Mental Health of Incarcerated Veterans and Civilians: Latent Class Analysis of the 2016 Survey of Prison Inmates

• Author: Emily R. Edwards,Ashley L. Greene,Gabriella Epshteyn,Molly Gromatsky,Adam R. Kinney,Ryan Holliday
• DOI: http://doi.org/10.1177/00938548221121142
• Published date: 01 December 2022
• Date: 01 December 2022
• Subject Matter: Articles

CRIMINAL JUSTICE AND BEHAVIOR, 2022, Vol. 49, No. 12, December 2022, 1800 –1821.

DOI: https://doi.org/10.1177/00938548221121142

Article reuse guidelines: sagepub.com/journals-permissions

© 2022 International Association for Correctional and Forensic Psychology

1800

MENTAL HEALTH OF INCARCERATED

VETERANS AND CIVILIANS

Latent Class Analysis of the 2016 Survey of

Prison Inmates

EMILY R. EDWARDS

VISN 2 MIRECC, James J Peters VA Medical Center

Yale School of Medicine

ASHLEY L. GREENE

VISN 2 MIRECC, James J Peters VA Medical Center

Icahn School of Medicine at Mount Sinai

GABRIELLA EPSHTEYN

VISN 2 MIRECC, James J Peters VA Medical Center

Teachers College, Columbia University

Icahn School of Medicine at Mount Sinai

MOLLY GROMATSKY

VISN 2 MIRECC, James J Peters VA Medical Center

Icahn School of Medicine at Mount Sinai

ADAM R. KINNEY

VISN 19 MIRECC, Rocky Mountain Regional VA Medical Center

RYAN HOLLIDAY

VISN 19 MIRECC, Rocky Mountain Regional VA Medical Center

Using data from the 2016 Survey of Prison Inmates, this study used latent class analysis to examine patterns of mental health

comorbidity within a large, nationally-representative sample of incarcerated adults (N = 24,848), including 7.6% with prior

military service. Classes were compared on Veteran status, military service-related variables, and treatment-related variables.

Results suggest four latent mental health patterns—“Low Psychopathology” (70% of the total sample), “Internalizing + Thought

Disorder” (8%), “Internalizing” (14%), and “High Psychopathology” (8%). The High Psychopathology class had the highest rates

of prior psychiatric/psychological treatment. Incarcerated Veterans were more likely to be in the Internalizing class, and rates of

combat exposure, military service-related injury, and less-than-honorable military discharge were highest in Internalizing and

High Psychopathology classes. Results attest to the importance of person-centered mental health care within correctional settings

and suggest a “treatment track” or “step-based” approach may best address the needs of individuals in these settings.

AUTHORS’ NOTE: Work for this article was supported by the Department of Veterans Affairs, Office of

Academic Affiliations, VA Special MIRECC Fellowship Program in Advanced Psychiatry and Psychology, by

the VISN-2 MIRECC, and by the VISN-19 MIRECC. The views expressed here are the authors’ and do not

necessarily represent the views of the Department of Veterans Affairs. Correspondence concerning this article

should be addressed to Emily R. Edwards, VISN 2 MIRECC, James J Peters VA Medical Center, 130 W.

Kingsbridge Rd., Bronx, NY 10468; e-mail: Emily.Edwards@yale.edu.

*Gabriella Epshteyn is also affiliated to University of Rhode Island.

1121142CJBXXX10.1177/00938548221121142Criminal Justice and BehaviorEdwards et al. / MENTAL HEALTH OF INCARCERATED VETERANS & CIVILIANS

research-article2022

Edwards et al. / MENTAL HEALTH OF INCARCERATED VETERANS & CIVILIANS 1801

Keywords: prison; incarceration; mental health; comorbidity; Veteran

The U.S. correctional system is the largest mental health institution in the nation, respon-

sible for the care of approximately 2.2 million persons in 2018, approximately half of

whom are diagnosed with a mental health condition (Al-Rousan et al., 2017; Bureau of

Justice Statistics, 2021a). Possibly due to limited treatment access in the community (Wilper

et al., 2009), a recent analysis of incarcerated adults in Iowa suggested almost all mental

health diagnoses were first made during incarceration, and many incarcerated adults suffered

complex mental health presentations, with up to 25% facing three or more co-occurring con-

ditions (Al-Rousan et al., 2017). Mental health is an essential consideration in correctional

settings, because epidemiological data suggest incarcerated adults with mental health condi-

tions are more likely to require potentially costly treatment, to be involved in physical or

verbal altercations with correctional staff and other incarcerated persons, and to be charged

with institutional misconduct (James & Glaze, 2006; Semenza & Grosholz, 2019). Given

this substantial burden of mental health needs among incarcerated persons, understanding

common patterns of mental health comorbidity and correlates of these patterns is vital to

informing prevention and ongoing treatment efforts within correctional settings.

Within this context of correctional mental health, military Veterans are commonly con-

sidered a special interest group. Commensurate with their presence in the general popula-

tion, military Veterans comprise 5% to 8% of people who are incarcerated (approximately

107,400 of 1,421,700 incarcerated persons in 2016; Maruschak et al., 2021). Veterans have

unique experiences of serving in the military, placing them at increased risk of exposure to

potentially traumatic events, such as service-related injuries and deployment to combat

zones and disaster relief efforts. Veterans are also more likely than civilians to have experi-

enced a range of nonmilitary traumas, such as adverse childhood experiences (Blosnich

et al., 2021; Katon et al., 2015) and interpersonal violence both inside and outside the home

(Lehavot et al., 2018; Marshall et al., 2005).

These exposures to trauma could have notable implications for Veteran mental health,

particularly in correctional settings (Aronson et al., 2020; Ross et al., 2018), where esti-

mates using convenience samples suggest approximately 90% of Veterans report at least

one form of prior trauma exposure (Hartwell et al., 2014; Saxon et al., 2001). Some evi-

dence suggests Veterans’ experiences of trauma, both within and outside of military service,

may be associated with greater risk of criminal justice involvement (Edwards et al., 2022).

Furthermore, elevated rates of psychopathology are generally observed among justice-

involved Veterans; across studies, approximately 4% to 39% of justice-involved Veterans

are affected by posttraumatic stress disorder (PTSD), 21% to 71% by substance use disor-

ders, 10% to 51% by depressive disorders, 14% to 51% by anxiety disorders, 3% to 11% by

bipolar disorders, 8% to 61% by adjustment disorders, 4% to 14% by psychotic disorders,

and 3% to 11% by personality disorders (Blodgett et al., 2015). Attesting to their unique

needs, incarcerated Veterans are also more likely than their civilian counterparts to meet

criteria for PTSD, substance use disorders, and traumatic brain injury (Blodgett et al., 2015;

Taylor et al., 2020), to be older, White, with more formal education, and to be convicted of

violent and driving under the influence offenses (Marshall et al., 2005; Mumola, 2000;

Noonan & Mumola, 2007; White et al., 2012).