Solitary Confinement Tied to Greater Risk of Death After Prison Release

Prisoners who are held in restrictive housing (i.e., solitary confinement) face an increased risk of death after their release, according to a new study led by researchers from the University of North Carolina (UNC) at Chapel Hill.

The findings show that incarcerated individuals who were placed in restrictive housing in North Carolina from 2000 to 2015 were 24% more likely to die in the first year after their release, compared to those who were not held in restrictive housing.

In addition, those held in restrictive housing were 78% more likely to die from suicide, 54% more likely to die from homicide, and 127% more likely to die from an opioid overdose in the first two weeks after their release.

Further, the number of restrictive housing placements and spending more than 14 consecutive days in restrictive housing were associated with an even greater increase in the risk of death and reincarceration.

“For the first time ever, using data shared with us from our partners at the North Carolina Department of Public Safety, we’ve been able to demonstrate a connection between restrictive housing during incarceration and increased risk of death when people return to the community,” said lead author Lauren Brinkley-Rubinstein, PhD, an assistant professor of social medicine in the UNC School of Medicine.

“In addition, our study found that the more time people spent in restrictive housing the higher the risk of mortality after release. This study provides empirical evidence to support ongoing nationwide reforms that limit the use of restrictive housing.”

“North Carolina is a leader in this thinking as the Department of Public Safety has preemptively implemented multiple reforms that have resulted in the limited use of restrictive housing.”

“We appreciate this research collaboration and recognize the importance of these results in shaping policy and practice,” said Gary Junker, PhD, Director of Behavioral Health for the N.C. Department of Public Safety Adult Correction and Juvenile Justice.

“Since 2015, the department has initiated several programs to divert people from restrictive housing, including Therapeutic Diversion Units for those with mental illness. While safety and security must remain our top priority, we recognize that reduced use of restrictive housing will likely improve post-release outcome.”

These findings, published in the journal JAMA Network Open, are from a retrospective cohort study conducted by Brinkley-Rubinstein and co-authors from UNC, Emory University, the N.C. Department of Public Safety and the N.C. Department of Public Health.

Incarceration data for people who were confined in North Carolina between 2000 and 2015 were matched with death records from 2000 to 2016.

“We also found that non-white individuals were disproportionately more likely to be assigned to restrictive housing than their white counterparts,” said co-author Shabbar Ranapurwala, PhD, MPH, an assistant professor of epidemiology in the UNC Gillings School of Global Public Health and a core faculty member of the UNC Injury Prevention Research Center.

“In fact, the mortality and reincarceration outcomes after release were also quite different between these racial groups. The post-release opioid overdose and suicide death outcomes among those receiving restrictive housing were more pronounced among white individuals compared to non-whites, while the all-cause and homicide death and reincarceration outcomes were higher among non-white Americans compared to whites.”

Given the observational nature of the study, establishing cause and effect may be difficult, yet, the strength and consistency of the findings points to the fact that restrictive housing is an important marker of increased mortality risk among formerly incarcerated individuals.

Source: University of North Carolina Health Care

Study: Competitive People Have Higher Risk for Using Drugs

A new study from Spain suggests hostile and competitive people are more likely to abuse drugs and alcohol.

“There are still many questions to answer but what we discovered is very significant,” points out Dr. Rosario Ruiz Olivares, head researcher at the University of Cordoba (Spain). Nevertheless, Olivares said that what could be called an addictive personality “does not exist.”

However, the study does confirm that there is a very strong correlation between a personality characterized by hostility and competitiveness and consumption of illegal substances, such as cocaine, cannabis and hallucinogens.

Investigators believe that people who are patient, less hostile, and not competitive have a much lower likelihood of being drug users. “This kind of personality is a protective factor for drug consumption and is especially meaningful in the case of alcohol and tobacco,” Olivares said.

In the study, socio-demographic and personality questionnaires were completed by 3,816 young people in the province of Cordoba between the ages of 18 and 29. “In the future, we would like to broaden the sample to a national level and study behavior patterns according to the person’s gender,” states Rosario Ruiz.

