Gender, Racial, and Ethnic Disparities in Mental Health, Substance Use Disorders, and Behavioral Health Treatment Utilization in US Parolees and Probationers within 12 Months Post-Release

Duke University, Durham NC

Investigators

Abstract

ABSTRACT Background: Rates of depression in US parolees and probationers range from 9-40%, and depression is the most commonly co-occurring MH disorder in those with substance use disorders (SUDs). Depression and psychological distress (PD) are barriers to community re-integration, and contribute to risk taking behaviors, substance use relapse, and recidivism. However, rehabilitative reentry efforts typically focus on substance use treatment alone, resulting in unmet mental health (MH) treatment needs. About 40% of all US ex-offenders recidivate within one year, and correctional spending is individual state's second largest expenditure after Medicaid. Isolated studies indicate differences in depression rates among US parolees and probationers by gender, race, and ethnicity, but national estimates are limited. Methods: The proposed study recognizes the influence of social determinants of health and intersectionality of gender, race, and ethnicity on behavioral health (BH) outcomes and treatment disparities. A secondary analysis of cross-sectional data from the 2014 National Survey on Drug Use and Health, guided by a modified version of Meleis' Transitions Theory adapted to the BH needs of US parolees and probationers, will be used to understand the BH needs and barriers to BH treatment utilization by gender, race, and ethnicity, in a group of US parolees and probationers relative to a group of non-parolees and non-probationers. The specific aims of this study are to: Aim 1: Compare the prevalence of depression, PD, and/or SUD in the parolee and probationer group relative to the reference group, and determine whether these BH outcomes are related to gender, race, ethnicity, and their interactions with group. Aim 2: Compare BH treatment utilization in the parolee and probationer group relative to the reference group, and determine whether BH treatment utilization is related to BH (depression, PD, and/or SUD) and individual (gender, race, and ethnicity) characteristics, awareness of BH needs, and their interactions with group. Aim 3: Compare barriers to BH treatment utilization in the parolee and probationer group relative to the reference group, and determine which BH treatment utilization barriers are related to BH (depression, PD, and/or SUD) and individual (gender, race, and ethnicity) characteristics and their interactions with group. Significance: An understanding of the gender, racial, and ethnic disparities in BH among US parolees and probationers is integral to informing a population-based health approach that allows for strategic resource planning, and service design for the dual-integrative treatment of co-occurring MH and SUDs. This will inform targeted and tailored interventions, and improve equity in access and treatment for BH disorders among the numerous health disparity populations disproportionately represented among US parolees and probationers.