Older incarcerated persons’ mental health before and during the COVID-19 pandemic

• DOI: https://doi.org/10.1108/IJPH-08-2021-0077
• Published date: 03 December 2021
• Date: 03 December 2021
• Pages: 138-148
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Alexandra DePalma,Deborah Noujaim,Emil Coman,Dorothy Wakefield,Lisa C. Barry

Older incarcerated persons’mental

health before and during the

COVID-19 pandemic

Alexandra DePalma, Deborah Noujaim, Emil Coman, Dorothy Wakefield and Lisa C. Barry

Abstract

Purpose –Older incarcerated personsare an especially vulnerable segment of the prison population,

with high rates of multimorbidity. This study aims to determinethe impact of the COVID-19 pandemic on

older incarceratedpersons’ mental and physical health.

Design/methodology/approach –Participantswere 157 currently-incarceratedpersons age 50 years

who were enrolled in an ongoinglongitudinal study before the pandemic. Anxiety symptoms(seven-item

generalized anxiety disorder questionnaire), depressive symptoms (eight-item patient health

questionnaire)and self-rated health (SRH) were assessedduring in-person interviews completedbefore

the pandemic and via mailed surveys during the pandemic (August–September 2020). A mediation

model evaluatedthe relationship among anxiety, depressionand SRH.

Findings –Participants were 96% male,racially diverse (41% White, 41% Black, 18% Hispanic/Other),

with average age 56.0(65.8) years. From before to during the pandemic, anxiety symptoms increased

(worsened) (from 6.465.7 to 7.866.6; p<0.001), depressive symptoms increased (worsened) (from

5.566.0 to8.1 66.5; p<0.001) and SRHdecreased (worsened) (from 3.060.2 to 2.660.2; p<0.001).

The total effect of worseninganxiety symptoms on worsening SRH (0.043; p<0.001) occurs entirely

because of worseningdepressive symptoms, i.e. the direct effect was statisticallynon-significant 0.030

(p= 0.068).

Practical implications –Older incarcerated personsexperienced worsening mental health during the

COVID-19 pandemic which was associated with worsening SRH. These findings have implications for

health-carecosts and services needed to carefor this vulnerable group.

Originality/value –This is the first studyto evaluate change in older incarcerated persons’mental health

from beforethe COVID-19 pandemic to during thepandemic.

Keywords Health in prison, Mental illness, Elderly prisoners, Prisoners, Mental health, Offender health,

COVID-19, Self-rated health, Incarceration, Older prisoners

Paper type Research paper

Introduction

The COVID-19 pandemic has taken a devastating toll in prisons. Despite mitigation efforts

including masking and providing personal protective equipment to staff, prisons around the

world have experienced particularly high COVID-19 infection rates largely because of

difficulties maintaining social distancing (Akiyama et al., 2020). Thus, to reduce the risk of

transmission, carceral facilities in the USA have used additional preventive measures, such

as institution-wide lockdowns (i.e. confinement of incarcerated persons to their living

quarters for a specific period of time), minimal movement outside of one’s cell/dorm (e.g.

reduced use of facilities, such as the dining hall and showers) and discontinuation of social

visits (Centers for Disease Control and Prevention, 2020). While these measures may be

necessary to minimize infection, being largely immobile and unable to interact with peers

and visitors may compound the inherently stressful carceral environment. Thus, the ordeal

(Informationabout the

authorscan be found at the

end of this article.)

Received 10 August 2021

Revised 21 October 2021

25 October 2021

Accepted 2 November 2021

This work was supported by the

National Institute of Mental

Health at the National Institute

of Health (Grant Number

R01-MH106529 to L.C.B.).

Dr Barry is also supported by

the UConn Claude D. Pepper

Older Americans

Independence Center (NIA

P30-AG067988). The authors

thank Danielle Zaugg, LCSW

for assistance with recruitment,

data collection and data entry;

and the Connecticut

Department of Correction. This

work reflects the opinion of the

authors and does not reflect the

views of the Connecticut

Department of Correction.

Declaration of conflicting

interests: The authors have no

conflicts of interest to declare.

PAGE 138 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jVOL. 18 NO. 2 2022, pp. 138-148, ©Emerald Publishing Limited, ISSN 1744-9200 DOI 10.1108/IJPH-08-2021-0077