These results represent an important step in the field of preventing drug consumption among young people, since it could focus specifically on people who demonstrate hostile and competitive traits.

Furthermore, it will not only help in prevention, but may also help clinicians given that individuals who have these characteristics can find it more difficult to overcome their addiction. Early detection of substance abuse can lead to specific psychological therapy designed to work on the personality traits that influence drug abuse.

Source: University of Cordoba

Mindfulness May Help Reduce Opioid Cravings in Chronic Pain Patients

People struggling with opioid addiction and chronic pain may experience fewer cravings and less pain if they use mindfulness techniques along with medication for opioid dependence, according to a new study published in the journal Drug and Alcohol Dependence.

Mindfulness is the meditative practice of focusing on the present moment and accepting one’s thoughts, feelings and bodily sensations, without judgment.

The study, led by researchers from Rutgers University in New Jersey, looked at the effects of mindfulness techniques and methadone therapy on 30 patients with opioid addiction and chronic pain.

The research team found that participants who received methadone and a mindfulness training-based intervention were 1.3 times better at controlling their cravings and had significantly greater improvements in pain, stress, and positive emotions, compared to participants who only received standard methadone treatment and counseling.

The findings held true even though the mindfulness participants were more aware of their cravings.

“Methadone maintenance therapy (MMT) has been an effective form of medication treatment for opioid use disorder,” said Associate Professor Nina Cooperman, a clinical psychologist in the Division of Addiction Psychiatry at Rutgers Robert Wood Johnson Medical School.

“However, nearly half of individuals on MMT continue to use opioids during treatment or relapse within six months.”

Cooperman said that people with opioid addictions often experience chronic pain, anxiety and depression while on methadone maintenance, which is why mindfulness-based, non-drug interventions are promising treatments.

The researchers said mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain.

Individuals with an opioid addiction could also be taught to change their negative thought patterns and savor pleasant events, which may help them to regulate their emotions and experience more enjoyment.

In 2017, more than 70,000 people died from a drug overdose, making it a leading cause of injury-related death in the United States. Of those deaths, almost 68% (47,600 overdose deaths) involved a prescription or illicit opioid, according to the Centers for Disease Control and Prevention (CDC). Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999.

Source: Rutgers University

 

Study: Fathers-to-Be Should Avoid Alcohol for Months Before Conception

Both men and women hoping to become parents should avoid drinking alcohol prior to conception to protect their baby against congenital heart defects, according to a new study published in the European Journal of Preventive Cardiology.

Previous studies investigating the link between alcohol and congenital heart disease have focused on prospective mothers, with inconclusive results. This is the first meta-analysis to also examine the role of paternal alcohol drinking.

According to the findings, babies have a 44% increased risk of congenital heart disease when their father drank alcohol three months before conception, compared to babies whose dads did not drink. When the mothers drank during this time period or during the first trimester, babies had a 16% increased risk of disease.

The researchers suggest that when couples are trying for a baby, men should not consume alcohol for at least six months before conception while women should stop alcohol one year before and avoid it during pregnancy.

In addition, binge drinking — defined as five or more drinks per sitting — was related to a 52% higher likelihood of having a child with birth defects among men and 16% among women.

“Binge drinking by would-be parents is a high risk and dangerous behaviour that not only may increase the chance of their baby being born with a heart defect, but also greatly damages their own health,” said study author Dr. Jiabi Qin, of Xiangya School of Public Health, Central South University, Changsha, China.

The researchers compiled the best data published between 1991 and 2019, which amounted to 55 studies including 41,747 babies with congenital heart disease and 297,587 without. The analysis showed a relationship between parental alcohol drinking and congenital heart diseases.

‘We observed a gradually rising risk of congenital heart diseases as parental alcohol consumption increased. The relationship was not statistically significant at the lower quantities,” said Qin.

The authors noted that this was an observational study and does not prove a causal effect, nor does it prove that paternal drinking is more harmful to the fetal heart than maternal drinking. The data cannot be used to define a cut-off of alcohol consumption that might be considered safe.

