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Individuals with a serious mental disorder (SMD) are disproportionately incarcerated in state prisons, and research has shown that individuals with SMD are more likely to recidivate upon release. Persons of color are also disproportionately incarcerated and at risk for repeat incarcerations. However, minimal research has yet to examine whether the relationship between SMD and recidivism is conditioned on race. This study used proportional hazards Cox regression modeling to investigate the effect of SMD on criminal recidivism over an 8-year period among 22,376 former prisoners in North Carolina. The interaction between race and SMD is explored to test for cross-racial variation in time-to-reincarceration. A significant interaction effect of non-Black minority by SMD was found. Non-Black minority former prisoners with SMD returned to prison significantly quicker than non-Black minorities without SMD. No interaction effect was found for either Black or White former prisoners. Hazard to return to prison was also significantly increased for former prisoners that were younger in age, male, Black, not employed at arrest, and indicated for substance abuse. Those factors contributing to the effect of SMD on criminal recidivism within non-Black minority former prisoners is unclear. Additional research is needed on the interactive effects of racial group and SMD on postprison experiences. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objective: Over 50% of released prisoners are reincarcerated within 3 years. Social support from loved ones postincarceration significantly reduces the likelihood of reincarceration. Increasingly, intervention developers aim to implement interventions that will enhance the stability of support available. This study responds to gaps in knowledge., Method: The current efficacy study reports findings from a randomized controlled trial (n = 57) of a social support intervention. A priori power analysis indicated moderate effect sizes could be detected. Participants were men, average age was 25 years, and over 90% were African American. Preliminary effects on social support, cognitions, substance use, and rearrest were assessed. Recruitment and consent occurred in prison; the intervention and 4 follow-ups occurred postrelease., Results: Findings converge with research indicating declines in social support (b = -.70, p < .05) and perceived quality of support (b = .05, p < .01) over time. Age showed inverse relationships with support (b = -1.77, p < .05). There were no statistically significant group effects for social support, cognitions, substance use (with the exception of marijuana), or recidivism. Clinical implications are discussed., Conclusion: This study advances research on intervention dosage, potency, and measurement considerations., (© 2017 Wiley Periodicals, Inc.)

Released prisoners face high risk of early mortality. The risk of violent death, specifically homicide and suicide, are addressed in this study. Data on inmates released from the North Carolina Division of Adult Corrections (N = 476) matched to the Violent Death Reporting System are analyzed to estimate rates and demographic and criminal justice-related predictors. Violent death rates for persons released from prison were more than 7 times higher than for the general adult population. Results from multinomial logistic regression indicate decreased homicide risk for every year of age, whereas male gender and minority race increased risk. For suicide, minority race, release without supervision, and substance abuse treatment in prison decreased fatality risk. By contrast, a history of mental illness increased suicide risk. Implications for practice and research are discussed.

Background: Although prison provides the opportunity for HIV diagnosis and access to in-prison care, following release, many HIV-infected inmates experience clinical setbacks, including nonadherence to antiretrovirals, elevations in viral load, and HIV disease progression. HIV-infected former inmates face numerous barriers to successful community reentry and to accessing healthcare. However, little is known about the outcome expectations of HIV-infected inmates for release, how their post-release lives align with pre-release expectations, and how these processes influence engagement in HIV care following release from prison., Methods: We conducted semi-structured interviews (24 pre- and 13 post-release) with HIV-infected inmates enrolled in a randomized controlled trial of a case management intervention to enhance post-release linkage to care. Two researchers independently coded data using a common codebook. Intercoder reliability was strong (kappa = 0.86). We analyzed data using Grounded Theory methodology and Applied Thematic Analysis. We collected and compared baseline sociodemographic and behavioral characteristics of all cohort participants who did and did not participate in the qualitative interviews using Fisher's Exact Tests for categorical measures and Wilcoxon rank-sum tests for continuous measures., Results: Most participants were heterosexual, middle-aged, single, African American men and women with histories of substance use. Substudy participants were more likely to anticipate living with family/friends and needing income assistance post-release. Most were taking antiretrovirals prior to release and anticipated needing help securing health benefits and medications post-release. Before release, most participants felt confident they would be able to manage their HIV. However, upon release, many experienced intermittent or prolonged periods of antiretroviral nonadherence, largely due to substance use relapse or delays in care initiation. Substance use was precipitated by stressful life experiences, including stigma, and contact with drug-using social networks. As informed by the Social Cognitive Theory and HIV Stigma Framework, findings illustrate the reciprocal relationships among substance use, experiences of stigma, pre- and post-release environments, and skills needed to engage in HIV care., Conclusion: These findings underscore the need for comprehensive evidence-based interventions to prepare inmates to transition from incarceration to freedom, particularly those that strengthen linkage to HIV care and focus on realities of reentry, including stigma, meeting basic needs, preventing substance abuse, and identifying community resources.

Women provide support for many vulnerable groups, work that is frequently discounted with gendered stereotypes. One growing vulnerable group is former prisoners who often return to women family members. We completed a qualitative study with 25 former prisoners and criminal justice staff to examine their conceptualizations of the demands placed on women supporters of former prisoners. Results indicate a significant burden of support experienced by women, discounted by prisoners and criminal justice staff through a dynamic of gendered idealization and stigmatization. Implications include the importance of exposing this dynamic and providing supports to decrease the burden of care that women experience.

Objective: Individuals with serious mental illnesses are at high risk of incarceration. Jails are often unable to obtain information needed to provide appropriate care. Psychiatric advance directives may be useful tools to communicate treatment information to jails. This study explored their use as a novel intervention for individuals with mental illnesses in jails., Methods: Eighty jail administrators in North Carolina were surveyed to determine their support for psychiatric advance directives in jails. Relationships between respondents' job type (jail administrator or medical administrator) or jail census and support for the directives were examined by using chi square tests. Open-ended responses were analyzed using qualitative methods., Results: Seventy-three percent of respondents indicated they supported psychiatric advance directives. Respondents from jails at or below a median census of 120 were significantly more likely to support psychiatric advance directives than those from larger jails., Conclusions: Psychiatric advance directives' informational function may prove valuable in jail settings. Additional research assessing directives as interventions for individuals with mental illnesses at risk of incarceration is needed.