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    2 Comments for this article
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    Effects of solitary confinement
    Frederick Rivara, MD, MPH | University of Washington
    While the results of this study may not be a surprise, the study is clearly important in showing the long term effects of solitary confinement during incarceration. It shows that those placed in solitary confinement are 78% more likely to die by suicide after release than their prison mates who were not subject to solitary. The whole issue of suicide after incarceration needs greater attention.
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Conclusions Confuse Correlation with Causation
    Ted Miller |
    For the most part, this study was careful to speak of association when reporting its findings. But the conclusions in both the abstract and text inappropriately shift language. They confuse correlation with causation, inappropriately using words like "exacerbate risk," "harms of restrictive housing," and "risk factor" [should read, "risk marker" or "risk indicator"]." Restrictive housing is used, most often, as a form of discipline, possibly with occasional usage to protect an inmate. Thus, this study may simply demonstrate that prisoners who misbehave, and especially those guilty of repeated or especially serious rule violations, are likely to continue their problem behaviors on release. To support statements like those in the conclusions, one could compare prisoners with comparable misbehaviors in facilities that used restrictive housing as their preferred discipline versus facilities that imposed other disciplines instead. Another approach would be to propensity-match a comparison group on characteristics that include behaviors requiring disciplinary action. The most informative design would randomize which prisoners with selected problem behaviors received restrictive housing versus an alternative discipline.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Original Investigation
    Public Health
    October 4, 2019

    Association of Restrictive Housing During Incarceration With Mortality After Release

    Author Affiliations
    • 1Center for Health Equity Research, University of North Carolina at Chapel Hill
    • 2Department of Social Medicine, University of North Carolina at Chapel Hill
    • 3Injury Prevention Center, University of North Carolina at Chapel Hill
    • 4Division of Infectious Diseases, University of North Carolina at Chapel Hill
    • 5Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia
    • 6North Carolina Department of Public Safety, Raleigh
    • 7North Carolina Department of Public Health, Raleigh
    • 8Department of Epidemiology, University of North Carolina at Chapel Hill
    JAMA Netw Open. 2019;2(10):e1912516. doi:10.1001/jamanetworkopen.2019.12516
    Key Points español 中文 (chinese)

    Question  Is restrictive housing, otherwise known as solitary confinement, during incarceration associated with an increased risk of mortality after release into the community?

    Findings  This cohort study included 229 274 people who were released from incarceration in North Carolina from 2000 to 2015. Compared with individuals who were incarcerated and not placed in restrictive housing, individuals who spent any time in restrictive housing were 24% more likely to die in the first year after release, especially from suicide (78% more likely) and homicide (54% more likely); they were also 127% more likely to die of an opioid overdose in the first 2 weeks after release.

    Meaning  The results of this study suggest that exposure to restrictive housing as a condition of confinement is associated with an increased risk of death during community reentry.

    Abstract

    Importance  Restrictive housing, otherwise known as solitary confinement, during incarceration is associated with poor health outcomes.

    Objective  To characterize the association of restrictive housing with reincarceration and mortality after release.

    Design, Setting, and Participants  This retrospective cohort study included 229 274 individuals who were incarcerated and released from the North Carolina prison system from January 2000 to December 2015. Incarceration data were matched with death records from January 2000 to December 2016. Covariates included age, number of prior incarcerations, type of conviction, mental health treatment recommended or received, number of days served in the most recent sentence, sex, and race. Data analysis was conducted from August 2018 to May 2019.

    Exposures  Restrictive housing during incarceration.

    Main Outcomes and Measures  Mortality (all-cause, opioid overdose, homicide, and suicide) and reincarceration.

    Results  From 2000 to 2015, 229 274 people (197 656 [86.2%] men; 92 677 [40.4%] white individuals; median [interquartile range (IQR)] age, 32 years [26-42]), were released 398 158 times from the state prison system in North Carolina. Those who spent time in restrictive housing had a median (IQR) age of 30 (24-38) years and a median (IQR) sentence length of 382 (180-1010) days; 84 272 (90.3%) were men, and 59 482 (63.7%) were nonwhite individuals. During 130 551 of 387 913 incarcerations (33.7%) people were placed in restrictive housing. Compared with individuals who were incarcerated and not placed in restrictive housing, those who spent any time in restrictive housing were more likely to die in the first year after release (hazard ratio [HR], 1.24; 95% CI 1.12-1.38), especially from suicide (HR, 1.78; 95% CI, 1.19-2.67) and homicide (HR, 1.54; 95% CI, 1.24-1.91). They were also more likely to die of an opioid overdose in the first 2 weeks after release (HR, 2.27; 95% CI, 1.16-4.43) and to become reincarcerated (HR, 2.16; 95% CI, 1.99-2.34).

    Conclusions and Relevance  This study suggests that exposure to restrictive housing is associated with an increased risk of death during community reentry. These findings are important in the context of ongoing debates about the harms of restrictive housing, indicating a need to find alternatives to its use and flagging restrictive housing as an important risk factor during community reentry.

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