Regarding specific defects, the researchers found that, compared to abstinence, maternal drinking was correlated to a 20% greater risk of tetralogy of Fallot, a combination of four abnormalities in the heart’s structure.

“The underlying mechanisms connecting parental alcohol and congenital heart diseases are uncertain and warrant further research. Although our analysis has limitations — for example the type of alcohol was not recorded — it does indicate that men and women planning a family should give up alcohol,” said Qin.

Alcohol is a known teratogen (causes malformation of an embryo) and has been connected with fetal alcohol spectrum disorder (FASD). Around one in four children with FASD have congenital heart disease.

Congenital heart diseases are the most common birth defects, with approximately 1.35 million infants affected every year. These conditions can increase the likelihood of cardiovascular disease later in life, even after surgical treatment, and are the main cause of perinatal death.

Source: European Society of Cardiology

Anxiety, Depression Tied to Greater Opioid Use After Surgery

Pain is an unavoidable part of the healing process after surgery. Yet the current opioid crisis has made the standard prescribing practices for painkillers loaded with risk.

A new study from Michigan Medicine (U-M) could help clinicians navigate this risk by identifying which patients may be more likely to continue using opioids after their immediate recovery period.

“There is not much research on which surgical patients require more or less opioids, despite a push in the field for personalized medicine,” said first author Daniel Larach, M.D., M.T.R., M.A., a resident at U-M at the time of the study and now an assistant professor of clinical anesthesiology at the University of Southern California.

“Often with postoperative opioid prescribing, personalization falls by the wayside, with surgeons using the same amounts for every person receiving a certain procedure.”

The findings are published in the Annals of Surgery.

For the study, the research team evaluated the data of more than 1,000 people undergoing an elective hysterectomy, thoracic surgery, or a total knee or hip replacement. Before their operations, each patient provided demographic information and completed several screening questionnaires.

The patients were given scores measuring their degree of depression, anxiety, fatigue, sleep disturbance, physical function, as well as the severity of their overall and surgical site pain. The researchers also measured how many pills were prescribed to each patient.

The patients were then contacted one month following the surgery to assess how many opioid pills they had consumed.

“We found that anxiety is linked with more opioid use, which is disheartening to see but also heartening in the sense that this is something we could potentially target,” said Larach.

Other patient factors linked to increased opioid use included younger age, non-white race, no college degree, alcohol and tobacco use, and sleep disturbance.

Chad Brummett, M.D., associate professor of anesthesiology and director of anesthesia clinical research and pain research, said people may be knowingly or unknowingly medicating for other conditions.

“The only thing we’re giving them is opioids and we’re not giving them alternatives or other options,” he said. For example, patients with high anxiety around the time of surgery could be offered behavioral care or other non-opioid medications for anxiety and resulting pain.

Brummett also noted that the study found overprescription of opioids for all surgical procedures and a link between the prescription size and use.

“I think it is striking that you see once again that the more you prescribe, the more patients take, even after adjusting for all of these other risk factors,” Brummett said.

The team noted that right-sizing prescriptions through initiatives such as the Michigan Opioid Prescribing Engagement Network (OPEN), which provides recommendations for prescription amounts for various medical procedures, is a critical first step.

But, they say, this step should be followed by more research into specific patient factors that can be addressed in other ways.

“We are asking surgeons to learn about and think about pain and behavioral health in ways that we have not previously done. It will require an open mind,” said Brummett.

Source: Michigan Medicine- University of Michigan

 

Working With Animals Can Increase Risk of Depression, Anxiety and Suicide

“Talking about veterinarian suicide certainly gets people to pay attention, but it does not tell the whole, nuanced story about what may be contributing to poor well-being in this population,” said Katherine Goldberg, DVM, LMSW, community consultation and intervention specialist at Cornell Health and founder of Whole Animal Veterinary Geriatrics and Palliative Care Services, who also presented at the meeting. “More research is under way to help better understand why veterinarians might be at an increased risk, but a combination of personality traits, professional demands and the veterinary learning environment all likely contribute.”

