with Sara Jacoby, an assistant professor in the School of Nursing, Addison assessed what science now knows about passing this arrest on the psychological branches of black men. Reviewing nearly two dozen articles from the past decade, he found that there is a link for this group in the United States to higher levels of incarceration and psychological distress, more severe symptoms of PTSD and depression, and many other aspects of poor mental health.
He, colleagues Jacoby and Penn Nursing shared their findings with Therese Richmond and Lisa Lewis. Journal of Advanced Nursing.
“Imprisonment is underestimated as a social determinant of health,” says Jacoby, whose research focuses on trauma and violence. “It’s something we talk about, but it’s not always something that’s articulated so precisely. This work is being done in a way that is lacking for nursing and the wider healthcare community. ”
Addison has always been interested in understanding health inequalities and mental health. In addition to the clinical experience of nursing in psychiatric hospitalization, she previously examined exposures to trauma and interpersonal violence among men, women, and youth. When he began Penn’s doctoral program, he thought he would investigate his imprisonment as a source of trauma for black men, who have been arrested nearly six times by white men in the United States.
But after delving deeper into the literature and under Jacoby’s guidance, Addison expanded the scope of his project, both in terms of how it took into account the mental health repercussions of incarceration and in terms of what he wanted to include. “My parents are immigrants from Ghana. When I think of black, I think of the diaspora, ”says Addison. “Census defines black people in a certain way, but I wanted to make sure that in this work and in the future, I’m thinking about what it means to be black in the United States.”
To that end, Addison introduced literature from 2010 to 2021 about men who were identified as Black in the U.S. He intended to be more specific about different identities: African American, Afro-Caribbean, Afro-Latino, or African immigrant groups. —But the literature is not yet sufficiently extensive. In total, he found 16 quantitative, six qualitative, and mixed method studies that met his criteria, with samples from more than 5,000 of the seven participants. The studies were conducted throughout the United States
“It’s a drop in the bucket,” Jacoby says. “If we were to study the differences in health conditions such as heart disease or diabetes, there would be thousands of studies to understand the problem. Here we find 23.”
His main goal was to identify differences in mental health outcomes among black men who were first incarcerated and never imprisoned. “In this context,” he says, “they both had poor mental health outcomes related to things like unemployment and family conflict. But black men who were incarcerated had more symptoms of PTSD. had”.
Longer incarceration and time spent in solitary confinement were also important, exacerbating the negative symptoms of mental health suffered by black men who were previously incarcerated. However, Addison and Jacoby found that few of these men discussed seeking help, reporting obstacles such as long waits and the need to re-prioritize different aspects of income, such as housing or employment.
Addison says he hopes this and future work will shed light on how to better contribute to the mental health needs of this community. “Things like health insurance are important after re-entry,” he says, “but do we also need to talk to the community center or church? ? ».
This research is an important start to a better understanding of imprisonment as a social determinant of health, Jacoby says. “Mass incarceration is one of the most prominent forms of structural racism in society,” he says. “How would you imagine that imprisonment in a possible reality would have no effect on one’s psyche and mental health?”
Future work, Penn researchers say, should look at how black men who were once incarcerated navigate community and health care resources to support their mental health needs. It should also include efforts to reduce barriers to care and improve health outcomes.
Funding for this research was the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services (Grant 5H79SM080386-03).
Helena Addison he holds a fourth-year doctorate and a doctorate in the presidency. member of School of Nursing in University of Pennsylvania2021-2023 Jonas Scholar and Fellow of the American Nurses Association SAMHSA Minority Fellowship Program.
Sara Jacoby he is an assistant professor of nursing and an assistant professor of nursing in surgery Department of Family and Community Health Penn’s School of Nursing.