Beyond the dichotomy: Incarceration dosage and mental health*

• Author: Lauren C. Porter,Laura M. DeMarco
• Date: 01 February 2019
• DOI: http://doi.org/10.1111/1745-9125.12199
• Published date: 01 February 2019

Received: 2 September 2017 Revised: 7 September 2018 Accepted: 11 September 2018

DOI: 10.1111/1745-9125.12199

ARTICLE

Beyond the dichotomy: Incarceration dosage

and mental health*

Lauren C. Porter1Laura M. DeMarco2

1Department of Criminology and Criminal

Justice, Universityof Mar yland

2Department of Sociology, The Ohio State

University

Correspondence

LaurenC. Por ter,Department of Cr iminology

andCr iminal Justice, Universityof Maryland,

2220GLeFrak Hall, College Park, MD 20742.

Email:lpor ter1@umd.edu

∗Theaut horswould like to thank Ryan D. King

forfeedback on an earlier version of this article.

Abstract

The findings from a growing body of research reveal that

incarceration is detrimental for both physical and mental

health. Incarceration, however, is typically conceptualized

and operationalized as a dichotomy;individuals eit her have,

or have not, been incarcerated. Considering that incarcera-

tion can range from one day to severalyears, a dichotomous

measure may be overlooking important variations across

lengths of exposure. In addition, most inmates are incarcer-

ated more than once. In this study, we help to fill this gap by

examining the relationship between incarceration dosage,

measured as time served and number of spells, and mental

health among a sample of young adults from the National

Longitudinal Study of Youth 1997. By using fixed-effects

modeling, we find that the number of spells and the months

incarcerated are positively related to mental health symp-

toms and the likelihood of depression. The association,

however,is contingent on whether a respondent is currently

or formerly incarcerated. Among current inmates, more

time served is expected to improve mental health and the

number of spells is unrelated to either outcome.

KEYWORDS

collateral consequences, incarceration, mental health

1INTRODUCTION

The consequences of incarceration are well documented, including adverse effects on employment

(Pager, 2003; Western, 2006), marriage (Huebner, 2005; Lopoo & Western, 2005), civic engage-

ment (Manza & Uggen, 2006), and health (Hammett, Harmon, & Rhodes, 2002; Massoglia, 2008;

136 © 2018 American Society of Criminology wileyonlinelibrary.com/journal/crim Criminology.2019;57:136–156.

PORTER AND DEMARCO 137

Schnittker & John, 2007; Schnittker, Massoglia, & Uggen, 2012; Turney, Wildeman, & Schnittker,

2012). Researchers, however, tend to measure incarceration as a dichotomy,examining the association

between an individual having any history of incarceration and these outcomes. On the one hand, this

measure comports with prevailing theory on the collateral consequences of incarceration, in which

incarceration is a marker or “master status” that can alter an individual's life chances along several

domains (Becker, 1963; Western, 2006). Indeed, if the status or stigma of being an “ex-con” is the

principal mechanism linking incarceration to postrelease hardships, a dichotomy may be a satisfac-

tory measure of exposure. On the other hand, incarceration can also be understood as an episode or

event that can last for days, months, or years. For example, most state prisoners in the United States

are sentenced to serve 2–4 years (43.5 percent), whereas approximately 14 percent are sentenced to

less than 2 years, 24 percent to 5–9 years, and an estimated 18 percent to 10 or more years (Carson &

Golinelli, 2013). Therefore, marked variation exists in the amount of time a prisoner may serve during

a given spell. Moreover, approximately two thirds of released prisoners are rearrested for a new crime

within 3 years (Durose, Cooper, & Snyder,2014), and as of 2004, the average state prisoner had served

1–2 times prior to his current stint.1In short, the operationalization of incarceration as a dichotomy

overlooks a substantial amount of variation in the incarceration experience.

Although it stands to reason that the effect of incarceration should vary depending on how much

incarceration an individual is exposed to (i.e., the “dosage”), in prior research, scholars have taken a

“fairly broad view” of incarceration (Massoglia & Pridemore, 2015: 302). Dosage may be particularly

consequential for health, given that the incarceration experience is laden with stressors. The direction

of the expected relationship is uncertain, however. In some prior work, scholars have either explicitly

or implicitly assumed that lengthier sentences should more damaging (see Schnittker & John, 2007),

which is consistent with a stress proliferation perspective (Pearlin, Aneshensel, & LeBlanc, 1997) and

with classic work on prisoner response (Clemmer, 1940). In another line of work, however, scholars

have suggested that shorter bouts may be more stressful because inmates should adapt over time

(Bronsteen, Buccafusco, & Masur, 2009; Zamble, 1992). Finally, according to a stigma or “status”

perspective, dosage may be irrelevant, at least for postrelease well-being, given that any amount of

time spent incarcerated should spoil an identity (Goffman, 1963).

In some studies, scholars have been interested in the heterogeneity of incarceration experiences and

postrelease outcomes such as employment, marital dissolution, or recidivism—with mixed results.

For example, most study findings indicate that time served is not a significant or strong predictor of

reoffending (Loughran et al., 2009; Snodgrass, Blokland, Haviland, Nieuwbeerta, & Nagin, 2011).

On the other hand, other research results demonstrate a positive relationship between time served and

the likelihood of marital dissolution (Massoglia, Remster, & King, 2011; Siennick, Stewart, & Staff,

2014), and there is some evidence that longer sentences increase employment hardships (Ramakers,

Apel, Nieuwbeerta, Dirkzwager, & Wilsem, 2014). In the realm of health, research findings have also

been equivocal. Schnittker and colleagues (2012) concluded that “length of a sentence is generally

unrelated to psychiatric outcomes beyond the difference between those with and without histories of

incarceration” (p. 452). Similarly, Schnittker and John (2007) found that “having had contact with

the criminal justice system is generally more important than the amount of contact” for explaining

poor health (p. 120). Alternatively, Patterson (2013) discovered that mortality risk increases with

time served, and some study results have demonstrated a positive association between dosage and

health-related outcomes such as feelings of hopelessness (Dhami, Ayton, & Loewenstein, 2007),

psychiatric disorders (Baillargeon, Binswanger, Penn, Williams, & Murray, 2009), and body mass

1Calculated by the authors using the Survey of Inmates in State Correctional Facilities, 2004.