Economic challenges could be a contributing factor, according to Goldberg, who noted that the average veterinary school graduate reported having more than $143,000 of school loan debt while earning a starting salary of around $73,000 in 2016.

“Personal finance concerns are stressful for many veterinarians, especially recent graduates, and at the same time, many clients regularly question the cost of care for their animals and may be suspicious that their vet is trying to ‘push’ services that their pet doesn’t need,” she said.

Goldberg also described a multi-center study that looked at rates of adverse childhood experiences — a term used to describe all types of abuse, neglect and other traumatic experiences — in veterinary students, in an effort to understand what may be causing their poor mental health.

However, veterinarians just starting their practice were not more predisposed to poor mental health than the general population as a result of adverse childhood experiences, she said.

“This indicates that something is happening over the course of veterinary student training or once veterinarians are working to cause poor well-being outcomes,” she said. “Well-being education should be integrated into the veterinary curriculum, emphasizing resiliency behaviors and cultivating professional partnerships between veterinary medicine and mental health care.”

Substance use among veterinarians is also an understudied area, she noted. Veterinary medicine is the only medical profession in the U.S. that does not have a national monitoring program for substance use and mental health issues, she added.

While veterinarians who are dealing with mental health issues may exhibit symptoms common to all populations, such as sadness that interferes with daily activities or changes in appetite, there are a few specific warning signs to watch for in a clinical veterinary setting, according to Goldberg.

“Increased medical errors, absenteeism, client complaints and spending too little or too much time at work” are factors to watch for, she said. “For potential substance use issues, warning signs could include missing drugs or missing prescription pads.”

Goldberg said there needs to be a shift in veterinary training to better prepare veterinarians not only for the animal-related aspects of their jobs, but the human elements as well.

“We need core curricular material that focuses on coping with the emotional demands of the profession,” she said. “Mindfulness, moral stress, ethics literacy, grief and bereavement, mental health first aid and suicide awareness all have a role in veterinary education. Colleges of veterinary medicine that have embedded mental health professionals are a step ahead of those that do not, and I would like to see this become a requirement for all schools accredited by the Association of American Veterinary Medical Colleges.”

Meanwhile, Fournier’s presentation looked at employees and volunteers in animal shelters, and animal welfare and animal rights activists, who are at risk for compassion fatigue and psychological distress.

“Animal welfare agents, as these people are often called, are exposed to animal abuse, neglect and oppression on a regular basis, as well as routine euthanasia that is common in these settings,” said Fournier.

More than 2.4 million healthy cats and dogs are euthanized each year in the U.S., most often homeless animals in shelters, according to the Humane Society of the United States.

“Shelter workers are then caught in a dilemma because they are charged with caring for an animal and they may ultimately end that animal’s life,” she said. “Research suggests that this causes significant guilt, which can lead to depression, anxiety and insomnia, as well as greater family-work conflict and low job satisfaction.”

Animal welfare agents may also hear gruesome stories of animal abuse or witness the consequences firsthand when they are rehabilitating the animals, which can cause a lot of distress and lead to compassion fatigue, said Fournier.

“Experts suggest that animal welfare agents carry an even heavier burden than those in other helping professions who are susceptible to compassion fatigue because of the issues unique to working with animals, such as euthanasia and caring for living beings who have experienced pain and suffering, but cannot articulate their needs and experiences,” said Fournier.

She suggests that psychotherapists who work with animal welfare agents offer patients strategies to reframe negative experiences, identify ways in which they get fulfillment and gratification from the work they do, and establish healthy boundaries between their work and personal lives.

“There are certainly positive and negative aspects of the job and over time or during times of acute stress, it can be difficult to see the positive,” she said. “It may be necessary to help someone focus on the big picture that overall they are making a difference and animals have been saved, rather than ruminating on individual stories of crisis and loss. Self-care is also critical to ensuring the best mental health outcomes for those who work and volunteer with animals.”

Source: The American Psychological Association